In November 2020, the Emergency Medical Assistant Licensing Board (EMALB) provided direction and support with regards to the preparation of medications for deferred, subsequent use.  Medication administration and assistance are permitted under the EMA Regulations, while dispensing is a controlled act performed by various professions under the authority of other statutes and regulations.

Under this guideline, advanced care paramedics (ACPs) are permitted to prepare a palliative care medication for parenteral use and administration by a family member or household caregiver after the paramedic has left the scene.

An ACP with the appropriate license endorsements (Schedule 2, Section 4(b)) is permitted to prepare a palliative care medication for parenteral use and administration by a family member or household caregiver after the paramedic has left the scene under the following conditions:

1. The medication is specified and prepared in accordance to a palliative care management plan developed and authorized by a physician or nurse practitioner; and
2. The medication has already been prescribed to the patient and is in the possession of the patient (i.e., the paramedic is not providing the medication from BCEHS supply); and
3. Authorization from CliniCall has been obtained if the medication is not specified within the Regulation; and
4. The ACP has successfully completed the BCEHS, 'Schedule 2 Endorsement: Palliative Medication,' on the PHSA Learning Hub; and
5. The ACP has received the EMA Regulation Schedule 2, Section 4(b) endorsement for administration of drug therapy on the direct order of a medical practitioner who is designated by BCEHS as a Transport Advisor. 

• Paramedics will complete a full history, obtain a full set of vital signs, and conduct a patient assessment prior to the preparation of palliative medications for administration by a family member or household caregiver.
• Paramedics will complete a full ePCR, documenting the nature of the call, any collaborative care, and ensure that the patient signs the refusal of conveyance or referral of care section (as appropriate). 

Clinical Pathway: Palliative Clinical Pathway