Vending Machines Help Ohio Medics Deal with Drug Shortages

Jackson Township paramedics use UCaplts to cut down on waste and costs


EARL RINEHART, The Columbus Dispatch | | Monday, August 18, 2014

A trip to the vending machine at work has a whole new meaning for Jackson Township paramedics. · The township installed two machines that, instead of chips and soda, dispense drugs and equipment to stock emergency squads. · The machines are one way the township fire department, which serves Grove City and Urbancrest, is dealing with shortages of common drugs and supplies and the resulting cost increases.

The saline solution used to clean wounds and keep patients hydrated once cost $1.25 a bag but now runs as much as $8, Jackson Township Fire Chief Rick Dawson said. The 58 percent increase in spending on medical supplies, from $83,000 in 2011 to $131,000 last year, is one reason the trustees are asking voters in November to increase the fire tax by 3.75 mills -- about $131 per $100,000 of property value for homeowners.

The shortages have several causes, according to the Food and Drug Administration, including quality-control problems and production delays. American pharmaceutical companies have lost interest in making older drugs and fluids that are staples of emergency care and instead concentrate on more-lucrative products.

The FDA, which updates a drug-shortage database on its website, said it can't require a company to keep making a drug it wants to discontinue. Some are being obtained from foreign companies and carry a premium price tag.

Saline and dilutions of dextrose, which is used to replenish body fluids and treat insulin shock, often are listed as "currently in shortage" by the FDA.

"So we have to be creative," said Jackson Township Fire Capt. Bill Dolby. "Years ago, we were throwing away $3,000 worth of drugs when they expired at the end of the month."

Now, the vending machines alert paramedics when the stock of a drug or piece of equipment is running low or nearing its expiration date. Items about to expire are returned to the distributor for a credit, and fewer are ordered next time.

"We only throw away a couple of hundred dollars' worth of drugs now," he said.

The machines require a thumbprint, code or key card for a paramedic to select an item. Two paramedics are required to obtain a narcotic. Distributor Bound Tree Medical in Dublin said the vending machines, called UCapIts, start at around $12,000. Other local fire departments with UCapIt machines include Delaware, Jefferson Township, Westerville and Washington Township, which also serves Dublin.

The Columbus Division of Fire doesn't use the vending machines but has a conservation policy to stretch medical supplies, Deputy Chief Jim Davis said. "We go through 80 to

90 liters of saline a day. We have 400 EMS calls a day, and half get an IV of some form."

Paramedics in Columbus and other departments sometimes insert an intravenous needle but don't connect a fluid or drug unless or until the patient needs it.

The shortages don't endanger patients, because there usually is an alternative drug that can be given, said Dr. Robert A. Lowe, a trauma physician at OhioHealth Doctors Hospital.

Paramedics used to replenish their supplies at hospitals after transporting a patient. When fire departments began billing patients they transport, hospitals sold them medical supplies at bulk cost. The FDA banned that practice two years ago, determining that hospitals are "end users" of the drugs they buy, not distributors.

That meant fire departments had to go to the more-expensive open market, even eBay.

Jackson Township trustees were hesitant to seek a new fire levy -- the first in 23 years -- but without it, ever-rising medical equipment and other costs would leave the fire fund with a $400,000 shortfall next year.


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