4 Effective Strategies to Cope with Drug Shortages in EMS

Sarah Calams // February 14, 2019

In 2010, pharmaceutical drug shortages began impacting order fulfillment and, as a result, EMS providers’ ability to appropriately care for their patients.

EMS providers experienced an uptick in drug shortages in 2018 after IV fluids went on national shortage and a number of injectables went on long-term back order. Experts indicate that these drug shortages will continue until 2020 and may become the norm going forward. (image/Pixabay)

The explanation for these national shortages varies from quality issues to raw material deficiencies. Unfortunately, nearly a decade later, EMS providers are still dealing with the effects of drug shortages.

In 2018, EMS providers experienced an uptick in shortages after IV fluids went on national shortage. Additionally, a number of Pfizer injectables went on long-term back order. Experts indicate that these drug shortages will continue until 2020, and some even say a certain level of shortages will likely become the norm going forward.

Today, notable items on shortage include:

  • Cefazolin
  • Diazepam
  • Dopamine vials
  • Diltiazem 100mg Add-Vantage vials
  • Epinephrine auto-injectors
  • Ketamine
  • Labetalol

How are the shortages affecting EMS agencies?

A 2017 Institute for Safe Medication Practices survey revealed that 90 percent of respondents increased their inventory and hoarded or rationed their supplies during drug shortages. In December 2018, Bound Tree gathered several of their largest customers to discuss current events – drug shortages being at the top of the list.

Stacey Barksdale Price, pharmaceutical product manager at Bound Tree, and James Augustine, MD, FACEP, an emergency physician and a clinical professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio, led the group discussion. Some of the EMS providers present said they feared the shortage of essential drugs may be viewed by patients and others as providing insufficient care.

“Many hospitals were accustomed to having routine IVs and fluids already started by EMS,” said Brian Collins, CEM EMT-P, an EMS outreach medical coordinator at Cooper University Hospital in Camden, New Jersey. “The shortage of fluids changed the practice of routine fluid maintenance to administering the saline for patients that truly needed fluids for their medical emergency.”

Collins added that once one drug comes back online and is readily available, another shortage is occurring with another drug.

When a shortage does occur, providers may panic by ordering a surplus of supplies. As a result, the supply chain becomes interrupted and full-blown shortages follow. For example, when manufacturers began indicating the shortage of IV fluids, many EMS agencies ordered large volumes, which crippled the system, Barksdale Price said.

The best coping method, she added, is to react as soon as you become aware of a shortage and start planning for alternate protocols.

Strategy 1: Active inventory management

Dr. Augustine shared best practices from the field during the discussion, including active inventory management, protocol changes and packaging.

Developing an active inventory management is key, Augustine said. In addition to tracking each medication, agencies can make a tabled list of their drugs, which should include the shortage status, a therapeutic substitution and a management plan in case of emergency.

For example, if a drug is on back order and Bound Tree is aware of an agency’s alternate therapy, then the supplier can order the substitute drug for that agency.

Agencies need to actively manage existing inventories, like placing drugs that are near their expiration dates in the most likely location where they will be used, instead of tucked away in a less likely area of practice.

Strategy 2: Expiration date awareness

Active inventory management requires all personnel in the department to be aware of expiration dates. Most drugs are stable longer than the dates supplied by the manufacturers, said Augustine, and reconsidering shelf life can help extend supply and reduce waste. But any use of medications beyond posted expiration dates needs to be approved by regulators, and only as a last resort.

In October 2018, the FDA sent out a memo in regard to extending some labeled expiration dates of a handful of Pfizer products “due to the intermittent supply interruptions of sterile water for injection.”

“The extension of expiration dates is huge,” said Augustine.

Strategy 3: Speaking up

Augustine also recommended that agencies expand their protocols to offer diverse options. For example, for drugs that do not have substitutions, start exchanging with hospitals and rationing available supplies of the medication appropriately.

Also, if hospitals are getting access to products when your EMS agency isn’t, alert your suppliers to spark conversations with manufacturers and the FDA.

“The FDA is saying the shortage is getting better, but we’re feeling a lot of pain here in EMS,” Barksdale Price said. “We have to look at the EMS experience differently.”

The federal agency, she added, may not realize that EMS is experiencing the greatest challenge from these shortages. But by continually engaging the FDA, agencies can make their voices heard.

Ultimately, making EMS a top priority for needed medications is key to eliminating the stress drug shortages put on EMS agencies.

“We can all agree that EMS represents the largest part of the market that’s critical to public health,” Barksdale Price said. “We told manufacturers EMS must be No. 1 on your list. It was a light-bulb moment for them – they hadn’t really thought about it.”

Strategy 4: Use color-coding to reduce errors, waste

Last, but certainly not least, agencies can’t forget about proper packaging. One effective strategy is to repackage drugs in color-coded packages based on the drug type. As a result, crews can easily recognize the drugs, which will help reduce the risk of medication errors and waste.

If there are changes, make sure packages are in recognizable forms. Furthermore, as medicines vary, be sure to put the information directly on the package.

Moving forward

As far as dealing with future drug shortages, EMS agencies continue to wonder what’s coming ahead.

“We have developed all these plans and all these workarounds, and we have cooperation between fire, EMS, hospitals and state regulatory agencies,” said Augustine. “We’re sharing best practices, but you always wonder what’s coming next.”

The biggest takeaway from the discussion, however, was the idea of being able to share protocols across agencies. Bound Tree is exploring ways to help agencies share and compare protocols to help spread best practices. The exchange of information is a critical tool when dealing with drug shortages that can make a difference in life-or-death situations.


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