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EMS Drug Shortages Discussion Gets Intense at 'Eagle Creek' in Dallas

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EMS Medical Directors from 60 of the largest U.S. population centers and London started Day #2 of their annual “Eagle Creek” Retreat in Dallas, Texas, jumped right into complex and controversial topics early this morning, discussing who, and under what circumstances, patient transport and hospital destinations should and could appropriately occur; and, the continuing, critical drug shortages that exist throughout the United States.

Atlanta Fire Department Medical Director James Augustine, MD, reported that 160 lines of substances (56 medicines) are still in short supply, particularly magnesium sulfate, atropine, epinephrine and dextrose (D50).

The current cost of Glucagon in the U.S. is now outrageously high ($164 per mgs) and is making it cost-prohibitive for EMS agencies. More outrageous is the fact that in London, the cost of Glucagon is just $15.

Acadian Medical Director Chuck Burnell, MD, told the Eagles physicians that the inability of drug companies to keep their reported/anticipated drug shipment dates is adversely impacting EMS agency and medical director planning and drug inventories.

Dr. Augustine noted that rotating drugs into drug boxes that require varying doses can be dangerous and may cause crews to refrain from using them.

Augustine and Craig Manifold, MD, (San Antonio Fire Department Medical Director) recommended that agencies set up systems to allow crews to report medication storage, inventory or administration problems.

Augustine also reported that his agencies and many other Medical Directors are now using active inventory control practices. He said that priorities are now focused on:

  • Protocol changes;
  • Point-of-care;
  • Packaging changes;
  • Sharing of medications (other than controlled substances); and
  • The potential need to allow crews to use medications beyond their package expiration dates in the best interest of the public/patients.

Only seven of the agencies present reported that they are using accredited compounding pharmacies. A PDF copy of Utah's policy on the emergency use of expired medications by EMS agencies can be downloaded by clicking on the link at the bottom of this article.

The two-day closed retreat precedes the annual two-day U.S. Municipalities Medical Directors’ Consortium, Friday-Saturday, February 22-23.

The physicians (“Eagles”) involved in the Eagle Creek Retreat spend two days of intense discussion on the present and future of prehospital medicine and have been credited with moving clinical practice light years ahead of traditional means by their colledtive research, practices and recommendations for change and enhancement.

JEMS Editor-in-Chief A.J. Heightman, a non-physician member of the Eagles group, will continue to post reports on the hot topics being discussed at the Retreat and the Eagles Conference. Stay tuned to jems.com for updates.

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