A broken femur with no pain control. A seizure prolonged for want of Valium. An octogenarian’s nausea unabated for lacking Zofran.
Welcome to EMS vs. the drug shortage. What’s previously bedeviled less populous corners of American healthcare has spread deep and wide into the prehospital world, where accounts like those above are amassing at a disquieting pace. Nearly 16% of respondents to an April NAEMT survey believed they’d seen patients suffer adverse outcomes due to lack of a needed medication.
Beyond EMS, people are dying. At least 15 known deaths in healthcare facilities have been linked to errors associated with recent medication shortages. No one in their right mind thinks that can’t happen to us.
But for EMS, ensuring stable and sufficient supplies of the common, frequently used drugs we’re now jonesing to get seems a long way off.
“A key difference with this crisis, as opposed to some of the low-intensity skirmishes we’ve had with other drugs in the past, is that there doesn’t really seem to be an end in sight this time,” says Eric Epley, executive director of the Southwest Texas Regional Advisory Council (STRAC), which manages emergency and trauma care in a 22-county region that includes San Antonio. “The other times it seemed like there would be some endpoint—‘By mid April we’ll have it solved, and you’ll be back in shape.’ It felt temporary. This time seems like, ‘Yeah, we’re running out, and there’s not going to be a solution.’”
With that, you know there are steps you need to take. You’ve probably acted already to pinch down par levels and find alternative supplies and therapeutic substitutes and other work-arounds for things you can’t get. You’ll need to keep doing that. But there’s other stuff you can and should be doing too, for both the immediate and long terms. We’ve rounded that up in the following guide.
Much will depend on your circumstances, of course—things like state law and the policies of pertinent governing bodies. And we can’t fix the complicated causes of this overnight. But consider this: You’re acting for the long haul. You want to ensure enough drugs into the future. Building long-term resilience isn’t easy, and changing law and policy isn’t fast. But apparently we’re going to have some time.
Best Practices Anytime
Let’s start at the beginning. These are basic measures you may already have taken. Frankly they’re best practices even if your drugs are abundant.
Awareness—There may be, in isolated pockets of good fortune, providers or services not yet touched by the drug shortage. More likely there are some in affected services who aren’t fully aware of its scope and dimensions beyond what’s different in their drug box today. They should be.
“The most important thing you can do is communicate with your staff,” says Scott Matin, vice president of clinical and business services for New Jersey’s Monmouth Ocean Hospital Service Corp. (MONOC), a hospital consortium whose EMS arm fields more than 100 ambulances. “We want to make sure they’re completely aware of the situation. Not to scare anybody, but they need to know there may be a day when there are no substitutes and we can’t get anything from a compounding pharmacy. If everybody understands that, they’ll be more careful about waste and expiration dates and things like that. They’ll have more buy-in. If you don’t really see something as a crisis, you may not work as hard to find solutions and help avoid catastrophe.”
Keep up with what’s short and what else is happening through the FDA (www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm), American Society of Health-System Pharmacists (www.ashp.org/shortages) and Bound Tree (www.boundtree.com).
Know what you use and have—The rate at which your service goes through medications is largely predictable. Past use is a barometer of future use and will tell you how long you can operate with current stocks.