A paramedic from Victoria has written to me and asked:
… a question regarding the poisons & drugs legislation within Victoria.
Essentially it boils down to what, if any, medication may be carried and administered to patients by first aiders acting in a voluntary capacity in Victoria. Does this change between different qualifications of first aider? Does it change for an RN?
I’m especially curious as to the status of Paracetamol, Analgesics (Methoxyflurane or Nitrous Oxide), Salbutamol and Adrenaline auto injectors within the Victorian context.
I’ve heard so many different opinions as to what is legal that I’m thoroughly confused…
It’s not surprising your confused; the answer is confusing and will remain unclear at the end of this post.
The relevant Act is the Drugs, Poisons and Controlled Substances Act 1981 (Vic). This Act incorporates the Poisons Standards 2013 (made under the Therapeutic Goods Act 1989 (Cth)) into Victorian law; (Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 12D and Drugs, Poisons And Controlled Substances (Commonwealth Standard) Regulations 2011 (Vic). The Poisons Standard can be found online at http://www.comlaw.gov.au/Details/F2013L01607. It is under this standard that poisons are listed in the schedules 1 to 8.
The relevant schedules are:
Schedule 2. Pharmacy Medicine – Substances, the safe use of which may require advice from a pharmacist and which should be available from a pharmacy or, where a pharmacy service is not available, from a licensed person.
Schedule 3. Pharmacist Only Medicine – Substances, the safe use of which requires professional advice but which should be available to the public from a pharmacist without a prescription.
Schedule 4. Prescription Only Medicine, or Prescription Animal Remedy – Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription. (See Poisons Standard 2013, Introduction).
The drugs identified in the question are scheduled as follows:
• Methoxyflurane and Nitrous Oxide are both in Schedule 4:
• Paracetomol when in tablets of less than 500mg and in packets of less than 25, Schedule 2; otherwise Schedule 4:
• Salbutamol when it is the only therapeutically active substance in aerosols delivering 100 micrograms or less of salbutamol per metered dose or in dry powders for inhalation delivering 200 micrograms or less of salbutamol per dose, Schedule 3; otherwise Schedule 4:
• Adrenaline in preparations containing 1 per cent or less of adrenaline except in preparations containing 0.02 per cent or less of adrenaline unless packed and labelled for injection, Schedule 3; otherwise Schedule 4.
For the sake of this answer I will only consider the use of the schedule 4 drugs. It is an offence to possess or supply scheduled poisons except in accordance with the Act, however:
any nurse practitioner is … authorised to obtain and have in his or her possession and to use, sell or supply any Schedule 2, 3, 4 or 8 poison approved by the Minister in relation to the relevant category of nurse practitioner in the lawful practice of his or her profession as a nurse practitioner; and
any registered nurse whose registration is endorsed under section 94 of the Health Practitioner Regulation National Law is hereby authorised to obtain and have in his or her possession and to use, sell or supply any Schedule 2, 3, 4 or 8 poison approved by the Minister in relation to the relevant category of nurse in the lawful practice of his or her profession as a registered nurse; (s 13(ba) and (bb)).
(But the registered nurse or nurse practitioner cannot supply those drugs by retail in an open shop unless specifically licensed to do so; s 13(2AA) and (2AAB)).
The Minister may list drugs and poisons that can be used and supplied by practitioners including circumstances when the drug may be used (s 13). This is relevant for registered nurses and nurse practitioners (see http://www.health.vic.gov.au/dpcs/prescriber/nurse.htm). People may also apply for a warrant or permit to use poisons (s 20). This is relevant for say private paramedic service providers who need to gain permission to allow their staff to carry and use scheduled drugs.
The Regulations also give specific exemptions; importantly regulation 5 provides the following authorities;
• an operational staff member of Victoria Ambulance may carry and use ‘Those Schedule 4 poisons or Schedule 8 poisons listed in the health services permit held by that ambulance service within the meaning of the Ambulance Services Act 1986.’
• A member of St John Ambulance Australia (Vic.) recognised by that organisation as qualified to Advanced First Aid level may carry and use “Those Schedule 4 poisons listed in the health services permit held by St John Ambulance Australia (Vic.).”
• An Australian Ski Patrol Association Inc. qualified ski patroller may carry and use “Those Schedule 4 poisons approved by the Secretary that are required in the performance of a ski patroller’s duties for the treatment of emergencies.” The website for the Department of Health says that the Secretary has approved the use of Methoxyflurane and Nitrous oxide by members of the ski patrol (see http://www.health.vic.gov.au/dpcs/approve.htm#skipatroller).
That doesn’t help us to understand what schedule 4 drugs can be used as we would need to see the permits issued to Ambulance Victoria and St John Ambulance (Vic) respectively. Whilst these exemptions or authorities are listed in the regulations, they don’t need to be; it follows that permits and warrants may have been issued authorising others to use various drugs.
Let me know return to the question which was “what, if any, medication may be carried and administered to patients by first aiders acting in a voluntary capacity in Victoria”?
Answer: it depends on their authority. A permit has been issued to St John Ambulance Australia (Vic) so to know the answer to that question one would have to see the permit. For first aiders outside St John it would also be necessary to see the terms of any authority that they had been granted.
“Does this change between different qualifications of first aider?”
Answer: Yes, for example the authorised St John first aiders are those ‘recognised by that organisation as qualified to Advanced First Aid level’. The same could and would be true for other organisations.
“Does it change for an RN?”
Answer: Yes, but the critical issue for RN’s is the terms of their registration or approval. As noted above the relevant provisions in Sections 13(ba) and (bb) refer to the use of drugs in the persons “lawful practice of his or her profession as a registered nurse”. If they are authorised by their registration to carry, use and supply scheduled drugs then they can in accordance with the terms of that registration; but whether that extends to volunteer work with volunteer first aid organisations one would have to look at the exact wording on their registration or authority.
So, as I said, having looked at the law the answer is no clearer – we can reach the conclusion that ‘first aiders acting in a voluntary capacity in Victoria’ can carry, use and administer whatever scheduled drugs they have been authorised to carry, use and administer by the Secretary and in accordance with the terms of any authorisation, warrant or permit.
Michael Eburn
2 January 2014
Australian Emergency Law 
As I have seen it and as per my remote area nurse and paramedic certificate. St john first aiders don’t prescribe medication unless an advanced care officer is there. Methoxy is not a first aid medication, nor is any of the other medications listed above. The issue is the license to prescribe, which is what a person is doing when you give someone else a drug, even if it is a schedule 2 medication. Just because you can buy it, doesn’t mean you can suggest it to another person.My partner is a NP and she can prescribe only at her place of business. Insurance is the key operative here.
I’m not sure what you mean by an ‘advanced care officer’ but I’m pretty sure St John first aiders who have completed the appropriate course in the use of analgesic gases do in fact use them on their own initiative, but perhaps they are what you mean by ‘advanced care officer’. As noted the ski patrollers can use Methoxyflurane and Nitrous oxide so doesn’t that make them ‘first aid’ medication? Again I suppose it depends on what you mean by ‘first aid’. It all comes down to words of course and again, in the absence of professional registration, terms like ‘first aider’, ‘advanced care officer’ and even ‘paramedic’ mean whatever the person using them intends them to mean. So to come back to our comment, St John first aiders who are recognised as Advanced First Aiders can use the drugs that are authorised in the permit issued to St John. It means they can, and we can assume do, determine the clinical need and supply the drugs in accordance with the terms of their licence.
Hi,
To enlighten those living in Victoria.
Our organisation holds a S2, S3 and S4 drugs/poisons permit with DHHS in Victoria.
To administer a S4, Only a AHPRA registered health professional can administer such drug. I.E our Nurses. Our nurses need to call up our on-call doctor for a over the phone consultation to receive a drug order for that patient.
Our paramedics and other staff cannot even with a Doctors order give a S4 under our permit.
S2 and S3 can be given by anyone under the discretion of the organisation… i.e Our business allows degree qualified paramedics to give S3 under our guidelines.
If you hold a NEPT (NON-Emerg license) you can give a selected number of medications (limited amount). With Methoxy S4 being one of those drugs. You don’t have to call a doctor for this.
The drugs/poisons regulation allows a selected number of non AHPRA registered people to give such a drug such as ski patrol and St Johns as indicated above.
Unfortunately in Victoria a number of our competitors have this license but don’t consult a doctor and have paramedics/first-aiders giving Methoxy which is in breach of the license.
Once paramedics become registered (soon ) they can give S4 with a Doctors order.
Cheers,
Andrew
Hi
it seems a couple of years between points but I will see what I can add to the discussion. And I am sure this will not be the common thought but here a different view point.
While much of this has centered around registered persons, organistions and DPCS and the Poisons Control Plan of the organisation to purchase and hold, I am curious to explore the space of the member of the public who has been trained in first aid, or workplace first aider and their ability to provide drugs in a first aid situation.
I am also curious that first aider “duty of care”, and Australian Resuscitation Guidelines for First Aid have not been mentioned in this discussion. I remember watching M.A.S.H. and the field Tracheostomy being done by the priest, and thinking wow he can do that, because he was under direction of a competent person.
If I consider the general aspect of the “duty of care” this would include provision of first aid to the level (and processes) by which the first aiders have been taught and assessed as competent. Hold the reason persons test concept at this point, as we know the knowledge retention for first aid training is really low.
If the training provided the recommendation for provision of drugs in a situation, then would the provision of said drug be appropriate and lawful for the circumstances?
An example in case, give “300 mg orally to adults with non-traumatic chest pain
unless the person has known anaphylaxis to aspirin” as extracted from the ANZCOR Guideline 9.2.1 – Recognition and First Aid Management of Suspected Heart Attack. file:///C:/Users/sargbz/Downloads/anzcor-guideline-9-2-1-suspected-heart-attack-apr-2021.pdf
Now lets expand this and ask if the same first aider can use the aspirin for pain management, like I do at home? The answer is No, as neither the training nor ARC provide the scope of operation for this situation.
So what about other drugs and can you have them in the first aid kit?
Well in there are two options, a private first aid kit in the car and one under the Victoria the Compliance Code Workplace First Aid. Generally I would see that the as long as the drugs can be purchased over the counter by a reasonable person, and kept within the first aid kit for the indented purpose, defined by both training and ARC guideline then the use would also fall under this framework.
Lets look at the other side, from the employer general duty in the Vic OHS Act and application of the risk assessment method for Compliance Code. If your workplace has a (high)proportion of employees who are at are at risk of heart attack (which we would know or ought reasonably know) then reduction of risk, looking at first aid, would be to prepare the first aid kit according to ARC guideline, including the drugs.
But how far does this go. Can I carry salbutamol or an EpiPen. School first aiders can spare EpiPen (at great cost when purchase without a script) and administer where the persons action plan provides for the use and within the first aiders training.
Just back to the reasonable person test and degrading knowledge of first aid. If they can’t remember what to give….. then do not give, they are likely on the phone to 000, ask them to confirm and provide direction.
Regards
Brett
The starting point is that scheduled drugs are restricted, regardless of the schedule. So Schedule 2 and 3 drugs, that can be purchased from a pharmacy without a prescription are still restricted – see The last word on scheduled drugs? (September 29, 2019) .
Whether a ‘member of the public who has been trained in first aid, or workplace first aider’ is authorised to possess, supply or administer a scheduled drug (including adrenaline in an epi-pen or salbutamol in a measured inhaler) depends on the legislation in their jurisdiction. For example, the Poisons and Therapeutic Goods Regulation 2008 (NSW) Appendix C, cl 10 says “A person who is in control of an industrial first aid post is authorised to possess and use any Schedule 2 substance that is required in connection with the carrying out of industrial first aid.”
The concept of a ‘duty of care’ is a common law concept relevant to the law of negligence. It has to be read consistently with other law in particular statute law. A first aider cannot have a common law duty to do something that is prohibited by law so it cannot be negligent for not carrying or using drugs that one is not authorised to carry or use.
As for the field tracheostomy in the TV show M*A*S*H, see Performing an Emergency tracheotomy (or life mimics art?) (March 11, 2018).
That would not be ‘permitted’ because someone was under the direction of a qualified person. Remember Australian health care regulation does not define scope of practice of medical or other health care practitioners. If one wants to do an emergency tracheotomy one may be grossly negligent – but not if you have some skills and are consulting with someone and it’s either that or certain death. But that’s not the same as the drugs issue as there is no law that specifically says who can, or cannot perform a tracheostomy. And, except in WA (Medicines And Poisons Act 2014 (WA) s 27; Medicines and Poisons Regulations 2016 (WA) r 35), doctors cannot simply delegate their authority to carry drugs – see Doctors delegating authority to carry drugs (August 20, 2014). It follows that even if someone has been ‘taught and assessed as competent’ in the administration of various scheduled drugs (such as adrenaline, salbutamol or methoxyflurane) that does not mean they can possess, supply or administer those drugs even if the use of those drugs are indicated.
On the other hand, to use one of my favourite phrases, the law is not self-executing so it does not mean there would be any legal consequences if they did. First everyone can help a person administer drugs that have been prescribed too them, so if the patient has their own Ventolin puffer or epi-pen there is no issue in administering that drug to them. Second even if a person is committing an offence by being in possession of a scheduled drug it does not mean they do anything wrong by using it when indicated. To refer to an analogy that I’m sure I’ve used before, it may be an offence to be in possession of a handgun, but that does not mean it’s illegal to use it to shoot someone in self-defence. Equally a person may be committing the relevantly minor offence of being in possession of a schedule 2, 3 or 4 drug, but its use could still be justified in the right circumstances.
The problem with the aspirin example is that aspirin can be used at home or in a first aid kit (as can paracetamol and ibuprofen) if they are not scheduled drugs – and depending on their packaging they are indeed not scheduled drugs – see Non-scheduled drugs (July 27, 2022). Anyone can possess and supply non-scheduled drugs and a reasonable person would use them in accordance with the directions on the packet.
So what about other drugs and can you have them in the first aid kit? – see Drugs in a private first aid kit (September 22, 2018) and Revisiting drugs in first aid kits (March 9, 2020). Just because you can buy schedule 2 and 3 drugs from a pharmacy without a prescription does not mean you can supply them to others. A pharmacy only drug can be supplied by a pharmacist, not by someone who bought the drugs from a pharmacist. I disagree with the statement that ‘as long as the drugs can be purchased over the counter by a reasonable person, and kept within the first aid kit for the indented purpose, defined by both training and ARC guideline then the use would also fall under this framework.’ That would still not deal with the limitations in the relevant poisons legislation (noting that the legislation may well allow people who have completed relevant training to carry various scheduled drugs).
But how far does this go. Can I carry salbutamol or an EpiPen? You can if the legislation says you can. The Drugs, Poisons and Controlled Substances Regulations 2017 (Vic) does not authorise someone to carry salbutamol or an epi-pen simply because they have been trained in its use. Compare that to the Poisons and Therapeutic Goods Regulation 2008 (NSW) Appendix C, cll 12 ‘Asthma first aid’ and 13 ‘Anaphylaxis first aid’).