S3 Before Class Activity 2 The Use of Drugs in Prehospital Care

Chapter 13
The use of drugs in pre-hospital care

Ruth Townsend
Learning objectives
After completing this chapter you will:
• Have been introduced to the laws that govern the use of drugs in Australia and
why they exist
• Have an understanding of drug schedules and how they apply to paramedic
practice
• Know how and why drugs should be stored and recorded
• Know how paramedics are authorised to administer drugs and which drugs
they are authorised to administer
• Have a broader understanding of the key issues affecting paramedics and
drugs including self-prescribing and medication administration errors
An introductory case
Multiple patient overdose
A paramedic is called to the scene of a New Year’s Eve party where a multiple
patient overdose is suspected to have taken place. Upon arriving at the scene the
paramedic discovers four people unconscious and suffering respiratory depression
(indicating a potentially life-threatening overdose). The paramedic is told that they
collapsed after trying a new party drug, which is quickly determined to be an
opiate. Because it is New Year’s Eve, emergency services are stretched and
back-up may not arrive in time.
The paramedic might normally administer the drug naloxone in these
circumstances. Typically, a paramedic would only carry two doses of naloxone.
One full dose would be needed to properly treat one person suffering from a
Copyright © 2019. Elsevier Australia. All rights reserved.
narcotic overdose. Half a dose may have a beneficial effect on a single patient,
but may not be enough to successfully counter the respiratory depression.
There are a number of issues to be concerned about and be aware of with regard
to paramedic practice and the regulation of drugs. This chapter will aim to
introduce you to the main areas of the law that are required to be known and
understood. This will assist paramedics to provide safe care to their patients, to
avoid legal liability with regard to the administration of drugs that may harm a
patient and to comply with the stringent laws that apply to drug storage, recording
and administration.
299
Townsend, R., & Luck, M. (2019). Applied paramedic law and ethics : Australia and new zealand. Elsevier Australia.
Created from vu on 2024-05-06 10:03:23.
APPLIED PARAMEDIC LAW AND ETHICS
Introduction
All paramedics administer, or at least come into contact with, medication as an
inherent part of their role. Whether transporting a patient from home to hospital
or back again, part of the role of the paramedic is to ensure that there is a continu-
ity of care with respect to the medications that have been prescribed for and/or
administered to the patient. In the pre-hospital care setting this information can
contribute to the paramedic forming a holistic view of what might be going on
with the patient and certainly assists with collecting a medical history about the
patient. Further to this, it assists paramedics to make informed decisions about the
administration of drugs and what the likely impact of drug administration may be
on the patient.
In addition, there are tight legislative controls around medicines in all states and
territories and the ways in which they are used. Only certain professionals are legally
allowed to prescribe drugs, and distributing medications without legal justification
is a criminal offence. This chapter will allow paramedics to understand the rules
regarding the storage, recording, carrying and administration of medication in
paramedic practice.
Regarding the nomenclature used in this chapter, many ambulance services refer
to the drugs they administer as ‘medicines’, whereas the term ‘drugs’ commonly
refers to street drugs. For the purposes of this chapter, medicines will be referred to
as drugs to remain consistent with the legislation.
The governance of drugs

There are laws regarding the supply and use of medications at state and common-
wealth level in Australia. It is the responsibility of each individual health practitioner
to know, understand and comply with these laws. The use of drugs is governed by
a national classification scheme. Drugs are classified according to the Standard for
the Uniform Scheduling of Drugs and Poisons (SUSDP) published by the National
Drugs and Poisons Schedule Committee established under the Therapeutic Goods
Act 1989 (Cth). The Poisons Standard is a commonwealth instrument that is
designed to promote uniform scheduling of substances and uniform labeling and
packaging requirements throughout Australia.
What are the ‘schedules’ of drugs?

Poisons are classified according to the schedules in which they are included. Table
13.1 provides a general description of the schedules. For the legal definitions,
however, it is necessary to check with each relevant state or territory authority.

The scheduled drugs that paramedics most commonly encounter are: schedule 2
or 3, over-the-counter medications (e.g. paracetamol or ibuprofen); schedule 4,
prescription only medications (e.g. midazolam); schedule 8, controlled drugs (e.g.
morphine); and schedule 7, some farm chemicals (e.g. organophosphates).
Who may possess and supply certain drugs?

The term ‘supply’ in the context of drugs has a specific meaning in law. It effectively
means that a person who is licensed to do so may legally make a drug available to
another person. The licensing of a person to supply obviously imposes restrictions
300
13 The use of drugs in pre-hospital care
Table 13.1 General description of the Poison Schedules

Schedule 1 There are no longer any schedule 1 poisons.
Schedule 2 Pharmacy Medicine – Substances, the safe use of which may require advice
from a pharmacist and which should be available from a pharmacy or, where a
pharmacy service is not available, from a licensed person.
Schedule 3 Pharmacist Only Medicine – Substances, the safe use of which requires
professional advice but which should be available to the public from a pharmacist
without a prescription.
Schedule 4 Prescription Only Medicine, or Prescription Animal Remedy – Substances,
the use or supply of which should be by or on the order of persons permitted
by state or territory legislation to prescribe and should be available from a
pharmacist on prescription.
Schedule 5 Caution – Substances with a low potential for causing harm, the extent of which
can be reduced through the use of appropriate packaging with simple warnings
and safety directions on the label.
Schedule 6 Poison – Substances with a moderate potential for causing harm, the extent
of which can be reduced through the use of distinctive packaging with strong
warnings and safety directions on the label.
Schedule 7 Dangerous Poison – Substances with a high potential for causing harm at low
exposure and which require special precautions during manufacture, handling
or use. These poisons should be available only to specialised or authorised
users who have the skills necessary to handle them safely. Special regulations
restricting their availability, possession, storage or use may apply.
Schedule 8 Controlled Drug – Substances which should be available for use but require
restriction of manufacture, supply, distribution, possession and use to reduce
abuse, misuse and physical or psychological dependence.
Schedule 9 Prohibited Substance – Substances which may be abused or misused, the
manufacture, possession, sale or use of which should be prohibited by law except
when required for medical or scientific research, or for analytical, teaching or
training purposes with approval of Commonwealth and/or state or territory health
authorities.1
on the availability of drugs, and that includes restrictions on the amount of a drug
that may be available to supply. In turn, there are restrictions on who may possess
drugs. In legal terms, ‘possess’ means the physical or manual control of a drug. For
example, under the Poisons Regulation 2008 (Tas), an ambulance officer is legally
authorised to have restricted drugs or narcotics in their possession ‘for the purposes
of his or her profession or employment’. In New South Wales the Poisons and Thera-
peutic Goods Regulation 2008 authorises persons who are employed in the Ambu-
lance Service of NSW as an ambulance officer or as an air ambulance flight nurse
to possess and supply schedule 8 drugs (drugs of addiction). In Victoria, an opera-
tional staff member within the meaning of the Ambulance Services Act 1986 is
authorised to use those Schedule 4 poisons or Schedule 8 poisons listed in the health
301
Table 13.2 Legislation on possession and supply of drugs

State/Territory Act
ACT Drugs of Dependence Act 1989; Drugs of Dependence Regulation 2005;
Medicines, Poisons and Therapeutic Goods Regulation 2008 Schedule 1 Part 1.1
NSW Poisons and Therapeutic Goods Act 1966; Poisons and Therapeutic Goods
Regulation 2002 cl 101
NT Poisons and Dangerous Drugs Act 1983 s43; Poisons and Dangerous Drugs
Regulations 2004
Qld Health (Drugs and Poisons) Regulations 1996 s66
SA Controlled Substances Act 1984; Controlled Substances (Poisons) Regulations
1996; Controlled Substances (Prohibited Substances) Regulations 2000; Drugs
Act 1908
Tas Poisons Regulations 2008 s9(d)
Vic Drugs, Poisons and Controlled Substances Act 1981; Drugs, Poisons and
Controlled Substances Regulations 1995 Column 1, Column 2, Part 2 10
WA Poisons Act 1964; Poisons Regulations 1965 s40, s42
services permit held by that ambulance service. In South Australia, the penalties for
the unauthorised prescribing or administering of a drug are heavy with a fine of
$10,000 or a custodial sentence of 2 years. In Western Australia, a person is autho-
rised to possess schedule 4 and schedule 8 drugs with the permission of the chief
executive officer of the Health Service. Table 13.2 outlines the laws with respect to
the possession and supply of drugs that are relevant for paramedics.
The Health (Drugs and Poisons) Regulation 1996 (Qld) states that ambulance
officers are authorised to obtain, possess or administer the drugs benztropine,
frusemide, haloperidol, hydrocortisone, metoclopramide, promethazine and the
others listed in a clinical protocol approved by the Queensland Ambulance Service
and listed in the appendix to the regulation (see Table 13.3).2
However, the Regulation then sets out some more specific criteria in s66.
66 Queensland Ambulance Service3

1) However, an ambulance officer who is a paramedic 3 (ECP) may administer

a controlled drug to a person only if the officer
a) is working in an ECP area; and
b) is acting on a doctor’s oral or written instruction to administer the drug
to a person.
2) An ambulance officer who is undergoing a certified course of training, upon
the successful completion of which the officer would be authorised to obtain,
possess or administer a controlled drug mentioned in appendix 2A, part 1,
column 1, is authorised to administer the controlled drug to a person under
the supervision of someone who
a) has completed the training; and
302
Table 13.3 Drugs authorised under Queensland legislation for Queensland paramedics
Column 1 Column 2
1AA atropine paramedic 3 (ECP), paramedic 4
1AAA amiodarone paramedic 4
1 benztropine paramedic 3 (ECP), paramedic 4
2 box jellyfish antivenom paramedics 1, 2 and 3, paramedic 3 (ECP), paramedic 4
2A ceftriaxone paramedic 3, paramedic 4
2AA clopidogrel paramedic 4
2B enoxaparin paramedic 4
3 frusemide paramedic 3 (ECP), paramedic 4
4 haloperidol paramedic 3 (ECP), paramedic 4
4A heparin paramedics 3 and 4
5 hydrocortisone paramedic 3 (ECP), paramedic 4
6 lignocaine paramedic 4
7 methoxyflurane paramedics 1, 2 and 3, paramedic 3 (ECP), paramedic 4
8 metoclopramide paramedic 3, paramedic 3 (ECP), paramedic 4
9 midazolam paramedic 3, paramedic 3 (ECP), paramedic 4
10 naloxone paramedic 3, paramedic 3 (ECP), paramedic 4
11 nitrous oxide paramedics 1, 2 and 3, paramedic 3 (ECP), paramedic 4
12 promethazine paramedic 3 (ECP), paramedic 4
12A reteplase paramedic 4
13 salbutamol paramedics 1, 2 and 3, paramedic 3 (ECP), paramedic 4
14 tenecteplase paramedic 4
b) is
i) acting under a clinical practice protocol approved by the Queensland
Ambulance Service; and
ii) working in an ECP area and acting on a doctor’s oral or written instruc-
tion if required by subsection (2).
3) To the extent necessary to perform ambulance duties for the Queensland

Ambulance Service, an isolated practice area paramedic at an isolated practice
area (paramedics) is authorised to
a) obtain a controlled drug; or
b) possess a controlled drug at a place in the isolated practice area (paramed-
ics); or
c) administer or supply a controlled drug to a person
i) on the oral or written instruction of a doctor, nurse practitioner or
physician’s assistant; or
ii) under a drug therapy protocol.
303
In addition to the possession and supply of drugs, there are laws regarding the
storage and recording of restricted drugs.
Storage and recording of drugs

There are strict regulations regarding the way in which some drugs must be stored,
in particular schedule 8 drugs. They are generally required to be kept in a locked
place that disallows access by those unapproved to access, namely, the public.
However, approval can be given by the appropriate state or territory authority for
schedule 8 drugs to be kept in first aid kits or paramedic kits.
All drugs used by an organisation should be accounted for; however, there are
specific legislative requirements for the recording of some drugs on a register.4 For
example, drugs of addiction are required under the Poisons and Therapeutic Goods
Regulation 2008 (NSW) s111 to be kept in a register:
111 Drug registers to be kept
1) A person who has possession of drugs of addiction at any place must keep a
separate register (a “drug register”) at that place.
2) A drug register is to be in the form of a book:
a) that contains consecutively numbered pages, and
b) that is so bound that the pages cannot be removed or replaced without
trace, and
c) that contains provision on each page for the inclusion of the particulars
required to be entered in the book.
3) Separate pages of the register must be used for each drug of addiction, and
for each form and strength of the drug.
4) The Director-General may from time to time approve the keeping of a drug
register in any other form.
Registers are audited and any discrepancies must be accounted for.
There are some aspects of drug registration that are more difficult to manage in
the pre-hospital care environment than the hospital. However, some jurisdictions
legislate for5 and all service procedures have protocols outlining that the administra-
tion of restricted drugs to patients must be witnessed by another person other than
the person administering the drug. This is sometimes difficult if administration is
required en route and the second officer is driving and unable to witness adminis-
tration. There is also the issue of substitution where the prescribed drug is substi-
tuted by another fluid so that an officer can self-administer the restricted substance.
Consider Case 13.1.
What are the issues to consider with ‘drug substitution’?

There are several areas to be concerned about with regard to the substitution of
drugs with water or other fluid. They include the fact that it is a criminal offence
to substitute, which constitutes theft and unauthorised possession and administra-
tion of a restricted substance. In addition, there is a risk to the public that they do
not get the pain relief they require, that they may be at risk of contamination and
harm from a potentially hazardous unknown substance and that they may be treated
by a paramedic who is under the influence of drugs while administering care.6
304
Case 13.1
The drug substitute
You commence work at a new ambulance station and notice the station is lax
with its drug security procedures. You hear a couple of officers talking about
‘drug substitution’. You ask what that means and they explain that some
medications, like the pain reliever fentanyl, are tampered with and ‘substituted
with other fluids’.
What happens if I don’t use all of the schedule 8 drug?

If only part of an ampoule of the drug is used, for example, if pethidine comes in
100-mg ampoules but the patient only requires 75 mg, the remaining 25 mg must
be discarded and recorded as having been discarded in the register. The recording
of this data is necessary so that there is a mechanism available for checking that
drugs are being administered in accordance with legislative intentions.
What happens if I notice a discrepancy?

If a drug of addiction is lost in some way, for example, has been misplaced or incor-
rectly drawn up or the like, a record must be made of this loss. In New South Wales,
there is a statutory requirement that the Director General of Health be notified
immediately if a drug of addiction is stolen or lost.7 This requirement to notify
police and the health department should be set out in each respective ambulance
service’s procedures manual. All drug inventory is subject to auditing, and this is
why it is necessary to keep accurate records of drug use. There have been some
instances where the use and access to drugs has been examined by external authori-
ties. For example, in New South Wales, there was an investigation undertaken by
police with regard to allegations of theft of drugs from the Ambulance Service of
NSW by paramedic employees.6
What if my patient is drug dependent?

It is not infrequent for an ambulance to be called to a patient who is suffering
from a drug addiction and is seeking easy access to a restricted drug. The paramedic
should perform a full patient assessment and never dismiss the complaint of a
patient merely by virtue of the fact that the patient has an addiction. However,
there are laws that prohibit the administration, prescription, selling or supplying
of restricted drugs to people purely for the purposes of supporting their drug
dependency.
Prescribing
The ‘prescription’ of a drug is the authorisation by an authorised person to another
to be supplied a restricted drug. Schedule 4 and schedule 8 drugs require a prescrip-
tion and are consequently referred to as ‘restricted drugs’. In no state or territory
305
are paramedics authorised to prescribe medications. There are specific prohibitions

against the prescription of schedule 8 drugs by anyone other than a doctor, nurse
practitioner, veterinarian or dentist in some jurisdictions. For example, the Victo-
rian Drugs, Poisons and Controlled Substances Regulation 2006 section 25 says:
Persons authorised to write prescriptions
1) A person other than a registered medical practitioner, veterinary practitioner,
dentist or nurse practitioner must not write a prescription for a Schedule
8 poison.
However, paramedics are not required to prescribe drugs, but rather they are
required to administer them.
Medication errors
There is a large body of literature on the ways to manage, and the reason for man-
aging, the adverse events that arise as a result of human error in the delivery of
health care. Medication errors by health practitioners contribute a significant per-
centage to those mistakes that result in harm to the patient.8 A medication error is
defined as:
… any preventable event that may cause or lead to inappropriate medication use or
patient harm while the medication is in the control of the healthcare professional,
patient, or consumer. Such events may be related to professional practice, health care
products, procedures, and systems, including prescribing; order communication;
product labeling, packaging, and nomenclature; compounding; dispensing; distribu-
tion; administration; education; monitoring; and use.9
A study conducted by Vilke et al found that 9% of paramedic respondents admit-

ted to making a medication error in the preceding 12 months.10 Knowledge of
adverse events in health care has led to a redesign of the health care system to allow
for fewer mistakes to be made but also to encourage practitioners to report errors.
The reporting of errors is important, not only so that patients can be made aware
of the potential harms that may have been caused as a result of the error and seek
to have those addressed, but also because it allows for the identification of systems
failures. This, in turn, allows for a redesign of the system in which policies, training,
the environment and even the equipment may be altered to ensure staff are working
in a system that makes it more difficult for them to make mistakes. Lucian Leape11
and others argue that there are a number of factors that contribute to errors being
made, including: working in environments with poor lighting that makes it difficult
to see the medications that are being administered; poor protocols that do not
reflect best practice – for example, adrenaline treatment for anaphylaxis is best
administered via an intramuscular injection rather than intravenously12; poor
equipment – for example, an inappropriately sized syringe for the drawing up and
administration of insulin; poor training that does not provide paramedics with suf-
ficient information to make good clinical decisions – for example, poor medication
calculation skills.13 Leape also argues that another mechanism for limiting medica-
tion error is to involve the patient in the process wherever possible.14 This is
discussed in more detail later on in this chapter.
306
Safety and medication administration

To maximise patient safety and minimise drug administration errors, there are a
number of elements that must be addressed prior to the administration of a drug.
These include gaining the patient’s consent for the drug administration (see the
section ‘Consent’ in Chapter 6, ‘Consent and refusal of treatment’). There are many
occasions where consent is not able to be gained because the patient is unable to
give it, and treatment is required urgently to prevent further harm or to save the
patient’s life. In the case of an emergency where the patient is not competent to
consent and there is no guardian, the drug may be administered. However, where
the patient is competent or there is a guardian present, consent must be sought.
This also involves education and informing the patient about the proposed course
of treatment and the associated benefits and risks of undertaking that treatment.
This requires the paramedic to have a firm knowledge of the range of drugs that
they are authorised to administer and the necessary skills to impart this information
to the patient so that the patient understands it. This process satisfies the legal and
ethical component of autonomy and informed consent, but it also importantly acts
as an additional layer of safety for the patient and the practitioner. For example,
consider Case 13.2.
In this case, the decision by the paramedic to include the patient in the discus-
sion about treatment allowed the paramedic to make a ‘safe’ and informed decision
about treatment.
The five rights of drug administration

Further to involving the patient in a discussion about treatment, you should also
consider the five rights of drug administration, how you will assess, evaluate and
Case 13.2
The safe paramedic
A paramedic arrives on scene to find a 50-year-old male patient having severe
chest pains. The paramedic determines that they should use a glyceryl trinitrate
(GTN) spray, which will lower the patient’s blood pressure and reduce the strain
on the heart.
Before administering this drug, the paramedic realises that she should ask the
patient if he has taken any erectile dysfunction drugs (such as Viagra) in the
previous 24 hours. She explains to him, in a measured and professional manner,
that it is important for him to disclose this, as the drug she would recommend as
treatment for his chest pain may interact with the erectile drug and cause an
adverse reaction (a dangerous drop in blood pressure) that could exacerbate
his dilemma.
The patient responded that he had not had Viagra, and so the paramedic safely
administered the GTN.
307
document the effects of the drug, and how you would respond were you to give a
drug in error or the administration of the drug resulted in an adverse effect.
• Check that you are giving:
- the right patient,
- the right medication, in
- the right dose, at
- the right time, via
- the right route.
• Check that the patient has no allergies to the drug to be administered.
• Consider what an adverse effect of this drug might result in, so that you
are prepared for it; for example, an overdose of a narcotic will require
the quick resuscitation of the patient with naloxone and respiratory
support.15
Each ambulance service will have its own protocols with regard to the safe admin-
istration of medication to a patient and should incorporate risk management sug-
gestions to assist staff to avoid making errors. For example, the Ambulance Service
of NSW provides a list of precautions (see Table 13.4). They also identify the occu-
pational health and safety issues that should be considered to ensure that staff also
remain safe during medication administration.
Assessment and documentation of drug administration

Always ensure documentation of administration including drug given, dose, route,
time given and patient response including any adverse drug reactions. Always ensure
that you have assessed and evaluated the effectiveness of medication administration,
particularly medicines that affect respiratory rate, heart rate, blood pressure, level
of consciousness and blood glucose. The importance of such checks can be illus-
trated by Case 13.3.
Table 13.4 Precautions and OHS issues16

Precautions Name the medication you are about to give and ask whether they
have had it previously and did they have any reactions
Ensure aseptic technique is used at all times
Swab sites, vials and bungs prior to administration
Use ampoule opener with all glass ampoules

Draw up medication with filtered drawing up needle
Apply an approved syringe cap to cover syringe hub between doses to
maintain asepsis
Occupational health Wearing of approved appropriate personal protective equipment
and safety issues during procedure
Do not re-sheath needles
Dispose of sharps into approved sharps containers immediately
Compliance to infection control procedures
Compliance to relevant OH&S and manual handling techniques
308
Case 13.3
The adverse event
A paramedic is called to a patient suffering from an anaphylactic reaction. He
administers adrenaline as per his protocol. The protocol states that the adrenaline
can be given in incremental doses. There is no requirement to check the patient’s
blood pressure in between doses. The patient’s blood pressure rises rapidly and
results in the patient suffering an intracerebral bleed that results in severe
disability.
In this case, a failure to evaluate the effectiveness of the drug in between doses
has led to harm to the patient. The paramedic followed the protocol and could,
therefore, not be found negligent in their treatment of the patient. However, it
could be argued that a foreseeable harm was suffered by the patient because adrena-
line is known to cause a rapid rise in blood pressure. If the paramedic had assessed
the effectiveness of the dose by taking blood pressure measurements in between
doses, the paramedic may have been alerted to the problem prior to it causing
significant damage.
What happens if I give a drug in error?

If a medication administration error occurs, the paramedic should at least undertake
the following:
• Immediately discontinue the medication.
• Treat symptoms of adverse drug reaction (ADR) per protocol.
• Assess for any ADR to the medication including changes in level of
consciousness, allergic reaction.
• Ascertain whether the patient has any known allergy to the medication
given in error.
• Notify the doctor of the medication error, along with any ADR to the
medication.
• Apologise to the patient.
• Document the reaction and response.
Conclusion
Knowledge and understanding of the law with respect to the area of medications is
necessary for the paramedic to ensure that they abide by the rules. The reason for
abiding by the rules with regard to drug possession, supply, storage, recording and
administration goes beyond ensuring that practitioners themselves are safe from
legal action. The reason for abiding by the rules is to ensure that the patient remains
safe. The high rates of harm caused to patients as a result of medication administra-
tion errors emphasise the need to consider the ethical maxim, do no harm, and how
it applies in this area.
309
Review questions
1 What are the most common schedule 4 and schedule 8 drugs used by
paramedics?
2 What are the rules regarding the recording of restricted drugs?
3 Why are the possession and supply of drugs regulated?
4 What is a medication error?
5 What are the elements that should be considered prior to administering a
drug to the patient? (This goes beyond the five rights.)
6 What should you do if you realise that a medication error has been made?
Endnotes
1 Poisons Standard 2010 (Cth) Online. Available: http://www.comlaw.gov.au/Details/
F2011L01612 (accessed 25 September 2011).
2 Health (Drugs and Poisons) Regulations 1996 (Qld) Appendix 2A.
3 Health (Drugs and Poisons) Regulations 1996 (Qld).
4 See also Medicines, Poisons and Therapeutic Goods Regulation 2008 (ACT); Poisons and
Dangerous Drugs Act (NT); Health (Drugs and Poisons) Regulations 1996 (Qld);
Controlled Substances (Poisons) Regulations 1995 (SA); Poisons Regulations 2008 (Tas);
Drugs, Poisons and Controlled Substances Regulations 2006 (Vic); Poisons Regulations
1965 (WA).
5 Medicines, Poisons and Therapeutic Goods Regulation 2008 (ACT) reg 351; Poisons and
Dangerous Drugs Act (NT), s41; Controlled substances (Poisons) Regulations 1995 (SA)
reg 31.
6 Wallace, N (2009) Ambos accused of stealing drugs. Sydney Morning Herald. 12
October 2009; Wallace, N (2010) Ambos slammed over drugs. Sydney Morning
Herald. 23 January 2010.
7 Poisons and Therapeutic Goods Regulation 2008 reg 124.
8 Roughead, L and Semple, S (2009) Medication safety in acute care in Australia:
where are we now? Part 1: a review of the extent and causes of medication problems
2002–2008. Australia and New Zealand Health Policy 6(18).
9 The National Coordinating Council for Medication Error Reporting and Prevention
(2005) The First Ten Years “Defining the Problem and Developing Solutions”, NCC
MERP, United States. Online. Available: http://www.nccmerp.org/pdf/
reportFinal2005-11-29.pdf cited in National Prescribing Service Limited ‘Medication
safety in the community. A review of the literature.’ Department of Health and

Aging. June 2009 viewed December 2011 http://www.nps.org.au/__data/assets/
pdf_file/0008/71675/09060902_Meds_safety_June_2009.pdf (accessed 13 December
2011).
10 Vilke, GM, Tornabene, SV, Stepanski, B et al. (2006) Paramedic self-reported
medication errors. Prehospital Emergency Care 10, pp. 457–462.
11 Leape, LL, Brennan, TA, Laird, N et al. (1991) The nature of adverse events in
hospitalized patients: results of the Harvard Medical Practice Study II. New England
Journal of Medicine 324, pp. 377–384. See also Leape, LL and Berwick, DM (2005)
Five years after ‘To Err Is Human’: what have we learned? Journal of the American
Medical Association 293, pp. 2384–2390.
310
12 Simon, GA, Brown, R, Mullins, J and Gold, MS (2006) Anaphylaxis diagnosis and
treatment. Medical Journal of Australia 185(5), pp. 283–289; Pumphrey, RS (2000)
Lessons for management of anaphylaxis from a study of fatal reactions. Clinical and
Experimental Allergy 30(8), pp. 1144–1150;
13 See also Crossman, M (2009) Technical and environmental impact on medication
error in paramedic practice: a review of causes, consequences and strategies for
prevention. Journal of Emergency Primary Health Care 7(3).
14 See also National Prescribing Service Limited (2009) Medication safety in the
community. A review of the literature. Department of Health and Ageing,
June 2009. Online. Available: http://www.nps.org.au/__data/assets/pdf_
file/0008/71675/09060902_Meds_safety_June_2009.pdf (accessed 13 December
2011).
15 Myers, E (2006) Nurse’s Clinical Guide, 2nd edn. Philadelphia: FA Davis Company.
16 Ambulance Service of NSW (April 2011) Medications and Fluids Pre Administration
Check. Sydney: Australia.
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Chapter 13

The use of drugs in pre-hospital care

The governance of drugs

What are the ‘schedules’ of drugs?

however, it is necessary to check with each relevant state or territory authority.

Who may possess and supply certain drugs?

Table 13.1 General description of the Poison Schedules

Table 13.2 Legislation on possession and supply of drugs

66 Queensland Ambulance Service3

1) However, an ambulance officer who is a paramedic 3 (ECP) may administer

3) To the extent necessary to perform ambulance duties for the Queensland

Storage and recording of drugs

Consider Case 13.1.

What are the issues to consider with ‘drug substitution’?

What happens if I don’t use all of the schedule 8 drug?

What happens if I notice a discrepancy?

What if my patient is drug dependent?

are paramedics authorised to prescribe medications. There are specific prohibitions

A study conducted by Vilke et al found that 9% of paramedic respondents admit-

Safety and medication administration

The five rights of drug administration

Assessment and documentation of drug administration

Table 13.4 Precautions and OHS issues16

Use ampoule opener with all glass ampoules

What happens if I give a drug in error?

safety in the community. A review of the literature.’ Department of Health and

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