Today’s correspondent works for a first aid training company that is based in Queensland and where they are:

… having trouble clarifying the law on medications and First Aid …

We usually train that a first aider cannot administer their own medication to a casualty with the exception being 1 aspirin in the case of a suspected heart attack. In all other circumstances, they can assist a casualty in taking their own medications (EpiPens, salbutamol, Panadol etc). We have had several teachers ask us the law on EpiPens. I read your article about medications, and I just want to clarify, does that mean that if they hold a current Asthma and Anaphylaxis training, they can administer an EpiPen or puffer even if it’s not the students own? Also, does the law change with an Advanced First Aider?

I’ve answered this type of question before, but this may be a way to bring other answers together.

Sources of law

First, we have to distinguish what we mean by ‘law’.  There are two sources of law, the statute laws made by Parliament and with them associated regulations made by a delegated authority (the Governor or a Government Department or committee); and the common law.  Statute law is usually quite specific, it is a set or rules made to deal with particular issues. The relevant example here is the Medicine and Poisons Act 2019 (Qld) and the Medicines and Poisons (Medicines) Regulation 2021 (Qld).

But not all legislation is specific. There is a trend to make legislation broad brushed to leave those bound by the Act wide scope to determine how they will comply.  A leading and relevant example is the Work Health and Safety Act 2011 (Qld) which (like the Acts in all jurisdictions other than Victoria) imposes a general duty on the Person Conducting the Business or Undertaking (the PCBU).  It sets out factors that a PCBU must consider but, because every undertaking is different, the PCBU is expected to come up with their own assessment of what is ‘reasonable’ and apply that in their own business.  There are not clear or defined rules which leaves lots of freedom, but also consequences if the PCBU’s assessment of what is a reasonable response to a risk does not accord with the regulators.

Finally, there is the common law.  The common law is developed on a case-by-case basis.  A case has direct and specific application to those who are parties to the case. But a judge will set out relevant legal principles but not specific rules.  As with legislation like the WHS Act it is up to those that come afterwards to decide how those principles apply to their business.

With that brief lesson in Law 101 behind us we can turn to some specific issues.

Poisons laws

State laws are trying to apply the Poisons Standard that is itself a Commonwealth standard (see Medicine and Poisons Act 2019 (Qld) s 9). The current standard is the Therapeutic Goods (Poisons Standard—February 2023) Instrument 2023; but the standard is updated every 6 months or so; so this won’t be current for long.  You can find the current version on the Federal Register of Legislation.  The February 2023 standard is here.  It is this standard that defines the various schedules of drugs.

The first thing to note is that the Queensland law says that is an offence to administer a medicine (Medicine and Poisons Act 2019 (Qld) s 35). The term ‘medicine’ means a drug listed in schedules 2, 3, 4 or 8 of the Poisons Schedule (s 11).  (Poisons are those substances listed in schedules 5, 6 and 7 (s 12)).  The term regulated substance refers to all the items listed in all the schedules and various substances regulated by the Australian Pesticides and Veterinary Medicines Authority (s 17).

So, the first thing we can see is that the Medicine and Poisons Act does not say ‘a first aider cannot administer their own medication to a casualty with the exception being 1 aspirin in the case of a suspected heart attack…’. What s 35 does say is:

A person must not administer a medicine to someone else … unless the person—

(a) administers the medicine in the authorised way; or

(b) has a reasonable excuse.

To administer a medicine includes ‘give a dose of the medicine to a person to be taken immediately’ (s 26).  To administer the medicine in an authorised way means that the person is authorised under the Act in this case to administer the medicine (s 31). 

Non-scheduled drugs

But a medicine is a drug listed in schedules 2, 3 4 or 8.  Not all drugs are, in particular common pain killers such as paracetamol, ibuprofen and aspirin provided they are packaged appropriately, do not appear in the schedules -see Non-scheduled drugs (July 27, 2022).  It follows that there is no law that says if someone asks for a Panadol because they have a headache, that a first aider – or anyone – cannot give them one (or two) from the pack they have in their bag and that they bought from a supermarket; but that doesn’t mean it’s a good idea.

Work Health and Safety Law

That is the specific law, but then there are the general laws. Remember the WHS imposes a duty on a PCBU. That duty includes a duty to provide first aid equipment and access to people trained to provide first aid (Work Health and Safety Regulation 2011 (Qld) r 42).  In the event of a misadventure at work, a PCBU can point to reliance on a published Code of Practice as evidence that it complied with its duty under the law (Work Health and Safety Act 2011 (Qld) s 275).  There is a published First aid in the workplace  Code of Practice   2021 (Workplace Health and Safety Queensland).  The Code of Practice says (at p. 30):

Medication including analgesics like paracetamol and aspirin should not be included in first aid kits because of their potential to cause adverse health effects in some people including pregnant women and people with medical conditions like asthma. The supply of these medications may also be controlled by drugs and poisons laws. Workers requiring prescribed and over-the-counter medications should carry their own medication for their personal use as necessary.  

However, workplaces may consider including an asthma-relieving inhaler and a spacer to treat asthma attacks and epinephrine auto-injector for the treatment of anaphylaxis or severe allergies. These should be stored according to the manufacturers’ instructions and first aiders should be provided with appropriate training. Queensland Health regulates the purchase and administration of emergency first aid medicines and should be contacted for more information.

That would give some support to the belief that a first aider – certainly one at work – should not carry or administer any drugs.  It makes no exception for ‘1 aspirin in the case of a suspected heart attack…’ but it does refer to ‘analgesics’. I note that aspirin in the case of a suspected heart attack is recommended by the Australian Resuscitation Council, and it is not being used, in that context, as an analgesic (ARC Guideline 9.2.1 – Recognition and First Aid Management of Suspected Heart Attack (April 2021)) so one would argue that its place in a first aid kit is not inconsistent with the Code of Practice.

With respect to analgesics, there is an issue of why you would need analgesics in a workplace first aid kit. If the workplace environment is inducing headaches or other pain then there is a structural problem – about ventilation, or noise, or air quality, or ergonomics, or something – that’s causing the workers to develop pain and that needs to be addressed.  And if it’s only one worker who needs them then there is something about that worker and their working conditions that needs to be addressed. 

But never say never.  A PCBU that has workers working outside in remote areas, a long way from other support, may think it’s quite reasonable to include a packet of paracetamol in the first aid kit. That is up to them and their risk assessment.

The common law

The common law principles that most people think about is negligence. A first aider owes a duty of care to their patient, and it may be unwise to give non-scheduled drugs to a person without at least first making enquiries as to their signs and symptoms. 

Conclusion 1

There is no law that says ‘a first aider cannot administer their own medication to a casualty with the exception being 1 aspirin in the case of a suspected heart attack’.  If we are talking about non-scheduled drugs, which includes some pain killers that you can buy from a supermarket, a first aider commits no offence if they administer that medication (which means give some to a person to be consumed immediately). But if they are at a workplace that is discouraged by the Code of Practice and it may be negligent if the first aider does not consider the patient’s signs, symptoms and history and consider any contra-indications.  But in some circumstances, it may be quite reasonable– eg an event first aid provider at an outdoor event where a person has been in the sun a bit too long but is now sitting in the shade, rehydrating and asks for a pain killer. The risk of an adverse event (if you ask about prior history etc) may be very low and you may be reasonably acting in the patient’s best interests by giving an adult what they ask for.

Scheduled drugs

Scheduled drugs an entirely different kettle of fish.  It is an offence to administer a scheduled poison (or in Queensland ‘a medicine’) without an authority to have that medication.  Adrenaline as found in a EpiPen is schedule 3 as is salbutamol found in a asthma puffer.  Unless a first aider carries an EpiPen or an inhaler for their own use they should not be carrying those drugs without an authority.

In Queensland a person who holds ‘a current certificate granted by a registered training organisation for the provision of first aid’ (ie a first aid certificate) may possess and administer methoxyflurane, adrenaline in an (epinephrine) autoinjector, naloxone and/or an inhaled asthma reliever provided they have completed training in the use of those drugs (Medicines and Poisons (Medicines) Regulation 2021 (Qld) Sch 5, Part 2).

Conclusion 2

An appropriately trained first aider can carry and administer medication methoxyflurane, adrenaline in an (epinephrine) autoinjector, naloxone and/or an inhaled asthma reliever.  To put that another way, in Queensland, if they hold a first aid certificate plus ‘current Asthma and Anaphylaxis training, they can administer an EpiPen or puffer even if it’s not the students own’.

Emergency

Remember too there is the doctrine of necessity or, to refer to s 35, ‘a reasonable excuse’.  If a person has an EpiPen or inhaler for their own use and can see another person is suffering an emergency, then of course you can administer the medication to save the other person’s life or relieve their critical symptoms.  It would be outrageous for a person to recognise for example, that a person was suffering an anaphylactic reaction but do nothing even if they have an EpiPen in their own pocket for fear that a regulator will prosecute them.  As noted s 35 allows for a defence of ‘reasonable excuse’ and saving the person’s life will meet that criteria – see Using someone else’s EpiPen (June 9, 2016).

Conclusion

The law does not say ‘a first aider cannot administer their own medication to a casualty with the exception being 1 aspirin in the case of a suspected heart attack’.

The law says a first aider cannot administer a medicine, that is substances listed in schedules 2, 3, 4 or 8 of the Poisons Schedule (Medicine and Poisons Act 2019 (Qld) ss 11 and 35) without an authority.  

Aspirin, paracetamol and ibuprofen when packaged appropriately are not in the Poisons Schedule so a first aid can administer those (which includes give a dose of the medicine to a person to be taken immediately’ (s 26)) but they should stop and think ‘is this is a good idea?’   As a general rule it is not a good idea in a workplace (First aid in the workplace  Code of Practice   2021 (Workplace Health and Safety Queensland, p. 30) but as noted it may, on a risk assessment be reasonable to have aspirin to administer in the case of a suspected heart attack.

In Queensland an appropriately trained first aider can possess and administer methoxyflurane, adrenaline in an (epinephrine) autoinjector, naloxone and/or an inhaled asthma reliever.  The law does not distinguish between ‘first aid’ and ‘advanced first aid’ but to carry these drugs the person must have a first aid certificate and the appropriate training in the drug involved.  A training organisation may recognise that extra training as the difference between ‘first aid’ and ‘advanced first aid’ but the law does not use those terms.

In an emergency of course you can use someone else’s medication if it’s a choice between life and death.  That may not be true if you don’t know the indications and contra-indications for the drug, but it will be a non-issue if we’re talking about an EpiPen or asthma inhaler and a person who knows when and how to use them eg a person who generously uses their EpiPen to save someone else’s life.  (And if you remember the scene from the movie ‘Pulp Fiction’ (1994) (viewer discretion advised) where John Travolta injects the Uma Thurman character with adrenaline to save her life, I doubt whether any authority would prosecute for unlawful administration of that drug.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.