Drug Shortages and Solutions

[RocketMedic]

I work in a small, steady rural service in New Mexico with a large area and a very large population base, especially over the summer. We are short of the usual meds. We are pushing meds from the reserve boxes to the first line and rationing some meds when non-emergent. As a small system, we're making it.

How is your service managing the shortage?

 

[NomadicMedic]

The same. Zofran and Fentanyl have been the recent shortages.

 

[Aidey]

Poorly. We are out of Ativan, Etomidate and Zofran. We are short on Fentanyl and Mag Sulfate. We've been told to expect rationing and no stock on and off for the next 18 months on those and other meds. We've also ended up with different concentrations/brands of some other drugs. The mag we were able to get in stock now looks exactly like our narcan (which we were super short on last year, along with epi*, succs, ativan, and versed).

There has been some discussion about getting alternative meds, but the local medical directors are concerned about people using drugs they aren't familiar with and possibly aren't as safe. My major concern is that without etomidate or ativan that leaves versed as our only sedative and anti-seizure medication. If we run low on that we are f*cked.




*When we ran short on 1:10,000 epi prefills the ensuing discussing about just using the 1:1000 caused an epic debate.

 

[akflightmedic]

In Florida, several Medical Directors recently got together and authorized meds to be used past expiration date. The directive is if it is not cloudy or have particles/floaters use it.

We all know the debate over arbitrary expiry dates anyways...and there is no proven evidence of meds being bad on that magical date.

I am trying to find a study which was recently done by the US Army which used Atropine from WW II and showed it to be 96% effective.

 

[LifelongEMT]

We get told to "deal" with it. Aint that some ****...

 

[RanchoEMT]

lol it starts again..

 

[Jay77]

Huge shortage of Amiodarone up here in MB. Surprised more people haven't mentioned this one. I can't seem to find the article but I had "heard" one of the largest Amiodarone production lines was closed down for sanitation problems at the plant. Hospitals here are phoning all local medic services trying to get their hands on some.

 

[RanchoEMT]

*When we ran short on 1:10,000 epi prefills the ensuing discussing about just using the 1:1000 caused an epic debate.

on a side note. My medic has drawn a 1:1000 epi vial(1cc), pushed it into a 100ml NS bag and withdrew 10cc of fluid for a 1:10,000 epi solution in a 10cc push. Among other possible variences. Fun stuff.

 

[usalsfyre]

on a side note. My medic has drawn a 1:1000 epi vial(1cc), pushed it into a 100ml NS bag and withdrew 10cc of fluid for a 1:10,000 epi solution in a 10cc push. Among other possible variences. Fun stuff.

That's not 1:10,000, try 1:100,000. Your partner was pushing 100 mcg at a time.

 

[usalsfyre]

We've discussed extending expiration dates and got a firm no from the state. Morphine, fent and Zofran we can't keep around long enough to expire anyway. We use phenagren as an alternative antiemetic and have discussed Dilaudid but are concerned about it for a number of reasons.

Unfortunately the "deal with it" answer is what we're hearing from suppliers.

 

[RanchoEMT]

That's not 1:10,000, try 1:100,000. Your partner was pushing 100 mcg at a time.

Well plus a zero, minus a zero, point being a vial was used. Im sure his math was appropriate.

 

[RanchoEMT]

That's not 1:10,000, try 1:100,000. Your partner was pushing 100 mcg at a time.

How is that 1:100,000 if he's pushing 10cc of it?

 

[Medic Tim]

How is that 1:100,000 if he's pushing 10cc of it?

1 ml of 1:1000 in 9ml NS would give you 1:10 000

 

[Aidey]

The one thing that my employer could do to help is refrigerate the damn ativan, but thus far no one has been able to sort out the logistics to allow it to happen. They firmly refuse to buy in rig locking fridges due to the expense. Also, since every medic is assigned their own drugs there would have to be a refrigerator to lock them in at the station. It would be difficult to arrange it so you only have access to your own drugs unless they separated the ativan from the other controlled meds and had a different accountability system for it.

 

[Aidey]

That's not 1:10,000, try 1:100,000. Your partner was pushing 100 mcg at a time.

Well plus a zero, minus a zero, point being a vial was used. Im sure his math was appropriate.

on a side note. My medic has drawn a 1:1000 epi vial(1cc), pushed it into a 100ml NS bag and withdrew 10cc of fluid for a 1:10,000 epi solution in a 10cc push. Among other possible variences. Fun stuff.

How is that 1:100,000 if he's pushing 10cc of it?

The concentration is the same. 1 ml or 10 ml t is still 1:100 000 concentration

Oh hell no. I refuse to lose any more brain cells to this topic. I can already feel them lining up to jump out of my ears and fall to their deaths.

 

[RanchoEMT]

1 ml of 1:1000 in 9ml NS would give you 1:10 000

And wouldnt u only push 1 ml from your 10ml syringe into the patient for the 1:10,000 dosage???

 

[Medic Tim]

And wouldnt u only push 1 ml from your 10ml syringe into the patient for the 1:10,000 dosage???

1 mg in 1 ml is 1:1000. Add 9 ml NS and it is 1 mg in 10 ml 1:10000

 

[Aidey]

*headdesk*

/repeat

 

[RanchoEMT]

I dont mean to over run the OP with drug calc, for those who want to continue their friday night doing division i'll post a new thread in the EMS section.

 

[RocketMedic]

We have in-truck refrigerators on our first and second-out trucks for all meds. Other. meds are stored in the EMS office in a dedicated refrigerator. That's smart.

We also have the advantage of being hospital-based, which is good for us.