Today’s

…  question relates to the administration of drugs by Registered Paramedics (within ambulance and not within ambulance), in Victoria, and the inability for them to receive a Doctor’s Order to administer a medication. 

There are three scenarios. The first, is the increase in paramedics working in urgent care centres. The management of these centres have advised me that whenever a paramedic is working there with a doctor, an EEN is required as well because the paramedic cannot receive orders from a doctor to administer a drug. The EEN would have to do it (or, an RN). 

The second relates to those paramedics working for AV. Whilst they have access to AV employed doctors who can give directions for them to administer medications outside of the normal CPG dosage, indication, route etc. Often paramedics are faced with low acuity cases who are referred to the VVED [Victoria Virtual Emergency Department?]. The paramedics (and patient) speak to a non-AV FACEM and, on occasion, the FACEM will advise the paramedics to administer either an ambulance drug (such as aspirin) or a patient’s own drug at a dosage or for an indication outside of the CPGs. 

There are also rare occasions where an interhospital transfer is underway and the sending facility can have a doctor order medications (non-AV meds or outside of guidelines) and document this order on the AV PCR system. Paramedics are to follow that order provided they understand it and the medication/risks enough for it to be safe. 

This concept of “no doctors orders” has been long discussed in some niche areas, but I would like to know which laws and/or regulations apply here in these now more specific contexts? Is the urgent care structure correct? Are AV Paramedics compliant when following orders from a non-AV doctor? Are there personal practitioner risks if they choose to ignore the orders because they are concerned about scope and legalities? 

And, if possible, is this unique to Victoria or do other states do the same thing?

For related posts see:

This answer relates to Victoria but the answer will be similar in all jurisdictions though in some, an oral authority to a paramedic may be sufficient.

Anyone can administer a drug that has been prescribed for a person (Drugs, Poisons and Controlled Substances Regulations 2017 (Vic) r 7, table cl 8).  If a doctor has prescribed the drug, a paramedic can administer it. 

A medical practitioner can authorise the administration of schedule 4, 8 and 9 drugs (r 78). That authorisation must usually be in writing (r 84) but may be given ‘…verbally to a nurse, registered midwife, pharmacist or registered Aboriginal and Torres Strait Islander health practitioner’ in an emergency. That list does not include a paramedic so for a paramedic the authorisation must be in writing. 

A person who is ‘is assisting in the care of’ the person for whom the drugs have been prescribed or authorised may possess and administer that drug (rr 7 and 103).  That covers the other situations described.  If a doctor or nurse (r 85) authorises the administration of a drug, in writing, then the paramedics ‘assisting in the care of that person’ can administer the drug.  There is no need that the person is a nurse. 

The more complex situation is the VVED. The doctor can authorise the treatment, but the authorisation, at least for sch 4 and 8 drugs, has to be in writing (r 84). Having the authorisation in writing would protect the doctor, the patient and the paramedic. One wouldn’t want a dispute at some future time where there is a disagreement between what the doctor claims they said and what they paramedic claims they heard. What follows is that there needs to be a system where the authorisation can be sent to practitioners in the field either by email or having the AV and the VVED records linked so an entry in one can be seen by a practitioner in the other. 

Alternatively the employers’ CPG’s could provide that a paramedic can deliver an alternative dose after consultation with the VED. A paramedic in Victoria can possess, use and supply sch 2, 3, 4 or 8 poisons in accordance with r 7 cl 1.11 (sch 4 and 8) and the Ambulance Victoria authority for sch 2 and 3 (see Paramedics and drugs – SA and Victoria – a question for my readers (June 11, 2026)).  If the CPGs provide for authorisation by the VED then the delivery of that treatment is part of the lawful practice of their profession. 

Conclusion

There were three scenarios- 

First, a doctor at an urgent care centre prescribes or charts a scheduled drug for a patient, then anyone ‘‘assisting in the care of that person’ can administer the drug. They don’t need to be a nurse.

 Second, contacting VED and getting authorisation to administer drugs outside the AV CPGs will be effective provided the authorisation is in writing or the CPGs themselves allow paramedics to act on that advice.

Finally, the interhospital transfer where drugs are ordered or prescribed. Like the first scenario anyone ‘‘assisting in the care of that person’ can administer the drugs so authorised.

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.