# EXPIRATION



## Summit (Mar 10, 2005)

Our inventory here is rather tedious, much of it busy work, especially with the amazing amount of extra items on our overstocked rigs and the requirement of writing down expiration dates of all drugs every day whether or not there were calls the previous day or that its the 20th of the month and everything that expired was removed 20 days ago... it can take 1hr+ toy inventory a rig.

Recently, we were asked to check expiration dates on  anything we could find a date on.

We are now replacing angios, ET tubes, ET stylets, NPAs, OPAs, syringes, etc etc that are "expired." Many question this as some of these items in our stocks simply have no expiration dates (probably because they really don't need them). (angios I can see)

Does your service repalce these when they "expire"? Why/Why not?


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## SafetyPro2 (Mar 10, 2005)

Well, the only items from your list that we have are NPAs and OPAs (used to have ET tubes, but no longer). I've never noticed an expiration date on them, but I guess I haven't really looked. We have one of the Engineers who's in charge of EMS inventory and checks out our supply storage at least monthly.

During our weekly checks of the ambulance, the three items we need to check expiration dates on are: 1) saline, 2) oral glucose and 3) AED pads. We do replace those if their past the date.

I'll have to look at the OPAs and NPAs next time to see if they have a date on them.


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## ffemt8978 (Mar 10, 2005)

We just implemented a system to replace expired items.  Our EMS Inventory person goes through periodically and checks the expirations date on items in our storeroom and ambulances.  She then prints up a list for each ambulance of when the items are going to expire (for that ambulance) and tapes it to the back of our clipboards.

When we restock the ambulance, we just update the new expiration dates on that list.


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## TTLWHKR (Mar 10, 2005)

When I did the "big" inventory to make sure we had all the state required items, and did the store room; I noticed that they are putting expiration dates on everything disposable now. I can understand why, but I refuse to throw away an oxygen mask or resuscitator bag b/c the date on the bag says it's expired. And gauze pads have a 2 year date on them, they expire two years from time of purchase usually. Again, I'm not throwing away a dozen cases of gauze sponges that are still sealed, and boxed. That's waste; and since I know the picky EMS inspector will comment on every date...    I cover the dates on gauze sponge boxes, O2 supplies, resus bags, and things of the same nature with "Inspected" stickers, or we have rolls of pre-printed tape with the service name and we will set things out for restock and put the sticker on the package as to what unit it goes to.

Cuts down on waste and unnessary spending.

We also save outdated IV supplies, fluids, airways for training on manikins.


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## Jon (Mar 11, 2005)

My one squad has sterile gloves. All with dates are expired. We don't really care, because we NEVER use them anyway. Maybe if delivering a baby, but remember, in the field sterile is a relative term anyway.

Never seen NPA experiations.

Only reason they would that I can figure is that the STERILE PACKING isn't good for more than a few years.

Other pains in the butt with expirations are:
Hot Packs
Glucose
Charcoal
Ipicac


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## ffemt8978 (Mar 11, 2005)

Don't forget:

AED Pads
3-lead patches
Combitubes
Epi-Pens
EMT Cards


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## Summit (Mar 11, 2005)

> _Originally posted by MedicStudentJon_@Mar 11 2005, 11:55 AM
> * Other pains in the butt with expirations are:
> Hot Packs
> Glucose
> ...


 Hot packs should still work, maybe just not as hot or as long.

How does glucose go bad? Start growin stuff?

You guys stll use charcoal, around here only the clinics and hospitals use it.

I thought ipicac was banned???

------

Well we got our new NPAs to replaced the "expired" ones. The new ones have no expiration dates and aren't in sealed packages... or any kind of package.  :blink:


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## Summit (Mar 11, 2005)

> _Originally posted by ffemt8978_@Mar 11 2005, 12:01 PM
> * Don't forget:
> 
> AED Pads
> ...


 Expired combitube... there goes $80!


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## TTLWHKR (Mar 11, 2005)

> _Originally posted by Summit_@Mar 11 2005, 12:50 PM
> * How does glucose go bad? Start growin stuff?
> 
> You guys stll use charcoal, around here only the clinics and hospitals use it.
> ...


 Ipecac isn't supposed to be used on ambulances b/c of the risk of aspiration; and charcoal is usually something you use after contact w/ poison control or medical command. I've used it twice, and it wasn't pretty. The inside of the ambulance is white, the floor, walls, seats and ceiling-so you can see blood to clean better. It looked like a dalmation turned inside out!

We change out the glucose as per the expiration dates, only b/c that's the rules. But we usually throw a half dozen the the expired ones in first aid kits on the fire apparatus, keep it for another year or so then get rid of it, or use it for EMT class training kits.

As a diabetic myself, I have a box w/ stuff to use in an emergency; I prolly have two dozen tubes of glucose-most are new, but some outdated in 2002 or before. The only difference is the potency changes and the cherry loses its flavor. But as long as the tube is sealed, I don't think it matters.


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## Jon (Mar 11, 2005)

> _Originally posted by Blueeighty8+Mar 11 2005, 03:26 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Blueeighty8 @ Mar 11 2005, 03:26 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Summit_@Mar 11 2005, 12:50 PM
> * How does glucose go bad? Start growin stuff?
> 
> You guys stll use charcoal, around here only the clinics and hospitals use it.
> ...


Ipecac isn't supposed to be used on ambulances b/c of the risk of aspiration; and charcoal is usually something you use after contact w/ poison control or medical command. I've used it twice, and it wasn't pretty. The inside of the ambulance is white, the floor, walls, seats and ceiling-so you can see blood to clean better. It looked like a dalmation turned inside out!

We change out the glucose as per the expiration dates, only b/c that's the rules. But we usually throw a half dozen the the expired ones in first aid kits on the fire apparatus, keep it for another year or so then get rid of it, or use it for EMT class training kits.

As a diabetic myself, I have a box w/ stuff to use in an emergency; I prolly have two dozen tubes of glucose-most are new, but some outdated in 2002 or before. The only difference is the potency changes and the cherry loses its flavor. But as long as the tube is sealed, I don't think it matters. [/b][/quote]
 Everyone around here never got the memo about ipecac. We still religiously replace it when it goes out of date, even though it ain't in the state protocol anymore.

My EMT class all tried 6-month expired glucose. Tasted just as nasty as the ok stuff  .

as for Hot packs, nearest I can figure is that the reaction isn't as good after x time period. Cold packs don't have expirations.  

We still CARRY charcoal. We let the ED give it, hopefully with the assistance of an NG tube     Again, something that stays until expiration, then is replaced.

AED pads - why do they expire? gel loses conductivity i guess.

Jon


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## Summit (Mar 11, 2005)

> _Originally posted by MedicStudentJon_@Mar 11 2005, 04:16 PM
> * AED pads - why do they expire? gel loses conductivity i guess.
> 
> Jon *


 Yep (or the gel dessicates)


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## ffemt8978 (Mar 11, 2005)

> _Originally posted by Summit+Mar 11 2005, 02:30 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Summit @ Mar 11 2005, 02:30 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Mar 11 2005, 04:16 PM
> * AED pads - why do they expire? gel loses conductivity i guess.
> 
> Jon *


Yep (or the gel dessicates) [/b][/quote]
 The more likely reason (IMHO) is the manufacture wants $$$ and doesn't want the liability if they don't work.


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## shorthairedpunk (Mar 12, 2005)

Combitubes do expire, reason being the natural latex rubber that makes the big cuff, as natual rubber degrades, its ability to strech goes away and it also begins to flake, so the cuff will leak, or burst. (BTW it really pisses me off what they charge for them, $43 is the cheapest I can get them)

Instant glucose will degrade and potentially turn into an alcohol containing goo

Gloves that have expiresed will tear and offer absolutey no safety other thana false sense

ipecac depends on your state whether you carry it, but it is a natural oil that could potentially sour

gaze is only bad if the package has yellowed and cracks because that means thats likely what the gauze is doing

The gell on electrodes and AED pads can dry out, even in the sealed pouch, also the adhesive can lose its tackiness or worse degrade and become more tacky, potentially causing skin tears or chemical burns

Hot and cold paks go bad because the lining seperating the two chemicals erodes and they mix slowly on the shelf, then dont work when you need them, they also break open much easier



I was told that there is an equation that pharm. companies use to figure the expirations for their medications, It places the date before the time that the medication is considered unusable to account for the lag in replacement.


Most stuff can be used for training if it expires, and liability is a big reason or companys to put an expiration on their product, not to mention the forced product purchase profits, though most distributors will offer some sort of program for exchanging expired items, just to keep your business on the other crap you buy.

BVMs need replaced because of the material degrading and flaking off that can be aspirated during forced ventilations, not to mention the high risk of the bag tearing, rendering it useless and adding to time.

A good rule of thumb is that anything that is latex, ingested, placed into the airway, injected, required to bend, or a chemical actually needs to be replaced, the rest of it, put the stickers on the dates so you dont get nailed by the a**hole inspector.


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## Jon (Mar 12, 2005)

> _Originally posted by shorthairedpunk_@Mar 12 2005, 04:58 AM
> * I was told that there is an equation that pharm. companies use to figure the expirations for their medications, It places the date before the time that the medication is considered unusable to account for the lag in replacement. *


 My understanding is that some of the Co's ship expired or almost expired meds overseas / to developing countries. That would be why they will replace your expiring meds.

Jon


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## BloodNGlory02 (Mar 15, 2005)

I recently ran across this issue. I happened to check our combitube dates and they all "expired" in 2000. One jr expired in 1997. I replaced them, but no one was aware they were expired or did expire. I guess the latex breaks down after so long thats why theres a date on them.

and after having the airway bag shoved on top of them time after time I can imagine friction breaks them down too


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## kyleybug (Mar 18, 2005)

Hey all, I haven't been in in a while. You all know how it goes too much work not enough free time, makes for great paychecks though!  I just wanted to comment on the truck check off. @ my service it has to be done EVERYDAY on EVERY truck even if you ran out of the truck the previous shift and just did the check off. The State is the reason for it and we all hate it. I keep a cheat sheet of my own for the drugs, I have a few list of a couple trucks that I run out of and just refer to the list when checking off. I do actually do a visual and count the drugs that are needed because there are alot of people @ the service that just flat don't do their job and are too lazy to replace what they use. I laughed @ the AED pads. I came across some on a truck that expired in 1995.......I am not kidding I opened the package and yes they were expired, the gel wasn't even tacky anymore and they wouldn't stick. My partner and I weren't brave enough to see if they would conduct! They aren't on the state check off sheet and that is why they were over looked for so long and they were on what I call "the ghetto cruiser" no one wants to run off of it and I am the one that has now been stuck with it. It is now in speck from front to back and it will stay that way because no one will take it for any runs I am sure....it sucks that bad! I also had BG strips that expired in 1999 on there and as far as the combi tubes I need to check that they will probably be from the 80's   I just wanted to let you all know how EASY you have it that you only have to check the trucks every week or every month and some of you not @ all....wish I was that lucky!


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## Ridryder911 (Dec 4, 2007)

kyleybug said:


> @ my service it has to be done EVERYDAY on EVERY truck even if you ran out of the truck the previous shift and just did the check off. The State is the reason for it and we all hate it.



*Wrong !* You do not do it for the State, you are doing it because it is your job, your responsibility to ensure that the patient will be treated with medications that are not harmful from being expired, having the right piece of equipment and having it operate right. 

Obviously, someone dropped the ball and unfortunately this is *why* the State had to step in. Technically it is negligence, that whom ever worked there or allowed to occur. 

Thank-goodness, you actually performed your job. Shameful that it occurs and that someone in authority has to ensure that we do our job. 

R/r 911


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## BossyCow (Dec 5, 2007)

Our rig check off sheet has a spot for the one doing the check off to write in the date of everything that has an expiration date on it.  That way we know who checked it last and what the date was at the last inventory.  We find lots of stuff outdated, like IV caths, combi-tubes, epi-pens.  It's a pain but lots of what we do needs that kind of attention to detail.


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## medicdan (Dec 5, 2007)

This is a sour note for me as well. At my station here, we often have 5-6 (BLS) ambulances sitting during the day (off duty staff can take them whenever they want, as long as they carry a beeper). Over the past month, there has been a crackdown on "Ezo"-- on properly checking the ambulances.

Ben/Bat Sherut (18-21 y/os who dont go to the army, but do service to the country) and I are responsible for checking all ambulances not on duty (on-duty crews check their own ambs), and the station equipment supervisor sticks "surprises" into the ambulances to make sure they are being checked-- that is, he sticks a gauze pad in that expired in 2003, or causes a leak in the O2 tank that should be caught when checked, etc. He will then check the 
inventory forms (excluding O2 leaks) and make sure that O2 levels are fairly stable over a week, etc. 

Doing a complete check of these ambulances does take about an hour-- because it involved taking every thing out, checking at least six different types of kits-- birth, IV, biohazard, mass casualty, terrorist attack, unstable building, not including our "ambu bag" with BVM, foot suction, BP cuff, cardiopump (the plunger), six different OPA sizes, three different suction catheters, glucometer and too many strips to count, glucogel, aspirin, etc. 

Then our "Baby Ambu bag" with the same, but smaller.

Then the two "Tik Hovesh"-- translated it means "medic's bag" with cravats, T"A, asherman, polidine, tourniquets, etc. 

Then we have to count _ taf aleph _ (T"A, tachboshet aleph, tachboshet beineonei, tachboshet beten), all different types of bandages (sort of like different sized abd dressings)-- with manufacture dates only legible in bright light (I am lucky I work the morning shift), then 6-8 ashermans (big stickers with one-way-valves, the work like 3-way, occlusive dressings). Then we move on to the six types of forms we need to carry-- and their various quantities, then the larger items-- backboard, then we test and check the stretcher (+ 20 sheets + 2 light blankets + 2 heavy blankets), stair-chair, helmets, bullet-proof vests, reflective vests, then at least four liters of water, then oxygen. 

Tomorrow I try to remember to scan in a copy of our inventory sheet-- its crazy. 

The newest craze (starting about a week ago), is that ambulances are not allowed to be overstocked. If there are 11 gauze pads when we need 10, I need to take it out, and put it back in the supply room. WHAT A HEADACHE. 

Two ambulances, particularly, are off-road ambulances, and have not been used on a call for close to two months now. Last week, I complied a list of expiration dates ON EVERYTHING, and figured out what the first to expire will be. I posted this list on the window of the ambulance, yet still have to check everything every day. In fact, the keys do not move between my daily checks. 

I look forward to calls in order to delay or, if I am lucky, put off my inventory until the next morning. 

I agree that it is important to check ambulances daily-- and understand that they are off-duty, but can be called up at any time, for anything, and that they need to be prepared, but this I think is too extreme. Failing an ambulance's inventory inspection because there is one extra gauze pad is excessive. Israelis are know to be terrible at long term planning, but excellent at improvisation, and solving problems in the moment, and this is a step in the right direction for them-- making sure ambulances are ready for the future. 

For the record, MDA is the national ambulance service, and the headquarters set protocols for the entire country. My check of the ambulance at the start of the day is sort of like a state inspection-- I am a representative of MDA making sure that the ambulance is fit to transport the ill-- okay, maybe thats a stretch...

... If only we could get all of the seatbelts to work... well, thats my task for tomorrow.


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## Arkymedic (Dec 5, 2007)

emt-student said:


> This is a sour note for me as well. At my station here, we often have 5-6 (BLS) ambulances sitting during the day (off duty staff can take them whenever they want, as long as they carry a beeper). Over the past month, there has been a crackdown on "Ezo"-- on properly checking the ambulances.
> 
> Ben/Bat Sherut (18-21 y/os who dont go to the army, but do service to the country) and I are responsible for checking all ambulances not on duty (on-duty crews check their own ambs), and the station equipment supervisor sticks "surprises" into the ambulances to make sure they are being checked-- that is, he sticks a gauze pad in that expired in 2003, or causes a leak in the O2 tank that should be caught when checked, etc. He will then check the
> inventory forms (excluding O2 leaks) and make sure that O2 levels are fairly stable over a week, etc.
> ...



In Oklahoma they gig us for too much just as much as they do for too little..never thought I would see the day we had too many IV caths or 4x4s or NRBs and NCs but hey....


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## Arkymedic (Dec 5, 2007)

Summit said:


> Our inventory here is rather tedious, much of it busy work, especially with the amazing amount of extra items on our overstocked rigs and the requirement of writing down expiration dates of all drugs every day whether or not there were calls the previous day or that its the 20th of the month and everything that expired was removed 20 days ago... it can take 1hr+ toy inventory a rig.
> 
> Recently, we were asked to check expiration dates on  anything we could find a date on.
> 
> ...



We do replace them and everything that has expired pretty much goes to the local college EMS program for training use. We learned a lot on our last inspection. For instance a lot of IV start kits now place the expiration date on the inside of the package making it damn near impossible to see. Our state is getting so picky that we had to take our OPA and NPA kits apart and each one has to be in a seperate package or bag. We also had some people that would open up some items (such as combitubes) to make them quicker to get into and they were $$ and had to be removed from service due to packaging not being intact and the sterility compromised.


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## VentMedic (Dec 5, 2007)

You don't want to get caught with expired stuff during a state inspection nor do you want to be caught with using expired devices that could ultimately  affect the patient.  Ex. expired ETT where the cuff has a slow leak and the pt must undergo another intubation 

After we sort out anything that is expired; ETTs, heat packs, catheters, needles, dressings, bandages, non medicated fluids,etc, they get tallied (tax purposes) and donated to animal rescue agencies.  Vet offices must follow the same standards as human medical facilities as far as quality control but do know of rescue agencies that can use these items.   Incidents such as the oil spill by San Francisco a couple weeks ago and their massive cleanup of wildlife required a large amount of supplies for the hundreds of birds and other animals rescued. 

Occasionally a "human rescue" team that provides services may ask for our donations for third world countries where the FDA can't control.  This is assuming our administration have checked their legitimacy  and the supplies are shipped under the guidelines of the law.


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## Summit (Dec 10, 2007)

Amazing resurrection of a 2 year old thread!


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