Following a seminar I presented for the Australasian College of Paramedicine I received these follow up questions:

Scenario #1: Commercial flight

If I were on a commercial flight and a passenger went into anaphylactic shock, but there was no EpiPen available, only adrenaline ampoules within the onboard physician kit. Would I be legally able to administer a standard IM adrenaline dose to preserve life despite not having a direct order from a doctor, assuming I was unable to obtain an order from a physician?

Scenario #2: Off-duty cardiac arrest

I work as an event paramedic and may at times be travelling home while still carrying scheduled medications and my paramedic equipment. If I came across an active cardiac arrest while off duty, would I be unable to administer medications such as adrenaline or amiodarone because I am not actively working under an employer or ambulance service at that time?

I appreciate these situations are likely context dependent, but I would be very interested in your general thoughts or any relevant legislation/guidance you could point me toward.

I have written a lot on drugs – see all the posts that appear here https://australianemergencylaw.com/?s=scheduled+drugs

Commercial flights

For a post that largely answers this question see Accessing medical supplies on an aircraft (August 9, 2017). The implication of that post is that you are not going to access the onboard kit without the permission of the captain and cabin crew manager and only on the approval of a medical practitioner that is ‘on call’ for the benefit of the flight.  In that case the question does not reflect the actual practice.

Thinking in more abstract – or academic – terms we can still think of the question and perhaps limit ourselves to an Australian domestic flight.  A paramedic going on holiday on a domestic flight has no authority to possess or administer the drugs.  But the concept of ‘necessity’ could be applied or, taking as an example, the Queensland Criminal Code 1899 (Qld) s 25:

… a person is not criminally responsible for an act or omission done or made under such circumstances of sudden or extraordinary emergency that an ordinary person possessing ordinary power of self-control could not reasonably be expected to act otherwise.

And to give another example, it may be an offence to possess a gun, but that does not make it illegal to use the gun in self-defence. 

I don’t think anyone would question a paramedic administering drugs that are indicated, in a manner that is consistent with their training and acting in good faith to advance the patient’s best interests provided they are not engaged in ‘officious intervention’ (In Re F [1990] 2 AC 1) that is if the paramedic pushes the cabin crew aside, or seeks to act without regard to the airline’s own procedures (and see above the discussion in international flights) then it would be a different picture.  In short if a paramedic identifies themselves to the cabin crew, the cabin crew manager or the pilot in command accept the offer of assistance and provide access to the drugs without saying ‘we have to get our doctor on the line first’ then I cannot see any issue with the paramedic acting to save the patient’s life.

Off duty cardiac arrest

A paramedic who is ‘travelling home while still carrying scheduled medications and my paramedic equipment’ is not off duty.  Assuming the authority to carry and use the drugs is vested in the company for which the paramedic works, then he or she is carrying those drugs because they are an authorised employee. And as an authorised employee they could administer the drugs in accordance with the guidelines or protocols issued by the employer.  If they are really off duty then the drugs should have been signed back into the drug safe. If that hasn’t happened yet, then whatever authority their employer gives them to use or possess the drugs still applies.

Even without that I think any law or lawyer would expect the paramedic to do what he or she can to save the patient’s life.  

Think of it as a risk assessment – what’s the risk of giving drugs even if it turns out you didn’t have the legal authority in the context – a regulator or employer might say ‘you shouldn’t have done that’ but how likely is that particularly if there was a good outcome for the patient? I would hope the answer to that question is extremely unlikely so that’s a low risk.

What happens if you don’t give the patient the treatment you are trained to give, that you know is indicated and which you have the necessary equipment to administer and there is a bad outcome for the patient?  The patient may seek to sue you (see Lowns v Woods (1996) Aust Torts Reports 81-376) and if the person who died was one of your loved ones are you going to sue the person who refuses to help because there’s a rule that might apply? Or the person who steps in and has a go even if there is no successful outcome?  And if they don’t sue they may well complain to the regulator who will have to consider what would a professional of equal training do?  Would they advance compliance with the rule over saving the patient’s life?  I’ll leave it to each paramedic to come to their own conclusion on the risk assessment.

Good Samaritan legislation

In all states there is ‘good Samaritan’ legislation that seeks to protect a person who comes forward to assist in an emergency (see Good Samaritan legislation – a comparison (February 22, 2017). That legislation protects a person from all civil (not criminal) claims where their actions are in good faith and would apply here – even the Queensland version if the paramedic is an employee of QAS or one of the organisations listed in the Queensland regulations.

In the circumstances described, back yourself and have a go.

POSTSCRIPT

Further to the post, above, and in light of some of the FaceBook comments received, I want to try and make my thinking clearer.

I don’t think anyone would object to the use of the available drugs in the circumstances described.  Where the drugs are indicated, necessary to save the patient’s life and their use is part of the routine use in the paramedic’s daily work so the paramedic can identify that the drugs are needed, the relevant dosage and the appropriate way to administer them then it really won’t be an issue.  After the event there are a number of legal rules that one could point to – including necessity and the good Samaritan legislation – if the issue was ever to arise in a legal context, but I’m sure it never would.

The issue with drugs, drug regulation and drug authority is not their use in an emergency where a paramedic is ‘johnny-on-the-spot’ and by some fortuitous means can access the necessary drugs – either because they are in an aircraft’s emergency kit, they are working in a PTO capacity but out of an emergency ambulance, or they are taking the kits back to base to sign back in at the end of a duty.

Where drug regulation will be an issue is when paramedics are making decisions to buy drugs to put into the first aid kit they intend to keep in their car, or where the school principal asks them to come and do first aid at their child’s school sports carnival, or where they are planning to set up their own event first aid service in a state other than Victoria where they don’t have to have a licence.  In those circumstances the issue will arise if an inspector from the relevant health department thinks ‘who are these cowboys’ and comes to audit the set up, or police look in the boot of the car and find a pharmacy of scheduled drugs, or a patient suffers an overdose and someone complains.   Or when a paramedic approaches a pharmacy and in particular a wholesaler and wants to order a commercial quantity of drugs and the pharmacist asks ‘on what authority can I sell these to you’ and not getting a satisfactory answer makes a complaint.

Then the issue will be on what basis are you allowed to posses these drugs?  And if they are scheduled drugs you need a relevant authority – see 

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.