Medicine and medicine management in the ambulance

The ambulance is not just transport – it is a mobile emergency clinic with a fixed selection of medicines, which you as an ambulance attendant are trained to administer in a number of defined situations. The right to do so does not follow from your own professional assessment of what is appropriate from situation to situation, but from clear, written guidelines.

§Who sets the framework

Regulation on ambulances and training of ambulance personnel etc. establishes that pharmacology and medicine handling are part of paramedic training. In practice you work according to regional or national prehospital treatment guidelines, which are prepared and approved by the responsible physician for the prehospital area. The guidelines specify exactly what medicine you can give, in what dose, for what condition — and when you should instead contact a doctor or duty center for a specific order.

• 01Treatment guidelines define indication, dosage and contraindications for each drug
• 02Some preparations you can give on your own within the guidance
• 03Others require phone contact with a doctor before you can give them
• 04All medicine administration must be documented in the prehospital patient record with time and dose

§Typical drug groups in the ambulance

§Control, shelf life and cold chain

Medicine in an ambulance is exposed to temperature fluctuations, vibrations and frequent use, and therefore there are fixed routines for checking. You regularly check that no medicines are about to expire, that quantities are correct, and that medicines requiring refrigeration have been stored properly. Especially for strong painkillers, which are subject to controlled substance regulations, stricter requirements apply to storage, locking and counting — typically with requirements that use and stock are checked and countersigned by two people.

§Responsibility and competence go hand in hand

The more experience and further training you have, the broader your delegated authority typically becomes – that's part of the reason why further training to paramedic requires several years of experience as an ambulance worker first. Regardless of level, the same basic principle applies: you can only give the medicine you are specifically trained and authorized for, and you must always be able to explain why you did what you did.

§Side effects and observation after medication

Giving medicine does not stop with the injection or inhalation itself. You must continuously observe the patient for both desired effect and possible side effects — for example whether pain medication affects breathing or whether an allergic reaction returns after epinephrine is given. That observation must continue all the way to the handover so the receiving staff gets a complete picture of how the patient has reacted along the way.

Medicine management is therefore an area where professional pride and humility go hand in hand: you must have confidence in your own competencies within the framework you are trained in, but at the same time always be ready to seek advice when a situation goes beyond what you are authorised to handle alone.

Treatment guidelines are continuously updated as new knowledge and experience emerge, and part of your responsibility as a paramedic is to keep up to date when new versions are released. This is one of the reasons the profession never stops learning — the medicine you gave a couple of years ago is not necessarily the same dose or preparation recommended today.