A Drug Shortage You Say? Let’s Blame Someone!

Posted by Patrick Lickiss on Apr 23, 2012 in Current Events, EMS 2.0, General | 0 comments

In news first broken by the First Responders Network, five of the agencies which represent EMS as a whole authored a letter, dated April 15th, to President Barack Obama, Vice President Joe Biden, Secretary of Health and Human Services Kathleen Sebelius and Secretary of Homeland Security Janet Napolitano detailing the predicament placed on EMS by recent drug shortages and requesting immediate action.  The letter from the Emergency Medical Services Labor Alliance, the International Association of Fire Chiefs, the International Association of EMS Chiefs, the National EMS Management Association and the National Association of EMS Physicians is available to read over at FRN.

It’s no secret that drug shortages have hit EMS hard.  The letter cites a report by the IMS Institute for Healthcare Informatics which indicates that 63% of drugs affected by the shortage are concentrated in five treatment categories, three of which affect day-to-day healthcare by EMS.  Compounding the problem is the fact that many of these drugs have only one manufacturer.  The letter calls upon the Federal government to take timely action and to treat the drug shortage as a public health and national security crisis.

WHO’S AT FAULT?!?
Obviously this is a difficult time for EMS.  Our drug formularies are admittedly limited meaning that we have little flexibility when drugs are in short supply.  Take midazolam for example.  From my understanding there is only one generic supplier of injectable midazolam.  That supplier decided to stop making the drug.  Now the cynic in me questions if that has something to do with profitability.  It’s no secret that there is far more money brand name drug production than in generics.  So as a for-profit business, why would a drug company make a product that isn’t profitable?

What about the government?  Drug companies cite federal regulations as the cause of drug shortages.  The government has an obvious role to play since the FDA approves drugs being tested and produced. Maybe they should force companies to make the drugs we need.

I think the true blame lies closer to home, however.  The real culprit was conspicuously left out of the letter to the President.  There is plenty of blame to go around but the lion’s share rests on the shoulders of EMS.

WHAT?

Yup, it’s our fault.  For too long we have focused too narrowly on the medications within our scope of practice.  One of the hallmarks of a good EMT or paramedic has always been flexibility in difficult circumstances by that is rarely applied to pharmocology.  I was extremely impressed when my system put lorazepam in the local scope to combat the midazolam shortage.  But why stop there?  Can’t get morphine?  Carry ketamine.  No epinephrine or amiodarone?  Study the effect on cardiac arrest outcomes without it!  The fact that all of these organizations signed this letter means that labor, management and medical direction are all on board to do something about the shortage.  So DO something.

We need to stop feeling sorry for ourselves and asking the federal government to help us out and start by helping ourselves.  Now I realize that this situation is not without risk.  With drug supplies in flux, we need to go back to the basics to make sure that we don’t make medication errors.  That means studying up on indications, contraindications and mechanism of action.  It also means going through the “six rights” of medication administration every time.  It also means calling and asking for input if you aren’t sure.  What it does though is allow us to expand our practice safely and still provide a high level of care to our patients despite shortages that show no sign of letting up.  It lets us do that without waiting for someone else to bail us out.  The flip side is that it places more responsibility on you as a provider.  Will you rise to that occasion?

What about your system?  Have you changed protocols or practices in response to the drug shortages? Is your system using one of the “compound pharmacies” talked about in the letter?  Let me know in the comments.