NOTE- in the first version of this I did not make it clear that I intended to ask about the South Australian Ambulance Service and Ambulance Victoria rather than paramedics working in other areas. I’ve amended the post, below, to better phrase my question.
Rather than answer a question, this time I’m going to ask one because I cannot find the answer – so hopefully a paramedic in SA or Victoria, or a legally qualified reader will be able to point me in the right direction.
On 30 June, I will be presenting a webinar for the Australasian College of Paramedicine on the use of drugs by paramedics. In preparation for that I’m going through the relevant legislation in each state and territory, and I have found two questions I cannot answer.
South Australia
By what authority do paramedics employed by the South Australian Ambulance Service possess and administer schedule 4 and 8 drugs?
The Controlled Substances Act 1984 (SA) s 15(1) says:
A person must not … supply to a person a poison, [or] medicine … to which this section applies unless the person—
(a) is a registered health practitioner … acting in the ordinary course of his or her profession
A paramedic is a ‘registered health practitioner’ (s 4). The term ‘poison’ means (amongst other things) ‘the primary substances listed in Schedules 1 to 8 and Schedule 10 of the Uniform Poisons Standard’ (s 4 and Controlled Substances (Poisons) Regulations 2011 (SA) r 5). ‘Medicine’ means ‘therapeutic goods (other than biologicals) that are represented to achieve, or are likely to achieve, their principal intended action by pharmacological, chemical, immunological or metabolic means in or on the body of a human’ (s 4 and Therapeutic Goods Act 1989 (Cth) s 3).
So far so good; that would suggest that a paramedic can supply any necessary drug whether in sch 2, 3, 4 or 8. BUT s 15 is limited to those poisons ‘to which this section applies’. Section 15(2) says ‘This section applies to such poisons (other than prescription drugs), medicines or medical devices as may be prescribed, individually or by class, by the regulations’. The term ‘prescription drugs’ means drugs listed in schedules 4 and 8 of the Poisons Standard (s 4 and Controlled Substances (Poisons) Regulations 2011 (SA) r 6). Regulation 12 says ‘Section 15 of the Act applies to all S1 poisons, S2 poisons, S3 poisons and S7 poisons’. Schedule 1 and 7 drugs are not relevant to paramedic practice. So the combination of s 15 and regulations 6 and 12 confirm that the authority in s 15 is limited to sch 2 and 3 drugs, not sch 4 and 8 drugs.
It is an offence to be in possession of a sch 4 or 8 drug unless the person in possession is authorised to supply the drug (s 18(3)). The supply and administration of ‘Prescription drugs’ (ie sch 4 and 8 poisons) is regulated by s 18. That section says that registered health professionals can supply (s 18(1c)(b)) and administer (s 18(1d)(b)) sch 4 and 8 drugs provided, either:
- They are a ‘a dentist, medical practitioner, nurse or midwife’ or
- Their ‘registration is endorsed under section 94 of the Health Practitioner Regulation National Law as being qualified to supply [or administer] a scheduled medicine or class of scheduled medicines and the drug is a scheduled medicine or of a class of scheduled medicines specified in the endorsement’ or
- ‘The practitioner is authorised to supply [or administer] the drug by the regulations’.
Clearly [1] does not apply to paramedics. A search of random paramedics who have listed their place of registration as South Australia does not identify any who have a relevant endorsement under s 94 so [2] does not apply. It follows that for s 18(1c) or (1b) to apply their authority must be in the regulations.
But I can find no regulations that authorise a paramedic to supply or administer a sch 4 or 8 drug. Regulation 18 provides an authority for dental hygienists, dental therapists, oral health therapists, podiatrists, optometrists and practitioners involved in vaccination schemes. It does not refer to paramedics or employees of the South Australian Ambulance Service.
The term paramedic does not appear in the Controlled Substances Act at all. It appears only in r 35 of the Controlled Substances (Poisons) Regulations 2011 (SA). That regulation says that a health practitioner supplying or administering a ‘monitored drug’ must check the monitored drugs database first, but this obligation does not apply to ‘a person registered under the Health Practitioner Regulation National Law to practice in the paramedicine profession as a paramedic who is acting in the ordinary course of that profession’ (r 35(3)(i)).
Equally there is no mention of ‘ambulance’ in the Act. The Controlled Substances (Poisons) Regulations, r 45 regulates the destruction of drugs of dependence unless the destruction is witnessed by an authorised person which includes ‘a person who has been authorised in writing by the Chief Executive of the SA Ambulance Service to administer drugs of dependence’. But there is no section, in either the Act or the regulation that says that the Chief Executive of the SA Ambulance Service may authorise a person ‘to administer drugs of dependence’.
Presumably therefore the Minister has granted an authority to the South Australian Ambulance Service ‘to Possess, Supply and/or Administer a Schedule 4 Prescription Drug and/or a Schedule 8 Controlled Drug’ (Controlled Substances Act 1984 (SA) s 55 and see https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Public+health/Drugs+poisons+chemicals+and+contaminants/controlled+substances+governance+and+licensing/Poisons+regulations+and+licence+applications) but that does not appear to be available online and I don’t want to pay the $40 plus for an FOI application to the SAAS.
Victoria
A similar question for paramedics employed by Ambulance Victoria, but this time it’s schedule 2 and 3 drugs.
The Drugs, Poisons and Controlled Substances Regulations 2017 (Vic) r 7 cl 1.11 says that ‘An operational staff member within the meaning of the Ambulance Services Act 1986’ is authorised to possess ‘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 to the extent and for the purpose specified in the permit’. Excellent.
But there’s no similar provision for sch 2 and 3 drugs. One might think that because you can buy these drugs at a chemist authority is not needed but that is not the case and the law in Victoria makes it clear. Regulations 133 to 133CD authorise various professions, including nurses and midwives to deal with sch 2 poisons, and ss 133D to 147 deal with sch 3 poisons. But none of those provisions refer to paramedics or ambulance officers. The term ‘paramedic’ does not appear in the regulation at all and although there are some references to ambulance officers these are not relevant in this context (see r 5, 108 and 115).
The Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 13(1)(bd) says that ‘any paramedic practitioner is hereby authorized to obtain and possess and to use, sell or supply any Schedule 2, 3, 4 or 8 poison approved by the Minister in the lawful practice of the person’s profession as a paramedic practitioner’. A ‘paramedic practitioner’ is (s 4):
a registered paramedic who—
(a) has completed a prescribed postgraduate qualification; and
(b) satisfies the prescribed experience requirements (if any);
There are no prescribed requirements so presumably there are, as yet, no ‘paramedic practitioners’.
We know, from r 7 that there is a ‘health services permit’ issued to Ambulance Victoria (see s 19) so I infer that it extends to sch 2 and 3 drugs, but again it’s not something that is publicly available.
My question to you
So my question to those legally qualified and in particular to paramedics who work for the South Australian Ambulance Service and Ambulance Victoria, do you have any documents you can share, or advice you can give, on where the authority comes to possess, supply and administer sch 4 and 8 drugs (in South Australia) and sch 2 and 3 drugs (in Victoria) can be found? Because I cannot find it so can only guess and my guess is that the SAAS and Ambulance Victoria have both been issued with an authority (South Australia) and a permit (Victoria) to allow the ambulance service to authorise relevant employees to carry and use the required drugs.
POSTSCRIPT
I have now been provided with a copy of the Licence to Possess, Supply and Administer Schedule 4 Prescription Drugs and to Possess, Supply and Administer Schedule 8 Controlled Drugs issued to the South Australian Amblance Service so that answers my question with respect to the South Australian Ambulance Service.
But what of Ambulance Victoria and schedule 2 and 3 drugs?
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.
Australian Emergency Law 
Good afternoon Dr Eburn, trust that you are well. Here is an interesting observation that you may wish to consider. An ambulance from Victoria attends an emergency in South Australia (or vise-versa). If there are differences between the services clinical practice guidelines for medication administration should the attending crew modify their guidelines to suit the geographical guidelines? I have not been too fair in asking this question as eleven years ago I worked in AV Wimmera District and AV & SAAS had a memorandum of understanding that Paramedics work to the guidelines of their employing agency. I thought that this may be worth a mention. You and I last spoke when you gave an online presentation to the Emergency Driver Training Network and I hope that you can present to us once again in the future.
State laws can have an interstate application so the Ambulance Services Act 1986 (Vic) has to have application in South Australia so the paramedics who cross the border remain employed and subject to the direction and control of their employer. Where there is a conflict eg where for example legislation says that a person must not possess a scheduled drug unless permitted by SA law, and there is no SA law that says Victorian paramedics have an authority, then it becomes a complex matter determined by the rules of ‘conflict of laws’ which are too hard to try to explain here. (I do note that in the Review of the Ambulance Services Act 1986 and supporting legislation: Consultation Paper (2016) it was conceded (at p. 15) that ‘… any ambulance service or paramedic from outside Victoria, not employed by Ambulance Victoria, is not legally allowed to possess or administer any drugs…’ but pragmatic enforcement has never put the issue to the test). But in short a paramedic employed by AV or SAAS remains employed and subject to the direction and control of that agency when they cross a border. The SAAS paramedic in Victoria is not employed by AV or authorised by Victorian legislation to carry drugs so if there is going to be an argument of choice of laws he or she has to comply with the SA law (and therefore the SAAS CPG’s) as that is their only source of authorisation. If any argument comes down to an issue of Victoria giving ‘full faith and credit’ to the laws of SA (Australian Constitution s 118) then the SA paramedic is going to have to be able to say, hand on heart, that he or she was complying with relevant SA law.
In short they have to ‘work to the guidelines of their employing agency’ because that is the only authority they’ve got.
OFFICIAL
Hi Michael,
As best I can work out by referring to internal policies
PRO FCS 058 Medication Management – Medication Safe Requirements PRO OPS 285 Medication Safety Standard
In Victoria, the authority for Ambulance Victoria staff to possess and administer medications does not come from a direct statutory provision aimed at individual paramedics. Instead, it sits within the broader framework of the Drugs, Poisons and Controlled Substances Act 1981 and its regulations, which allow the Department of Health to issue permits to organisations providing health services.
Ambulance Victoria holds such a permit – formally described as a Permit to Purchase or Otherwise Obtain Poisons or Controlled Substances for the Provision of Health Services. That permit provides the legal authority for AV, as an organisation, to obtain and hold scheduled medicines, including Schedule 2 and Schedule 3 substances. (ref PRO OPS 285 Medication Safety Standard)
From there, the authority flows internally. The organisation authorises its operational staff, including paramedics and ACOs, to handle, possess and administer those medications as part of their duties. This is not an open-ended authority; it is tied to employment, credentialling, and scope of practice. In practical terms, staff must hold a current Authority to Practice and act in accordance with Ambulance Victorias Clinical Practice Guidelines and approved medication lists. (ref PRO OPS 285 Medication Safety Standard)
That framework applies equally to lower schedule medicines such as paracetamol or salbutamol. Although these are Schedule 2 and 3 substances in the community, within the ambulance context they are still accessed under the same organisational permit and governed through the same internal controls as higher schedule drugs. The AV medication lists and clinical guidelines determine which of those medications can be used, in what circumstances, and by which level of clinician (ref PRO OPS 285 Medication Safety Standard)
So, in essence, paramedics in Victoria do not rely on a specific legislative provision that personally authorises them to administer S2 or S3 medicines. Their authority is derived from the permit issued to Ambulance Victoria, combined with the organisations internal systems of delegation, clinical governance and scope of practice. Hope that helps. If you require the documents AV would probably provide them FOI@ambulance.vic.gov.au
Cheers
Dave
Dave Jones (He/Him) Senior Team Manager – East Gippsland Bairnsdale Lakes Entrance Paynesville Orbost