Purpose
To outline SLSNSW policy and procedure for methoxyflurane use in lifesaving operations.
Policy
Background
Lifesavers/Lifeguards are often primary responders to emergencies where a patient is in significant pain. Some of these incidents occur at relatively isolated locations where paramedic assistance can be some time away. The administration of basic pain management medicine can add value to service provision in some areas where there is proven need.
Introduction
The provision for clubs/services to hold pain management medicine requires adherence to strict NSW Department of Health regulations and SLSNSW approval – specifically related to need, supply, training, storage and auditing/reporting requirements.
Pain Management Medicine Type
The pain management medicine approved for use by NSW Lifesavers and Lifeguards is restricted to methoxyflurane dispensed from an approved inhaler.
Authorised Personnel
Methoxyflurane is to be administered by an authorised person, only for the purpose of emergency first aid in the course of their duties as a member or employee of SLSNSW, in accordance with the protocols issued by SLSNSW and SLSA, and in accordance with the authority issued under the Poisons and Therapeutic Goods Regulation by the NSW Department of Health.
Approval to hold Methoxyflurane
Clubs/services seeking to hold methoxyflurane must complete a ‘SLSNSW Application to Stock Methoxyflurane’ form outlining their desire to obtain and administer methoxyflurane and the proven need and club/service capacity to do so effectively.
Clubs/Services must forward completed application form to Branch for endorsement. Branch must endorse the application before SLSNSW can review the application.
Approval will be subject to the review of the application by a panel made up of the Director of Lifesaving, Lifesaving Manager, Education Manager and Manager Australian Lifeguard Services (NSW).
A set number of units (inhalers) will be approved for a club/service.
Approval considerations will include:
- Distance/average response time to ambulance services – a club/service within a close distance/response time to ambulance services may not be eligible to hold methoxyflurane.
- Club patrol membership size – whether the club/service holds a sufficient number of personnel to make the provision of methoxyflurane effective.
- High incident numbers and frequency of need.
- Personnel qualified in the administration of methoxyflurane.
Training/Personnel Requirements
In accordance with clause 170 of the Poisons and Therapeutic Goods Regulation 2008 (NSW), only a SLSNSW member or employee who meets the following requirements is authorised to administer methoxyflurane for initial pain relief in persons suffering an injury.
Conditions of Authorisation
A SLSNSW member or employee (current/financial), over the age of 18, who holds the following awards:
- First Aid (current)
- SLSA Certificate in Silver Medallion Advanced First Aid (current)
- SLSA Certificate in Advanced Resuscitation Techniques (current)
- SLSA Certificate in Pain Management or equivalent (current) as endorsed by Surf Life Saving New South Wales
Note: equivalent (non-SLS) first aid qualifications will be recognised.
Authorised persons are to be re-accredited to the satisfaction of the SLSNSW Director of Lifesaving at least every two years and documentary evidence of re-accreditation retained by SLSNSW in the authorised person’s service records.
Methoxyflurane Supply
In accordance with the NSW Department of Health authority the supply of methoxyflurane shall be to approved clubs/services with SLSNSW as the only supply agent.
Approved clubs/services shall submit a purchase request on the approved ‘Order Form for Methoxyflurane’ to SLSNSW.
Orders following the initial (first time) supply must be accompanied with a copy of the incident log which resulted in the use of stock.
Reporting (forms/documents)
A ‘Drug Register Logbook’ shall be maintained within the lockable storage cabinet with the supply of methoxyflurane and utilised by the patrol/service captain (who holds the key) to ‘sign-out and sign-in’ the drug when released for patrol duties and log drug use (incident) and resupply.
A ‘Patient Handover Form’ shall be used and completed by the authorised personnel administering the drug. A copy is provided for handover to Ambulance.
A ‘Methoxyflurane Order Form’ shall be submitted to SLSNSW by the club/service wishing to obtain or replenish its stocks of methoxyflurane.
A copy of the relevant ‘incident log’ which gave rise to the need to replenish stocks shall be provided with the ‘Methoxyflurane Order Form’ to SLSNSW.
A copy of the ‘Patient Handover Form’ shall be provided to SLSNSW with the ‘Methoxyflurane Order Form’.
Records relating to the administration and disposition (receipt and supply) of methoxyflurane are to be retained for twelve months.
Storage
Lifesaver/Lifeguard Sites
Methoxyflurane shall be stored in a locked cabinet which is either fixed or not easily moved. Access to the cabinet is via a key or electronic code by the authorised service captain only (Club Captain, Patrol Captain, Lifeguard Supervisor etc.). The register of keys/access shall be maintained by the Club Captain or Lifeguard Supervisor.
During lifesaving duties, the methoxyflurane may be ‘signed out’ from the drug register and placed within the first aid kit or similar so long as it remains under the direct supervision of the authorised lifesaver/lifeguard at all times. At the completion of duties, or when not under the direct supervision of the authorised lifesaver/lifeguard, the methoxyflurane must be signed back in and locked within the designated lockable storage cabinet.
The signing into an out of the drug register should be done by the lifesaver/lifeguard in charge and witnessed by another lifesaver/lifeguard if at all possible.
Vehicles
A vehicle registered to a lifesaving/lifeguard service, which is in use for lifesaving duties, may be used to secure drugs in so long as they are stored in a lockable secure area of the vehicle and the key to that secure area and vehicle remain with the authorised lifeguard/lifesaver who has signed the drugs out from the patrol base/club.
Disposal
All used/empty drug ampoules requiring disposal are to be placed in a ‘sharps container’ and disposed of as per ‘sharps’ requirements. This includes:
- Empty ampoules
All ampoules containing Methoxyflurane requiring disposal must be disposed at a Chemist or Pharmacy and a disposal certificate received. This includes:
- Expired ampoules
- Damaged ampoules (refrain from transporting damaged ampoules which are leaking)
Where Ambulance services attend the incident, request ambulance services to dispose of used ampoules.
Audits
In accordance with the NSW Department of Health authorised clubs/services holding methoxyflurane shall be regularly audited at intervals of not more than two months. This shall be completed in a combination of the following ways:
- Club/Service Captain to maintain internal records of supply/use of methoxyflurane. These are available for audit presentation and inspection at any time. Club Captains shall conduct their own internal checks/audits of supplies and storage requirements regularly.
- SLSNSW shall review each methoxyflurane order against the required copy of the incident log, which generated the need for additional supply.
- SLSNSW (or an authority delegated to by such) shall retain the right to randomly inspect a club/service against the requirements of this SOP and associated regulations.
- Branches and the Australian Lifeguard Service shall include in their annual ‘Gear and Equipment Inspection’ processes inspection/audit of club/service adherence to this SOP and associated regulations.
Misuse/Breach of Requirements
A report of misuse or breach of the regulations/rules within this and associated documents shall result in the immediate suspension of a club/service from utilising methoxyflurane until an investigation is concluded.
Investigation shall be conducted by the Director of Lifesaving, Manager, Lifesaving, Training and Education Manager, and Operations Manager, Australian Lifeguard Service (NSW) (or agent delegated to by such).
Should misuse/breach be proven, the following shall occur:
- The immediate and indefinite suspension of Club/Service from use/stocking of methoxyflurane (or any other pain management medicine).
- Medicine misuse shall be referred to the NSW Police as a criminal matter.
- The individual/s involved shall be immediately suspended from the organisation, pending appearance in front of the State Disciplinary Committee.
- Any individual/s proven to have misused the drug in a non-emergency situation shall at a minimum be suspended from the organisation for a period of 2 seasons. Depending on the scale of misconduct, expulsion from the organisation may be considered.
Administering Medicine (Methoxyflurane)
The administration of methoxyflurane by authorised personnel to a patient shall adhere to the requirements within the SLSA Pain Management Certificate and relevant regulations outlined in this SOP and related regulations/rules.
Methoxyflurane shall not be administered to any patient who intends to transfer themselves to hospital, other medical centres, or none at all. Methoxyflurane shall only be administered where a direct ‘handover’ can be undertaken from Lifesavers/Lifeguards to ambulance/hospital staff.
Administration to a patient is limited to 6ml/day (or 2× 3ml ampules).
In addition:
- Patient Handover Forms shall be maintained with the methoxyflurane and used for any/all incidents where methoxyflurane is administered, with a copy being forwarded to SLSNSW with a copy of the incident log.
- An Incident Log must be completed and submitted to SLSNSW. Ambulance/hospital staff (or equivalent) must be notified during the ‘hand-over’ that the patient has been administered methoxyflurane.
- The name of the patient to whom the drug is administered should also be recorded in the drug register, signed by the administering lifesaver/lifeguard and witnessed by another lifesaver/lifeguard, if at all possible.
Reference
Poisons and Theraputic Goods Regulation 2008 (NSW)
Medicines, Poisons and Theraputic Goods Act 2022 (NSW)
NSW Health