As a result of a national drug shortage, MONOC and other Paramedic Programs throughout the country are beginning to run out of many of the lifesaving medications that they give every day to ill and injured patients. The first drugs to run out will be those used to stop seizures and those often needed to assist Paramedics in placing an advanced airway in patients unable to breathe adequately on their own. While in many cases there are several medications that can be substituted for one another, unfortunately today’s drug shortage affects entire groups of drugs such as benzodiazepines which are used to stop seizures. The most common benzodiazepines used by Paramedics include intravenous Valium, Versed and Ativan. All of which are in very short supply.
What is the cause of the shortage? It isn’t clear. Some blame the federal regulatory agencies while others blame the manufacturers. According to the American Society of Health-System Pharmacists’ website, some of the reasons stated for shortages include: the drug was discontinued, the company cannot provide a reason for the shortage, the company voluntarily suspended all manufacturing and distribution on a temporary basis for maintenance and requalification of equipment, manufacturing delays and demand exceeding supply due to current market conditions. As of today, there are over 50 emergency medications that are backordered due to the national shortage.
In addition to the concern of simply running out of certain medication, EMS agencies must also deal with how this will affect compliance to state regulations which all New Jersey Paramedic programs musts abide by. To address this concern, MONOC has requested a regulation waiver from the New Jersey Department of Health and Senior Services Office of Emergency Medical Services to allow a Paramedic unit to remain in service even when one has run out of a mandatory medication.
The American College of Emergency Physicians, National Association of EMS Physicians, National Association of EMTs, National Association of EMS Officials and others are working to find solutions. As of March 1, 2012, MONOC has run out of the medications Ativan and Etomidate on more than one of their Paramedic units. For the time being, both drugs are being replaced with Versed until that too is depleted. Solutions are few and far between since manufacturers are giving delivery dates months away or are not even committing to when drugs will become available. While not a fix for all medication shortages, one option for some drugs is accessing the national and state strategic medication stockpiles. This is a daunting task due to the bureaucratic maze that must be navigated. Another is to look to pharmacies that can custom compound medications. While this option is extremely costly, allows for a very limited shelf life, and is only a possibility for certain medications, MONOC is planning on purchasing compounded medications wherever possible. What is clear, however, is that this situation, which affects both Paramedics and hospitals nationwide, will only get worse before it gets better.
MONOC Mobile Health Services is a non-profit hospital cooperative consisting of 16 acute care hospitals located throughout New Jersey. Formed in 1978 MONOC’s mission is to improve health care and reduce costs. MONOC Mobile Health Services is accredited by the Commission on Accreditation of Ambulance Services (CAAS) and employs over 730 employees and operates a fleet of over 100 ambulances. Together this shared services consortium acts as a health care cooperative for these acute care hospitals and over 2.8 million residents that they serve living in more than 1,800 square miles of the Garden State.