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Oklahoma EMS Face Drug Shortage

A shortage of crucial drugs has led to a national public health concern that is frustrating doctors and could make operating rooms riskier places.

The U.S. Food and Drug Administration, a pharmacist and several anesthesiologists agree it's the worst shortage of critical drugs in many years.

The critical shortages led to a patient waking up during an operation and four patients dying, according to a new national survey of 1,800 health professionals conducted by the nonprofit Institute for Safe Medication Practices. More than one-third of respondents said the drug shortages have led to errors that could have harmed patients.

"It's a real crisis," said Keith Madison, a pharmacist for more than three decades and the director of pharmacy services for Mercy Health Center.

"In all my years, I've never seen the number of recalls and the drug shortages that we've had in the last year. Never. Unprecedented."

Some of the most important drugs in short supply are propofol, succinylcholine and a form of epinephrine. All are common, even crucial, drugs used in operating rooms.

One of the most critical drugs used in hospitals and ambulances is a pre-mixed special dosage syringe of epinephrine.

"It is a mainstay in cardiac arrest," said Dr. Alexander Hannenberg, president of the American Society of Anesthesiologists. "In cardiac arrest, you want to be able to intervene very rapidly."

The drug is a key item on crash carts in Mercy and other hospitals. When a patient goes "code blue," hospital staffers rush the drug-filled crash cart to the bedside to try to restart the patient's heart.

In some emergency incidents, hospital workers have had to stop, dilute the epinephrine and set up the syringe before administering it.

One code-blue patient in an undisclosed city died because the preloaded emergency syringe epinephrine wasn't available.

The preloaded syringes, in low supply because of an unanticipated increase in demand, also are commonly used by doctors to restart the heart after heart surgery, as well as by emergency medical technicians during some emergency runs.

"It is alarming," said Jason Likens, director of clinical services for the Emergency Medical Services Authority.

He said Oklahoma City-area ambulances use 40 to 50 doses of the preloaded epinephrine monthly. He said the ambulance system learned of the shortage about midsummer and stocked up. They're supplied now for many months, he said.

Survey respondents attributed another death to the absence of an antibiotic and two deaths to administering the dosage for morphine when a substitute drug requiring a different dosage had to be administered.

More than 1,000 medical errors and patient problems happened because about 50 drugs became suddenly unavailable, the survey indicates.

An anesthesia called succinylcholine has been in severely short supply for several months, Hannenberg said.

Increased demand and manufacturing delays have been blamed for the shortage. It can so quickly paralyze patients and leave them paralyzed for five minutes or less. Hannenberg said it is used in emergency surgeries and for shock therapy to treat depression.

But doctors are canceling elective shock therapy so the drug can be conserved for emergency surgeries in which the drug allows doctors to insert breathing tubes in patients with obstructed airways, he said.

Propofol is a common anesthetic. In an effort to conserve supplies, a patient received too little and woke up during surgery, according to a survey response. Another patient who received too little sedative bit through her tongue.

Recalls because of quality concerns last year led two propofol makers to shut down production. About the same time, Hannenberg said production issues had arisen for manufacturers of drugs used in place of propofol.

Like other Oklahoma hospitals, St. Anthony Hospital has had significant problems getting propofol, succinylcholine and the special dosage epinephrine, and has used substitutes, said Charles Dreyling, pharmacy director.

Integris Health bought those medications through alternative sources and have sufficient supplies on hand, spokeswoman Brooke Cayot said.


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