Drug shortages for paramedics forces review

Alarmed by drug shortages that could affect the lifesaving efforts of paramedics, a medical board that oversees emergency medical services in Southern Nevada is exploring the possible use of alternative medications, which would require the re-education of rescue personnel.

The board also voted Wednesday night to extend the expiration dates on eight critical drugs, giving them a longer shelf life if new supplies are slow in coming.

Stressing that ambulances remain well-equipped with the drugs long in use by first responders, Dr. David Slattery, chairman of the medical advisory board of the Southern Nevada Health District, said it is being proactive in dealing with a national problem that is affecting both hospitals and emergency medical services.

What makes the situation even more acute when it comes to emergency medicine practiced in the field, Slattery said, is that ambulances don't have the space to carry a number of medications that can basically achieve the same standard of care.

"A hospital can carry alternatives on site that we can't," Slattery said, which he noted makes planning even more essential for emergency medical services. "We're OK right now, but we foresee the possibility of running out of some medications."

The eight drugs that had their shelf life extended for six months by the advisory board are dopamine, a medication used to increase blood pressure; adenosine, a drug used on a heart beating too rapidly; atropine, a medication to increase heart rate; morphine, a pain medication; midazolam, a drug used to combat seizures; magnesium sulfate, a medication often used in problem pregnancies; zofran, an anti-nausea medication; and etomidate, which helps facilitate intubation of a patient.

Though the FDA requires manufacturers to conduct studies to determine the stability and shelf life of their products and to label them accordingly, medical advisory boards can legally extend their expiration dates in the interest of public health, according to Dr. Dale Carrison, head of emergency and chief of staff at University Medical Center.

He said drug suppliers were contacted about the eight drugs and noted that drug expiration dates are generally "very conservative." Notable exceptions include nitroglycerin, liquid antibiotics, and insulin.

What has been widely reported in recent months is that a scarcity of more than 220 medications, caused largely by fewer manufacturers wanting to produce less profitable generics, has meant hospitals have had to rush to find substitute or alterative drugs so that patients can get the treatment they need.

Though area hospitals have had to scramble to find medications through wholesalers or find alternative drugs, none has reported having to stop treatment of patients because of drug shortages.

Only recently, at a February conference of emergency physicians in Dallas, has it come to light that the problem could extend to paramedics.

If drugs do need to be changed, that would result in paramedics being trained in how to give them, said a representative of the AMR ambulance service in Las Vegas.

In 2010, the Institute for Safe Medication Practices reported that two patients in the United States died from the wrong dosage of a substitute for the painkiller morphine. That is one of the drugs that the advisory board said could be in short supply.

Slattery said the medical community does not have a good handle on when, or if, some supplies will dry up.

"I would encourage the people of Las Vegas to get in touch with their congressmen and senators on this issue," he said. "Emergency physicians are already doing so, but the constituents of representatives have a lot of power."

Dr. James J. Augustine, who spoke at the conference of emergency physicians in Dallas, said what makes changing out drugs dangerous for paramedics is that "they've become adjusted to doing one thing" in an emergency where time is of the essence.

He said that if paramedics have to suddenly switch to new drug protocols, "it will only be a matter of time" before a patient is hurt or loses his life.

Carrison shakes his head when he talks about the shortage of inexpensive generic drugs, noting that there is never a shortage of expensive brand name medicines that pharmaceutical companies still have patents on.

"You have to remember they're in the business of making money," he said.

Contact reporter Paul Harasim at pharasim@review journal.com or 702-387-2908.