Section 56 Class Exemption for Primary Care Paramedics, Intermediate Care Paramedics, Advanced Care Paramedics and Critical Care Paramedics in Nova Scotia

Pursuant to section 56 of the Controlled Drugs and Substances Act (CDSA), paramedics with the title of Primary Care Paramedic, Intermediate Care Paramedic, Advanced Care Paramedic or Critical Care Paramedic in the province of Nova Scotia are exempted for medical purposes from the application of the following provisions of the CDSA and its regulations:

• - Subsection 4(1) of the CDSA with respect to fentanyl, ketamine, morphine, pethidine and hydromorphone
• - Subsections 5(1) and 5(2) of the CDSA with respect to diazepam, fentanyl, ketamine, lorazepam, midazolam, morphine, pethidine and hydromorphone
• - Subsection 8(1) of the Narcotic Control Regulations with respect to fentanyl, ketamine, morphine, pethidine and hydromorphone
• - Subsection 2(1) of the Benzodiazepines and Other Targeted Substances Regulations with respect to diazepam, lorazepam and midazolam

In respect of this exemption,     

• Controlled substance means one of the following substances: diazepam, fentanyl, ketamine, lorazepam, midazolam, morphine, pethidine and hydromorphone.
• Designated Administrator means a person who is in a managerial position and is ultimately responsible for ordering (with the approval of a Medical Oversight Physician), transporting, storing and providing controlled substances for an emergency health service operator contracted by the Nova Scotia Department of Health under the Emergency Health Services Act (Nova Scotia).
• Medical Oversight Physician means a registered practitioner in the province of Nova Scotia who is contracted by the Nova Scotia Department of Health to provide medical direction to paramedics and is responsible for approving orders for controlled substances for an emergency health service operator contracted by the Nova Scotia Department of Health under the Emergency Health Services Act (Nova Scotia), with which he/she is affiliated. 
• Paramedic means a person who is registered by the Nova Scotia Department of Health under the Emergency Health Services Act (Nova Scotia) to practice paramedicine as a Primary Care Paramedic, Intermediate Care Paramedic, Advanced Care Paramedic or Critical Care Paramedic, and who is authorized by the Nova Scotia Department of Health to administer controlled substances as part of the practice of paramedicine.
• Unserviceable controlled substance means a drug product containing a controlled substance that is expired, contaminated, damaged, or any residual controlled substance remaining in a multi-dose vial.

This exemption provides the aforementioned paramedics with the authority to possess, transport, administer and destroy controlled substances when providing pre-hospital care to patients within their scope of practice as set out in relevant policies by the Nova Scotia Department of Health, and subject to the terms and conditions of this exemption.

The exemption is only applicable if the following conditions are met. Paramedics must:

1. Administer controlled substances in accordance with the relevant protocols endorsed by the Nova Scotia Department of Health, or under the direction of a practitioner designated by the Nova Scotia Department of Health;
2. Record all transactions involving controlled substances, i.e., date, name and quantity of controlled substances obtained, administered and returned, and provide such a record to their Designated Administrator for record-keeping purposes;
3. Take necessary steps, in accordance with the policies concerning controlled substances established by the Nova Scotia Department of Health, to ensure the security of the controlled substances on their person and in their ambulance or aircraft;
4. Report immediately to their Designated Administrator when they become aware of any loss or theft of controlled substances in their possession or in their ambulance or aircraft;
5. 1. For paramedics working in ground ambulance services, dispose of any unserviceable  controlled substances in accordance with the guidelines concerning controlled substances established by the Nova Scotia Department of Health with respect to witness and record-keeping;
   2. For paramedics working in air ambulance services, return any unserviceable   controlled substances to the originating hospital pharmacy; and
6. Obtain controlled substances only from the Designated Administrator of the emergency health service operator contracted by the Nova Scotia Department of Health under the Emergency Health Services Act (Nova Scotia), with which they are affiliated.

This exemption will remain in effect until revoked. Failure to comply with the terms and conditions of this exemption may, among other things, result in immediate suspension of this exemption, and ultimately, in its revocation.

Signed for and on behalf of the Minister of Health

Original signed by

Julie Thompson
Director, Office of Controlled Substances
Controlled Substances Directorate
Healthy Environments and Consumer Safety Branch

Effective Date: May 1, 2016