A volunteer officer with Ambulance Tasmania writes:

I have been researching the legislation that applies to the use of drugs by Ambulance Officers in Tasmania. Specifically those for pain relief. This led me to three pieces of legislation:

  1. The Ambulance Service Act 1982
  2. The Poisons Act 1971
  3. Poisons (Declared Restricted Substances) Order 1990

My first question is simply “Am I an Ambulance Officer?”  I suspect the answer is “no”. This surprised me as we are often referred to as such. I don’t fully understand the difference, the Ambulance Service Act doesn’t make it clear.  Could you interpret it for me please?

The answer to my first question will help answer my next questions.

We have a number of drugs in our protocols, some are S4 and so come under the definition of Restricted Substances. I can see clearly that Clause 38 (1)(h) of the Poisons Act 1971 allows us to use these drugs within our Clinical Field Protocols. However, I’d like to ask you about the legislative position of two specific drugs, one that we used to have in our protocols Panadeine Forte, now removed, and one that many VAOs would like to see added, Fentanyl IN.

Panadeine Forte contains Codeine (S4) which is listed in the Poisons (Declared Restricted Substances) Order 1990 and so is covered by clause 36 (1C) of the Poisons Act 1971.  Could you explain this for me please? When it says written permission from any Secretary, what does that actually mean? With such permission, would/could it allow a VAO to use this drug, without any legislative changes? Assuming Ambulance Tasmania wanted us to do so and updated our Clinical Field Protocols, of course.

Fentanyl IN is used by some Ambulance Volunteers in other jurisdictions, notably Victoria. If Ambulance Tasmania ever wanted to allow its use by VAOs could that be achieved without legislative change? I note that it’s covered by clause 47 (1)(dd) of the Poisons Act 1971, but it rather depends on the definition of Ambulance Officer in the Ambulance Service Act 1982.

I hope my questions fall within the scope that you can answer through your blog.

The Ambulance Service Act 1982 (Tas) does not define ‘ambulance officer’ but it does define the term ‘officer of the Ambulance service’. An ‘officer of the Ambulance service’ is a person ‘appointed or employed to enable the Commissioner to provide ambulance services in accordance with this Act’ (ss 3 and 14(2); emphasis added).   I have emphasised the phrase ‘or employed’ because the use of the term ‘or’ indicates that a person who is appointed need not be employed – they could be a volunteer!

Section 16 says:

(1)      The Commissioner may appoint such persons as he thinks necessary to be volunteer ambulance officers.

(2)      A volunteer ambulance officer–

(a)       shall perform, without remuneration, such functions relating to the provision of ambulance services as the Commissioner may from time to time direct; and

(b)      shall be subject to the control and supervision of the Commissioner.

A volunteer ambulance officer is appointed to perform functions relating to the provision of ambulance services by the Commissioner so a volunteer ambulance officer is, necessarily, an ‘officer of the ambulance service’.

The Poisons Act 1971 (Tas) s 26 makes it an offence to supply a medicinal poison (that is a Schedule 2 drug; see s 3) unless the person is a licenced medical practitioner, nurse or other relevant health or veterinary professional.   A similar provision applies to restricted substance (that is a Schedule 4 drug; see ss 3 and 26). These provisions do not, however, apply to the administration of a medicinal poison or by:

… a volunteer ambulance officer, an ambulance officer, a paramedic or an interstate ambulance officer–

(i) at the direction of a medical practitioner; or

(ii) in accordance with the Field Protocols applying with respect to the administration of scheduled substances as approved by the Commissioner of Ambulance Services from time to time;

Ambulance officers and paramedics may also use narcotic substances in accordance with the appropriate field protocols (s 47(1)(dd)).   For the purposes of the Poisons Act 1971 the term ‘ambulance officer’ means ‘an officer of the Ambulance Service as defined in the Ambulance Service Act 1982’ (s 3). As argued, above, that must include a volunteer ambulance officer.   So, for the purposes of the Poisons Act 1971, a volunteer ambulance officer is an ambulance officer.

What follows is that volunteer ambulance officers may use and administer schedule 2 and 4 drugs as well as narcotic substances to the extent that they are authorised by the Commissioner.

According to ‘Pharmacy direct’, Panadeine Forte is Paracetamol 500mg & Codeine Phosphate 30mg. Codeine when compounded with other therapeutic substances and with 30mg or less of codeine is a schedule 4 drug.   Fenatnyl is a schedule 8 (narcotic) drug (see the Poisons Schedule at https://www.comlaw.gov.au/Details/F2015L01534).

Could the ambulance service allow the use of these drugs without legislative change? Yes they could. The Commissioner would have to approach the Secretary of the Department of Health and Human Services who would have to give, in writing, an authority to allow ambulance officers to possess Panadeine Forte (s 36(1)(c)).   The regulations already provide that an ambulance officer may possess a narcotic substance (which must include Fenatnyl) ‘for the purposes of his or her profession or employment’ (Poisons Regulation 2008 (Tas) r 9)).   A volunteer ambulance service is not engaged in employment but in context, I would have no difficulty suggesting that they are covered by the reference to the purposes of ‘his or her profession’ that is for the purposes of their duties as a volunteer ambulance officer.

What follows is that the use of these drugs is a matter for the Commissioner no doubt in consultation with the Department of Health and Human Services. If they took the view that it was appropriate they would have to develop the ‘field protocols’ to determine which officers could use the drugs in what circumstances, provide the training and then they are authorised to use the relevant drugs. No legislative change would be required.

Section 36(1)(c) refers to a person authorised:

… in respect of ambulance services, to have in his or her possession, or to attempt to obtain possession of, a substance to which this section applies [that is a restricted substance or schedule 4 drug] to the extent the person is authorised under any Secretary’s written authority for the use of the substance to which this section applies for ambulance services.

That means just what it says. The Secretary of the Department of Health and Human Services must authorise ambulance officers to carry schedule 4 drugs. The authorisation could be to named officers or could be a class of officers such as ‘those authorised by the Commissioner’ or holding a particular qualification.

Let me then return to the questions:

  1. “Am I an Ambulance Officer?”  Yes, a volunteer ambulance officer is an ‘officer of the ambulance service’ (Ambulance Service Act 1982 (Tas) ss 3 and 14(2)) and is therefore an ambulance officer for the purposes of the Poisons Act 1971 (NSW) (see s 3).
  2. When s 36(1)(c) refers to authorization by the Secretary of the Department of Health and Human Services it means just what it says. Lawful permission to carry schedule 4 drugs requires the Secretary to authorise ambulance officers in writing. That authority could be given to names officers or to a class of officers.
  3. With such permission, would/could it allow a VAO to use this drug, without any legislative changes? Assuming Ambulance Tasmania wanted ambulance officers, including volunteer ambulance officers to use those drugs and updated the Clinical Field Protocols, then yes.
  4. Fentanyl IN is used by some Ambulance Volunteers in other jurisdictions, notably Victoria. If Ambulance Tasmania ever wanted to allow its use by VAOs could that be achieved without legislative change?