EMS Drug Shortage Survey 1. Please indicate your type of involvement in prehospital patient care. Check all those that Response Response Direct patient care as an EMT or Paramedic answered question skipped question 2. Have you experienced short notice protocol changes due to a lack of availability of medications? Response Response Yes, 1-3 changes. answered question skipped question 3. Have you experienced short notice drug concentration changes due to a lack of availability of medications? Response Response Yes, 1-3 changes. answered question skipped question 4. Have you been unable to administer medications in accordance with protocols due to lack of availability of the medications? Response Response answered question skipped question 5. Have you been instructed to use medications past their expiration date? Response Response answered question skipped question 6. Have you been instructed to use a different medication as a substitute for a medication that was not available? Response Response answered question skipped question 7. Have you had to administer medications in alternative concentrations due to a lack of availability of medications? Response Response answered question skipped question 8. Have you had to administer medications using alternative delivery methods due to a lack of availability of medications? Response Response answered question skipped question 9. Do you believe that any of your patients have experienced an adverse outcome due to the lack of availability of a medication? Response Response answered question skipped question 10. If you answered "Yes" to question #9, please explain. Response answered question skipped question 11. Please share any other comments on the EMS drug shortage issue here. Response answered question skipped question Q1. Please indicate your type of involvement in prehospital patient care. Check all those that apply.
Direct patient care as a Flight Nurse.
As the Support Services Specialist I order all medications and supplies
Q1. Please indicate your type of involvement in prehospital patient care. Check all those that apply.
Manager of Controlled medications fpr the Medical Director
Supply & Equipment Officer for our organization./Purchasing agent. Q1. Please indicate your type of involvement in prehospital patient care. Check all those that apply.
Division Chief - Logistics Fire Department
Q1. Please indicate your type of involvement in prehospital patient care. Check all those that apply. Q1. Please indicate your type of involvement in prehospital patient care. Check all those that apply.
EMS Coordinator/Medical Control Authority
Q10. If you answered "Yes" to question #9, please explain.
an example was when we had solumedrol on back order and had to use
decadron. When giving pt's decadron there is increased pain at the injection siteand when giving it IV pt's have extremity and chest pain.
Unable to medicate for pain due to lack of fentanyl and pt too hypotensive for
morphine. This includes ventilated patients. Therefore, patients are beingparalyzed without proper pain and sedation management due to unavailablemedications.
PO zofran doesn't work in old people as effectively as IV zofran. cardizem
shortage and lopressor substitute with wide range of side- effects
Patients with nausea/vomiting have not been treated due to lack of Zofran.
Poor ability to manage pain. Now there will be a poor ability to mange anxiety.
Not having medications available, pt has suffered.
prolonged seizure due to valium unavailable
Needed the use of Fentanyl and unable to give due to the lack of.
This hinges upon how one defines, "adverse outcome", I suppose. But the
shortage/absence of fentanyl, for example, now results in no pain managementoptions for the patient with either allergies to other medications and/or theconcern for secondary hypotension associated with other narcotic analgesics. Not controlling pain, when it can and should be controlled, results in an adverseoutcome.
This is difficult to tell. Not being able to see a patient's reaction to both the
optimal drug AND the alternative drug, we cannot tell.
Many people have allergies to meds that are an alternative- Morphine vs.
Fentanyl. Also, black boxed drugs like Phernergan are being used in place ofZofran. This makes patient care difficult and does not allow paramedics andEMTs to advocate for our patients.
Valium is longer acting, and we needed to use Versed which is shorter acting,
and therefore needed to give more of Versed over the transport time.
As part of our Chest Pain Protocol we utilize an anti-emetic that is in short
supply. STEMI patients that are nauseated and vomit increase their intrathoracicpressures and cause more distress to infarcted muscle.
Dystonic reactions noted in patients with the use of Droperidol due to lack of
availability of Ondansetron. Benedryl now has to be administered prior toDroperidol in all cases.
Morphine is not as affective as Fentanyl in regards to pain control. Q10. If you answered "Yes" to question #9, please explain.
Personally I have not had any patients that have but I believe this could become
a real issue as more and more drugs become unavailable. I'm not going to say ithasn't happened in our organization because the fentanyl shortage is a problemwhen your patient has an allergy to morphine.
This is a hard question to ask, have we had anyone die no but we have had a
delay in proper treatment due to not having the medication available that wasrequired to treat the patient
Unable to calm a patient down and ended up tubing them. How do you treat a
patient having a grand mal who is allergic to Diazepam and you can not get anyativan.
Unalbel to give pain medications to people who are allergic to morphine and
problems with attempting to RSI pts due to the lack of medications
I do not believe a patient has been harmed but patients have recieved less pain
control and a lower standard of care due to lack of availability of medications.
We have withheld odansetron, magnesium, and morphine in our patients due to
shortages. One of my patients, an asthmatic, was intubated due to magshortages. In my opinion, the mag may have saved that patient a tube, and anextended hospital stay.
Substitute medications are not the same as the first line. Side affects, duration,
and a patients ability to metabolize the substitute medication is totally different.
We are instructed that a patient care is of the highest importance, with patient
comfort being paramount. Several times I have had to tell patients that I amunable to help their discomfort due to a drug shortage. If it was one patient, itwould have been enough. But it's not. It's been many.
intubation without good induction, benzos unavailable for seizures
Increased suffering due to lack of adequate pain management
Unable to stop nausea in 89 y/o female due to no zofran, forced to put CPAP on
frail old male due to lack of Mag Sulfate which worked fine once in hospital afterCPAP was removed
Lacking fentanyl and having to substitute with lower doses of morphine due to
patient with pain but also with respiratory compromise. Have had to limit the useof benzodiazapines for anxiety control in mechanical ventilated patients due tothe fact that is would not be replaced and we need a minimum amount to remainin service.
The biggest change is we have suspended chemical sedation which mean
patients fight more and cause harm to themselves and medics. We can still callin for orders which does allow the most violent patients to be contained. Q10. If you answered "Yes" to question #9, please explain.
When attempting to intubate a patient not uising the proper weight based dose of
Valium is the drug of choice for certain recreational drug overdose and when it is
not available, the second line drug is ineffective and puts the patient and EMSprovider at increased risk for violent behavior
Intubated SOB pt, no mag sulfate for resp distress rx
Yes, medications indicated for their proper use are not available and has
No pain control for broken femur. Severe pain causing Natassia and vomiting
Patients have had more pain due longer in transport due not having pain
Trauma patient received Ms04 for pain which dropped the BP where alternative
pain management of Fentanyl which would not have was not available due toback order issues
Reduction in vasopressin has changed our arrest protocol which I believe has
created an adverse outcome to our cardiac arrest patients.
I do not have any DIRECT knowledge of adverse reaction due to
concentration/med changes. But we are forcing our crews to go outside ofstandard knowledge/practice to treat our patients. Bad stuff is certainlyhappening and going to happen until this is resolved.
Any time you do not administer the second best choice, your patient is suffering.
Patients who are allergic to Morphine have no other options due to the lack of
Not being able to deliver the proper dose or concentration will prevent the proper
effects of the drug to be achieved. This is especially true with pain management.
Many patients have had pain medications that are not potent enough or have
had more side effects due to the primary pain medications being unavailable.
The lack of benzodiazepines is effecting our ability to safely treat patients with
Major airway problems, Head injuries and seizures.
I don't believe some of our patients pain control has been reduced as well with
I've had patients who have had projectile vomiting that could have benefited from
Zofran. I've had seizure patient's who have needed Ativan because theyrespond better to it, then valium or versed
Q10. If you answered "Yes" to question #9, please explain.
Without some of the medications to treat the patients some of them deteriorate
lack of zofran has caused problems when admin of Morphine, or in the presence
Either delay in treatment or lack of treatment until patient could be transported to
appropriate facility with alternative medical resources.
Zofran IV is more effective than Zofran ODT.
Pain management is hurting our patients die to lack of meds. Shortage in almost
all narcotics which hinders patient care especially with RSI and ICU patients onvents. Short HTN meds causing us to use shorter acting meds with more sideeffects.
We have attempted to categorize pain as serious and mild. Although there has
been an emphasis on the "subjective" nature of "Pain" in past years, we havetried to withhold pain meds if there are no observable indications of "actual" pain.
Although Morphine was still available after Fentanyl was unavailable, the
shortage of Benzos have created major patient care issues in our service area
Not able to use Magnesium for patient experiencing difficulty breathing due to
shortage. Using mess could have helped.
Before we could get our alternative protocals approved by the department of
Health, there were some medications that we didn't have and caused a problemwith seizure patients, diabetics, and pain management with others. Some wereallergic to the alternative medications that were available. There came a risk withdiluting some medications and the concentration of the drugs might not alwaysbe be exactly correct when you are having to do it in the field. Also dealing withdrugs that are not as familiar to the Medics as what they have been using on adaily basis for most of their career.
Patients are having to go without receiving drugs due to the fact that we are
currently having to be very selective with drug usage and administer to criticallyill or injured.
Valium has become in very short, supply so due to this shortage rhe pharmacy
only put a small dose in the box without notice and a pt with active seizure I wasunable to get the seizure to stop with dose I had available, the seizure wasstopped at ER and now we carry ativan so this problem dont occur again.
Fentanyl is often tolerated better than Morphine. IV Zofran is often more effective
Patients with dystonic reactions because of no IV zofran for antiemetics, had to
Q10. If you answered "Yes" to question #9, please explain.
The alternative drug is now not available because everyone is switching to it.
Lack of pain medication causes patient's in acute pain to be transported long
Few patients experience the side affect of nasuea with fentanyl. With the
shortage of that drug I am forced to give morphine with seems to make morepatients nauseated. Also our service has experience a shortage of zofran. It hasbeen difficult to control patient's pain with morphine without causing numerousside affects.
Patients with seizures are receiving Versed versus Valium and Valium is a better
drug for the seizure patient not a sedative.
Lack of efficacy and having to use whatever we can get, especially for seizure
two patients needing Brethine, (terbutaline) respiratory failure
had to deal with pain they shouldn't have had, vomited or been nauseous longer
than if medication was there, and sedative assistance was not as favorable withalternatives, thus harder to establish advanced airway and relaxation.
constantly changing concentrations have led to several "close calls" with regard
The lack of Fentanyl availability has reduced the population of patients we are
able to provide pain relief to. We are currently using Morphine as a substitute.
We were unable to get Valium for a period of time and were unable to treat
We currently are not able to restock Fentanyl and those patients that are allergic
to Morphine receive no prehospital pain relief. Very sad to transport a patient inthe back of the ambulance with a femur fracture or long term transport withoutpain relief.
Pain management was not effective. Toradol is not as good as claimed or "just
For instance, the use of one class of antinausea medication may change from an
IV dose to an oral dose as the only alternative - if they are nauseous, they areunable to tolerate the oral medications!
Adverse effect - Continued acute nausea vomiting due to the inability to
administer Zofran which we can no longer obtain.
Dosage errors due to concentration differences with new forms of medications. Q10. If you answered "Yes" to question #9, please explain.
Have had patients experience severe pain from fractures without relief due to
shortage of medication to provide pain relief.
Increased pain & suffering due to lack of Fent. Multiple times in past year.
intubations difficult without versed, lack of valium for seizures
Prolonged time to extubation due to shortages of faster acting sedation meds.
About 3 months ago I had a pt having a massive stemi and all we were out of
morphine so all I could give him was aspirin and nitro. This pt coded on meenroute to the ER. I got him back but I still wonder if he would have ever coded ifhe would have gotten some morphine.
Valium is much more preferred to Versed for the control of seizures,
unfortunately a crew member accidentally overdosed a patient with versed whichis 10 x more powerful and caused respiratory depression to the point in wherethe patient then required intubation and a ventilator. These drug shortages areunacceptable, in the past there has never been this type of drug shortages andthis is harmful to patient care.
Alternate dose has less effect on pt (Zofran). Alternate administration route
slows or decreases drug effectiveness (Zofran, Versead). Different packagingincreases time need for set up (vials & ampules vs luer lock). Some drugs arejust not available to treat different Pt conditions (Mag, EPI).
Sub standard treatment. Unable to provide adequate pain/nausea control. Very
real threat of not being able to treat life threatening seizures. Has not happened,but close.
Pts w/ nausea and vomiting for instatnce cannot get Zofran. No pain managment
drugs being available due to no Fentanyl being available. These shortages allhappen w/ little to no notice and that leaves a lagtime between alternatives beingavailable and protocol changes being made.
Unable to do RSI because of no paralytics cause problems for patient.
When concentration and therefore doses change quickly due to medication
availability medication administration errors will occur. This is not a possibilitybut guaranteed to happen. We are creatures of habit and unless thoroughtraining happens over time to change behavior we will do what we normally do. Patients that require medications we normally have and carry in specific doseseither become difficult to care for as we try to remember and triple checkourselves for proper administration or accidentally revert to what we have donefor 12 years say .
Some patients have had to endure uncomfortable and sometimes painful
procedures due to lack of sedation medications and narcotic pain meds.
N&V pt are not getting the best medication because of allergies or tolerance to
Q10. If you answered "Yes" to question #9, please explain.
Due to these shortages and changes, I have been unable to completely treat my
patient's conditions. Pain management and emesis control being the mostcommon conditions.
unavailability of valium has caused us to use ativan instead and procain is in
short supply but dont use much and the most recent is atomidate
Unable to control actively seizing patients. Unable to control pain.
Increased oain due to movement without appropriate management of pain.
Excessive nausea and vomiting from incredible pain.
Hypotension due to MS vs fentanyl. Delirium due to Demerol vs fentanyl.
Emergence reactions due to ketamine vs amidate.
I myself have not had to do-I do not give meds. The paramedics on the scene
N/V from the lack of Zofran after giving Morphine for a fx
The increased unavailability of antiemetics has caused lack of treatment in
patients complaining of nausea and vomiting. These patients have had to go without treatment sometimes for prolonged periods of transport.
Difficult intubation due to inadequate medication.
An improvised solution is not as good as a planned solution.
Medics not familar with a new or different medication will be less likely to give a
The morphine shortage has caused us to be more subjective in our
thia ia only a NOT YET. I anticipate that the shortage of facilitating medications
for intubation, will present some serious issues.
Because certain medications were not available, I was unable to perform
procedures that I would normally perform. This resulted in patients having to waituntil we brought them into an emergency department to receive what theyneeded. It took my years of critical care training and experience and turned meinto a 1940's era "ambulance (hurst) driver"
No versed available in our EMS region for sedation due to shortage. Unable to
use for long term sedation with intubated and ventilated patients.
Patients that have allergies to, or have a condition that contraindicates the use of
a pain medication such as Morphine, and the patient has a serious injury, we areunable to control their pain due to the shortage of Fentanyl, or evenbenzodiazepines such as Versed. This causes the patient to experience pain fora longer amount of time, thus increasing their heart rate, and respiratory drive. During long transports from facility to level 1 trauma, we have had physicians
Q10. If you answered "Yes" to question #9, please explain.
order a medication prior to transporting, such as Tramadol, and even Dilaudid.
Zofran is a more benign medication than the caustic affects of promethazine.
with the shortage of particular medications used in the treatment for seizures.
the alternatives that have had to be used we've run across issues with thesebeing medications that patients normally use and therefore by using themedications they have and will continue to be less likely to work. causing thepatients seizure to last longer heightening the possibility of permanenteffect/damage or even death.
Hard to treat a comatose diabetic patient without D50. Hard to treat combative
psych patients without Haldol. The latter actually involves rescuer safety.
pregnant female with seizures. No Mag-Sulfa was available due to the shortage.
Child was born pre-maturely at 32 weeks. Overall outcome was good, but I wasunable to control the patients seizure.
but the potential is there and should NOT be
It's not so much that the patient experienced an "adverse" outcome due to the
lack of availability of the medication; rather, we are using alternative medicationsthat may not be as efficacious as the medication normally used (i.e. Valium inlieu of versed for seizures. This requires us to use needles increasing risks toproviders instead of mucosal administration and also requires a higher dose toachieve the same outcome.)
Not real "adverse" but enough for the patient not to have a better outcome. ie.
Zofran is being withheld for more active vomiting patients.
Due to shortages, I am unable to provide the highest quality of care to my
patients. It effects their view of me as a professional and the view of the EMSsystem as a whole.
The first-line choice of anti-convulsives in the local region is diazapam with a
secondary option of midazolam. The optional drug allowed under regionalprotocol is lorazapam. Diazapam was not available, midazolam was notsuccessful and lorazapam was not available. The seizure, status epilepticus,remained uncontrolled pre-hospital. It was controlled in hospital with diazapam. Q10. If you answered "Yes" to question #9, please explain.
Due to lack of magnesium sulfate an eclampsia patient was not able to receive
the medication needed and although the seizures were able to be controlled withValium, ultimately the condition warranted additional treatment with magnesiumsulfate which was not available due to the shortage. My company has beentrying to order this medication for months with to no avail.
Pain meds,(ie) fentanly,morpine, having to call other squads if they have the
meds and pts have to wait in pain or versed not able to stop seizures becauseshort of versed, or not having the meds in general,waiting several weeks forrestock
no Zofran, pt's continue to throw up, c/o stomach pain from efforts to vomit.
Shortage of morphine doesn't allow pt's with pain to get relief
Pain management has suffered, both in cardiac symptoms and traumatic injuries
Several shortages Fentanyl and etomidate. Pain management issue and
induction for head injured patient Ketamine not a great option
Pts needing doses of sodium bicarb for treatment of various conditions have had
to be transported to an ER 26 miles away before they carn receive theintervention. Making the deterioration of the patient a very plausible possibilityand potentially increasing the percentage of long term deficits and a greaterchance of mortality.
Due to shortages in Valium and Ativan we were instructed to use Versed for
seizures which in some of our Pt's have been proven less than effective. Also,we are unable to treat severe anxiety as Versed was not approved for anxiety inout area. PO Zofran is not as efficient or expedient as IV. Diphenhydramine hasno real alternative in EMS protocol and we had to use it sparingly and onlyadminister it for Anaphelaxis (which several low level reaction turned into)
Status sz pt. That needed diazipam iv had to give midazolam im and had no
We haven't had fentanyl on the ambulances for months, it would have done a lot
better job on my pt with a hip fx instead of a boat load of morphine. Which madeher sick despite the zofran
Pain management and nausea was not able to be addressed
Shortages in Versed, Fentanyl. I'm not exactly sure which other meds we've
been short on but I've witnessed many, "It's on backorder." When we restockfrom the pharmacy. It's crazy. There have been times we have gone withoutand planned to bring in a supervisor rig if we need a med we don't have.
Only having a "set" amount of zofran and fentanyl on an ambulance has led to
only being able to give the patient what I have on my unit, which at times is notenough to deal with the medical issue.
On multiple occasionals paramedics have been unable to control a seizure using
Q10. If you answered "Yes" to question #9, please explain.
Pain medication that was used as a substitute was not effective.
Delay in getting the medication on board since it was a different concentration
that had to be drawn up in a certain way that took what felt like forever
Not receiving respiratory medication that would improve patient outcome.
Pain Management is unable to be addressed appropriatly due to the shortage of
We have run out of pain medication several times, and had to transport patients
with no pain control at all other than positioning.
Without having Ativan or Valium on hand for seizure patients, guess what they
keep seizing!! Hope their brains are not scrambled now.
The biggest problem is due to the lack of morphine.patients remain in severe
pain because we have none and also cardiac patients don't receive the benefit ofit's anxiolytic effect.
Serious brain injury patient, having seizures and no valium to administer to help
Unaware if there have been in adverse reactions.
For pain management, we have nubain. We have had fentynl on order for
several months but it has been backordered for a lengthy amount of time. Wejust want the better pain management drugs for the patients that need it! Also,zofran is gone as well making IM phenergan the only alternative.
Exacerbation of the problem and problem non resolved due to lack of medication
There have been no life-threatening adverse outcomes, however patients
experiencing nausea and vomiting have been unable to receive Zofran as ouragency is running out.
We are currently operating without versed, Valium, magnesium sulfate, and are
running out of morphine and zantac. We have no means of stopping seizures orsedating, an altertnate means of respiratory treatment, and soon no analgesic
Shortages of morphine and zofran. Unable to manage pain and nausea/vomiting
As a Flight Paramedic, I routinely encounter patients who have a legitimate
anxiety related to flying. In the past, we have routinely given these patients asmall dose of lorazepam which made their flight much less stressful. We havenow been instructed to use this drug only for status epilepticus due to theshortage. Stress can have a significant adverse effect on the sick and injured,and this shortage can cause our patients harm. Q10. If you answered "Yes" to question #9, please explain.
I believe my pts have remained in pain due to the shortages
But that doesn't mean this could not happen. All Americans should have the
medications needed to help them if the drug companies are holding back tocreate a supply demand issue or ship the med overseas because they can makemore money then our government needs to step in an stop this practice withheavy fines, taxes and criminal charges. Others over our own people = treason
Our agency currently has zero diazepam and midazolam. We have a few vials
left of lorazepam but once those are gone we will have no medication option forsedation or muscle relaxation. We have been told that once we're out, we're out. I am greatly concerned by this. I am certain that when that happens (which couldbe today) our patients will suffer. This crisis must be fixed.
Shortage of pain mngt drugs, for cardiac patients. In ability to perform MAI due to
In the narcotic realm we carry fentanyl, morphine, and dilaudid. Both fentanyl
and morphine have been backordered causing us to us the stronger dilaudidwhen lesser meds could have been used.
Unable to treat acute conditions or administer medications that can lessen
suffering, ease pain, assist in minimizing symptoms. Additionally, having to usemedications that are different concentrations increases the risk of administrationmistakes.
Seizure activity did not stop until proper med was administered in ER - Valium
Lack of pain meds keep the patients uncomfortable
I feel some patient's havent received the new medications because the
paramedic wasn't as familiar with it and they decided the risks out weighed thebenefit.
I had a patient have hypotension and nausea secondary to morphine
administration due to lack of Fentanyl and then Zofran
Due to lower concentrations of Versed a patient has to have multilple IM
injections versus 1 IM injection. Alternative concnetrations also cause a delay ingiving meds while making sure the dose is proper, the potential is there fro alarge error
Not yet however if it continues, I would see decreased treatment for pain and
Did not have meds needed to stop the seizure due to the shortage.
Lack of Valium lead to patient being restrained and combative with hospital staff
Care was delayed. Additionally, treatment was not definitive.
With the shortage of pain medciations the patient now remains in pain along with
the anxiety that can cause further damage/injury. With the shortage on drugs
Q10. If you answered "Yes" to question #9, please explain.
such as Etomidate we now have an issue with Rapid Sequence Intubation andwhen it needs to be done it needs to be done. It is unethical to not treat thepatient as they need to be due to lack of medication!
Unable to treat pain associated with orthopedic injuries due to unavailability of
As of now, IV zofran has been absent for two months. And more importantly,
fentanyl for three months. We carry morphine but I have had a patient in extremepain who had a bona fide allergy to morphine, but not fentanyl. Not to mentionversed and mag sulfate, both of which don't have an equivalents or eclampsiaand seizure/sedation after RSI. Compounding that problem is the near completeshortage of etomidate for RSI. Our backup for etomidate is versed which ofcourse is nearly gone as well.
We have several patients who only respond to versed and have not had the
Etomidate shortage, substitutions are versed which drastically affects BP
adversely and ketamine which has a wide range of contraindications.
I believe patients may have possibly experienced adverse outcomes due using a
different medication because of a shortage in the primary medication. Due toversed being shorter acting than diazepam, patients may have had additionalseizure activity while en route to the emergency room than they would have ifdiazepam would have been used.
The potential foe errors in dosing when 1:10000 epi shortage. Having to make
due with diluting multi dose vials of epi 1:1000. Along with other medications a dintroducing them with no warning of concentration changes
Don't have the proper drugs to treat patients with.
We are mixing Fentanyl and patients report little change in pain.
No pain control since the opiates were gone.
lorazepam is our biggest issue currently.
Inability to administer IV/IM ondansetron to pts with acute nausea/vomiting
Multi-dose pain control not available and pain recurred - Pre-eclamptic patient
Q11. Please share any other comments on the EMS drug shortage issue here.
There shouldn't be shortages of medications. When people call upon our ems
providers and or emergency department nurses they should be able to recievethe appropriate medicine instead of delays while a substitite can be prepared. Allof healthcare is about providing care to the sick and or injured in a timely andsafe manner.
It is unbelievable this is a reality! Patients are suffering! Imagine if there was no
etomidate, fentanyl, versed available when Sen Gifford was injured. If amember of congress, or one of their family members had the unfortunateexperience of being involved in a trauma and Pre hospital personal were notable to adequately manage their pain and sedation, things might be differenttoday.Lack of pain control has been shown to increase length of hospital stay!
As of this moment, there has been no adverse outcomes, however, should the
shortage continue, this can not be guaranteed.
why are we really having this drug shortage and effecting OUR citizens of United
TDSHS should OK the use of medications up to 6 months past expiration date if
on backorder and service has documentation to prove backorder status
to date have not been ordered to use expired drugs> How ever the state medical
medical director has advised any expired drugs should be maintained and storedin the same maner as in date drugs in the event of changes in policy
This is a national emergency that someone needs to take notice of.
Diazepam and Fentanyl major shortages, waiting 90-120 days. Some D-50
I think we are way behind the ball game on fixing this issue.
Very little explanation has been given. We waited 6 weeks for Versed to arrive
back on our truck. Thank God we didn't need to use it. Multiple other drugs takemonths to recieve back with new dates.
We are getting medications as they are available. We have not had a BIG
problem yet but are close to not having any etomidate at all. We will not usemedications past the expiration date.
Think it's a game the drug manufacturing industry is using to increase the price.
The absence of availability of benzodiazapines (valium, versed, ativan), for
example, has forced those medications to be reserved only for seizure/statusepilepticus patients. This necessarily means they are witheld from other patientsthat could benefit from them. Additionally, most of the medications in shortsupply are cheap, generic medications that are used across the entire spectrumof healthcare and not just one in particular.
This type of problem should not occur. As an EMS Director/Paramedic - I have
enough day-to-day 'stuff'to deal with besides medication shortages. The drug
Q11. Please share any other comments on the EMS drug shortage issue here.
companies need to put 'somepepin their step'. They charge us (the providers)enough money to ensure this doesn't happen.
I refuse to put my patients in danger by using alternative methods I do not
This is absolutely a result of needless bickering between the government and
drug companies. Lets get it together and get it done so the citizens we serveand the customers of the drug makers continue to receive quality care despitethe best efforts of politics to tie our hands! Get off your high horse and move thisforward so our moms and dads, kids and elderly do not suffer any longer.
whats the possibility of using medications past their expiration date, till we get
I believe we need to flex our new muscle at the federal level and get some
awareness. Call it a national public health emergency, call it a threat to nationalsecurity, call it something to keep us from taking steps backward in treatment.
Because we are priviledged enough to carry enough medications and were able
to swap from backup trucks, etc, our patients did not experience any adverseoutcomes but we came terribly close a few times. This may change is we doNOT receive the controlled drugs that we need very, very soon.
While some of the answers above are currently 'No', it is only a matter of time
that these will change to 'Yes'. We have been fortunate to have not had anyadverse outcomes yet. Our supply, while critically low on a few key medications,is not depleted yet to the point of potentially causing harm to the patients. Butthis could be the case any day now.
It would be really ehlpful to have as much advanced notice of an impending
shortage whenever possible - I realize there are a lot of factors, but any infohelps.
In a country as rich as ours we let the pharmaceutical companies decide which
drugs they will and will not produce and it all comes down to how much moneythey will make and that is a colossal crime.
This leads to med errors and is dangerous!
I believe that the government needs to start working toward correcting this
problem and manufacture medications as needed instead of making AmericanCitizens suffer so they can make more money. They should have to come outinto the field and do our jobs for a little while and see what a hardship they arecreating.
Although I did not answer yes to question 9, I feel that the only reason my
patients have not had adverse outcomes due to the shortage is because mycompany has done everything it could to limit the impact and provide us withalternatives. My company has been adversely impacted and I'm sure severalothers have as well due to having to adjust protocols, get different meds, provide
Q11. Please share any other comments on the EMS drug shortage issue here.
education on the new meds to continue to provide proper care for our patients. This shortage is a travesty. The drug companies should be ashamed.
As a small private ambulance company who buys drugs from small pharmacies
or mail order (EMP) we have very little ability to get on priority lists compared tolarger agencies or those that get drugs from their hospitals.
Pharm industry is forcing me to hoard meds, risk over stocking and money loss
for my district. I am surprised patient care has not been more affected than ithas.
The shortage is causing an undue administrative nightmare and a lot of time
spent on looking for the alternatives or advising employees or how to handlesituations when the drug is not available. We also have to explain that it is notthe cost of the drug as some think with the current budget cuts but the fact thatwe cannot get them. I feel like a pill seeker having to shop pharmacies andvenders to see who may have the drug(s) we are looking for.
Would like to understand exactly why we are having drug shortages in this
country. Does not seem that we should experience this.
While the answer to # 9 is currently no; it is not a matter of if but when. It is
inevitable that this will cost lives if not corrected very soon. I am in a situationthat requires me to project usage 3 months out. This is rather impossible as mostof our patients aren't courteous enough to schedule their heart attacks, medicalemergencies and accidents 3 months ahead.
Imagine being 45 minutes on a backboard in the back of an ambulance with
extremity fractures, on Highways that can not be maintained for a smooth rideand now you have N/V to deal with. No pain medication and no nauseamedication. All because someone doesn't make enough money on production ofmedication.
The unavailability of Carpuject has necessitated the need to draw some
medications with a needle. This is more time consuming and presents a greaterrisk of needle sticks. The shortage of things like amiodarone, fentanyl, diazepam,etc. has been an obvious huge problem.
We are having to use medications with a higher incident of injury because some
I just don't understand why or how esp if the hospital are able to get these
Substitute meds must be considered so as to have contigency for unavaliability
of particular meds. Question 7 i find misleading since we have been asked tocarry in different concentration however we don't adminster a differentconcentration since we can assure that we give the proper concentration bydilution. Or, we assure that we read the label to assure proper dosing.
There are higher risks of adverse outcomes due to substitute medications and
alternate concentrations. The drug shortage problem is going to lead toincreased medication errors. Q11. Please share any other comments on the EMS drug shortage issue here.
I have not been aware of any pts. not getting the drug they need yet. As of now
we finally got MS in, but Valium and Fentynal is still out. Epi was short for a whileso we made a different set up to push. D50 was short also and had a differentset up.
I believe that a lot of these medication "shortages" are profit driven by the
pharmaceutical companies. Many of the drugs can be found in generic form,which decreases the companies profit margin. Their goal is to push you to useanother medication which is more expensive.
These Drug Shortages are rediculous. Medications that are needed to treat are
patients appropriately and to relieve there pain are running out and on backorder with no time listed for delivery. This is uncalled for in this day and age. The government needs to step up and take care of the problem.
Whatever the problem is, fix it. Before people do die or have adverse outcomes.
No warnings are our biggest issue. The Rx backorder list is after the fact.
In EMS, you do the best you can for each patient given what you have to work
with. You very quickly learn to adapt, but it is very frustrating to be forced tocompromise on something so basic as medications for our patient's well being.
One possible solution may be to expand our formularies locally, to give us
options. Ie) If we have morphine and fentanyl on our trucks, when there's amorphine shortage, fewer people suffer, because there exists a readyalternative. We need to be progressive and cover our bases. NREMT andNAEMT should consider lobbying local agencies as well as the fed, in theinterests of better patient care for all.
Our Patients deserve the best available treatment. So what works should be
The DEA and Texas DPS have been of little to no assistance during this drug
People need to learn to read labels. People also need to understand
pharmacology to the extent that they formulate an alternative patient care plan toaccommodate what drugs they have. I understand this may not be possible in allcases, but I'm talking about "oh no I had to treat my seizure with Valium insteadof Versed."
With this shortage, we have been forced to carry meds past their expiration date
and alternate concentrations. This is DANGEROUS! Too many chances tomake a mistake in dosages since one of our ambulances may have a differentconcentration than the next. Our personnel operate off of different ambulancesfrom day to day.
This problem is becoming a circus for those that need them for patient care.
It's intolerable. There's not that many meds we give. The pharmacies and drug
Q11. Please share any other comments on the EMS drug shortage issue here.
Presently, we've had to substitute morphine for fentanyl for the past 6 months
and we are alternately unable to obtain lorazepam and midazolam.
Although we have not experienced any problems as yet, I sure it will come. We
are a small volunteer one ambulance service and do not use that many drugsregularly, however, several of our volunteers also work in a hospital setting andthe shortages are becoming crucial in the rural hospitals. For example, in theone I work in, we are not able to get Tordal, Stadol, Visteril is iffy, Morphine ison again off again, and there are others.
This shortage is outrageous. These medications are vital to provide care for the
public, who count on us every day to be equipped with the necessary items to beable to provide exceptional care when valley upon. It is unacceptable that thesemedications are unavailable. It is the responsibility of our lawmakers to enactpolicy and legislation so that this type of crisis is not allowed to occur ever again. The safety of America's people, both rich and poor, is in jeopardy if this crisis isnot resolved immediately.
to date at different jobs, I have been short the following meds; Zofran, morphine,
Per Question 9, Adverse outcomes no, not getting the right/most appropriate
medication yes. Also we are told by one state agency that if our medicaldirectors advise us to administer expired medications we are in the clear andthen the state medical board over doctors puts out a notice 2 weeks later thatadvised doctors that administering or delegating the administration of an expiredmedication will get them reprimanded by the state medical board.
I don't believe any of our patients have experienced adverse outcomes as of yet.
I DO believe it is only a matter of time as some alternative medications arebarely suitable as substitutes.
It's getting very tough to manage some of the critical patients that we transport
daily with these shortages. When you an intermediate analgesic like morphineon back order status and your service only carries morphine it creates issues. My 911 service wound up adding fentanyl to are arsenal of meds. But we havesome medics that are reluctant to use it due to unfamilarity and differences inpotency. Then there is the need for rebolussing during lengthy transports. Asecond service I work for carries Dilaudid, Morphine, and Fentanyl. It's thoughthe Morphine isn't as needed there, it is a good intermediate analgesic, and veryhandy. The lack of availability of promethizine as an antiemitic is alsofrustrating. Though Zofran works for 60% of my patients, the other 40% it eitherdoesn't work or is contraindicated. So yes. this is having an impact.
As for questio 9,10. We have been able to barely get by. We havent ran into the
problem of not being able to treat our patients. It is getting very close to that now. I believe we will run out before we can be restocked. I also firm belive it will havean adverse effect on patients that won't rteceive the proper medications as theyneed it.
We are a low call volume service that has been able to work around the
shortages with extra effort on our part. We are only able to do this because weare small and do not need the quantities that larger services require. However
Q11. Please share any other comments on the EMS drug shortage issue here.
the longer this goes on the more issues were are incuring.I feel for the largerservices that have not been able to adapt due to their call volume and higheruseages of these medication and fear that we will soon fall victim to the samesituation. Which as we all know will adversely impact our patient care.
Currently the medication shortages have not impacted our ability to provide for
the needs of our patients. There is a significant potential (impending) for impactto our service area.
It seems the shortage issues have increased over the past couple of years and
I'm not sure why. This problems can become more problematic as timeprogresses
Most shortages are caused by reduce production not increased need. We are at
the mercy of the pharmaceutical companies and their decisions on whether acertain drug is economically feasible to continue to produce.
Medications not being available in the "normal" doses/concentrations requires
update training that for large organizations is difficult to get to all of the medics. Also, being told to use expired medication is not a solution to shortage problems. If there were a negative outcome after giving expired medications or not beingable to follow protocol because we don't have the medication necessary to doso, I see providers, affiliates, and Medical Directors opening themselves up forliability issues.
It is my opinion that this problem has many causes - one in particular is
unreasonable government rules and regulations.
These shortages are a product of corporate greed and needs to be stopped by
It is good that we are anticipating these shortages and that we are developing
plans and changing protocols to address, such as the recent PAI changes.
I truly just don't see how this happens on medications that are always used. Is it
for a price increase? Just thoughts.
It is, as always, about the money! The drug companies get millions of federal
dollars from the government in monies, incentives and tax breaks for variousthings. Make them start paying there way! Require the companies to make thegeneric and cheap drugs that we are running out of.
It's been a tough road the last few years just trying to keep ahead of the curve on
shortages. Operationally this has meant an increase in risk for our agencyinmedication errors and a large amouint of time lost in meetings, protocolrewrites, Special Orders to crews to change practices. If we continue down thispath, I cn only foresee more issues with patient care. We've managed to dodgebullets with a proactive approach but options are running out and patient carewill begin to suffer. Not a good thing when you are reponsible for first responsein health care. Q11. Please share any other comments on the EMS drug shortage issue here.
The availability of drugs in the proper doses or delivery route is critical for EMS
services. Many of the drugs need to be drawn up instead of pre-packaged bristajets. This delays care for the patients. Alternatives are out there but theavailability is still hard reaching.
EMS Staff are poorly trained to deal with drug shortages. We have always
operated under a very simple approach to medication administration, almostalways getting the same drug in the same packaging at the same concentration. We must do a better job of preparing our people to be more fault tolerant topackaging and concentration changes.
The deal is this. If I had a status epilepticus patient right now we do not have
valium. We also cannot get Versed. We are trying to get drugs made from aconpound pharmacy but they expire very rapidly between 30 - 90 days so this isoutrageously expensive for extra purchasing then the disposal cost. This needsto be fixed. Personally I feel that its probably over legislation that caused thisproblem in the first place. When this country would finally learn that we aresinking this nation with over legislation and over taxation is killing us. Heypharmacy companys the DEA wants you to jump through 80,000 hoops to make20 cents a dosage unit. Wonder why companys decide its not worth it. A fifthgrader could figure that out.
We are having a terrible time getting medications needed to run our organization
I believe that drug "shortages" are due to greed and this greed is going to cost
someone their life when a life-saving drug is on short or no supply.
The fact that most of this, I am told, is driven because these medications don't
make the drug companies a whole lot of money is nauseating. If they had towatch their grandmother writhe in pain because there was no medication to giveher for her broken hip I bet they would change their methods- or maybe not.
It is very difficult for our personnel to have any consistency when each new duty
day they are seeing protocol and medication changes. Enough is enough, havewe forgotten what we are all here to do? Taking care of our citizens are ournumber priority and it makes this hard job even harder when we face nationwidedrug shortages.
I believe this shortage is caused by the drug manufacturers greed. They can not
make the billions of dollars so they create the shortage to drive up the prices.
Medicine has advanced so much in the EMS field, and now we can not help
because we can not get the tools(medicine) we need. It is not fair to theproviders or the patients.
This has been a very difficult time for EMS management, the impact on field ops
units are 10 fold. I can only imagine the possibility of using the wrong dosage orconcentration because the scene was hectic and the PM used their "standard"dose when in fact the concentration was different for this particular drug.
It's time that patients lives take precedence over the pharmaceutical companys'
wallets. The back order needs to end ASAP. Q11. Please share any other comments on the EMS drug shortage issue here.
We have been blessed with a great drug rep. who advised the supply clerk of
upcoming shortages and have been able to obtain adequate stock. Ourdepartment has a lower call volume and was therefore not impacted as much.
Although we are a small agency with less than 2000 patient contacts a year
total, the drug shortages have placed a considerable burden on theadministrative side by havingto jump through hoops and searching far and wideto obtain some medications. The next medication that we will have to gothropugh an extensive search for is Amidate. Again this issue jhas notyeteffected the patient but we are rolling our dice.
Our patients are being effected by these problems. Its amazing the hospital
system still has access to them but EMS doesn't. WE need to act now so ourpatients don't continue to suffer.
The potential for medication administration errors is compounded expotentially
with the current trend of changing concentration and/or actual medication almoston a daily basis. Street Paramedics do not have the luxury of multiple levels ofverification.
One of these days a Politican is going to need a med that we are in shortage of
and maybe then this BS will be over and FDA will ease up some on themanufactures.
Challenging. Sometimes frightening not knowing how long and far reaching this
Most of these medications are generics. If they were brand name only, the
manifacturers would gladly keep production up!
I've had 3 different Morphine Sulfate concentrations over the past 3 days:
My service is relatively small compared to some as we average 4,500 calls a
year. There are medications that we have used that the pharacy cannot replacedue to the shortage, but we carry at least two of each drug. So far, we have nothad to give alternative drugs or change protocol, yet. Our time will come like ithas for so many other services as some units are not carrying multiples afteradministering a drug needed and not being able to replace it. I sincerely hopethis does not get to the point of affecting vital patient care.
We have developed alternative protocols, e.g. dosing regimens for ativan versus
versed, in anticipation of shortages.
Unable to substitute meds due to state regulations.
My agency has been lucky, but our drug supplies are running out.
How can this great nation have a drug shortage??? Yes, we want safe
medications but to what end do we allow government red tape control freeenterprize? Our Pt's need help now, not 10 days or 2 months from now when the
Q11. Please share any other comments on the EMS drug shortage issue here.
medications are available. Lighten up a little. Old standerds are not always bad. I'm 50 years old and did just fine with the old standars.
I have spent literally hours trying to order and then negotiate quantities of drugs
from multiple suppliers. Our biggest issue has been pain managementmedication and sedatives. Additionally, we have been without MagnesiumSulfate for three months. Patient care has been affected mainly by withholdingchemical restraint measures.
We have had no adverse events, but care has not been optimal, especially in
terms of pain control. We are critically short on Fentanyl, Magnesium Sulfate,and Midazolam, and short on Zofran and Morphine. The extra hours spentaltering protocols, shopping among pharmacies, and breaking orders intosmaller, fillable amounts has consumed resources that could better be spent oneducation and supervising patient care.
Any assistance would be appreciated to address this issue for pre-hospital.
Drug shortages continue to wreak havoc on EMS personnel trying to provide
best patient care. To continually worry about calculations due to changes inconcentration or administration routes places the Paramedic and patient at risk
I am wondering how much reserve stocking is going on Nationwide within EMS
We are about 3 vials away from not having any benzodiazepines with which to
treat status seizures. I truly don't know what I'm going to have my medics dowhen this happens and fear for the safety of my patients as a result. The amountof time that I'm spending on rewriting protocols to adjust for alternative drugs isamazing and keeping me from doing an awful lot of other tasks. This is a HUGEissue.
pain meds are a big issue, pt's are being told that there are no more ingredients
to make them. we are told to use versed for seizures instead of valium oradivan.
We have multiple shortages that will be coming in the next few months if
absolutely no excuse to not have needed medications on the ambulance.
Please hold the FDA and the drug makers accountable for this issue. No one
else is to blame. Because I use "just in time" as a cost saving measure does notmean that my issue is the problem. Even using that system I still have backorders from 9 months ago.
This is a shortage experienced not only by EMS, but by hospitals and clinics all
across the nation. Very little attention has been given to this serious issue.
We have incurred in creased costs due to the Med shortages without a change
Q11. Please share any other comments on the EMS drug shortage issue here.
in our reimbursements from Medicare or Medicaid. We are on a very tight budgetalready that the increased cost have required our department to decreaseservice to our patients.
It is disturbing that raw products is available to make these medications, but
makers refuse to produce them because of cost associated with what the FDA issaying needs to occur before production can begin. I understand why themakers are doing what they are doing, however, FDA needs to considers theend result of the patients needing these medications.
This shortage issue has required a large amount of time and expense to
administer, and has great potential for negative patient outcome. Thus far, ouragency has been able to find the same concentrations however the packaginghas changed several times. We have also had to resort to compounding, whichhas a much shorter shelf life. We have found ourselves almost out of stock, butmanage to get lucky often. I could go on and on, but I'm sure you already knowmost all the issues. Lastly, the increased costs is out of controll!!!!. My co-workers just love listening to me while I'm trying to work dope deals. I'm alwayslooking to get "my fix".
Using different concentrations will increase risk of medication errors.
I am looking at extending the expiration as a means to avoid treatment omission
We have BLA & ILS meds only (no paramedics), and no prehospital med
shortages. Yes shortages in hospital, e.g. no Versed/midazolam.
Not only does this shortage create issues with patient care, protocols, it also cost
us more money because we are having to spend extra time searching for thedrug we need.
In my opinion, the national focus is on the drugs for cancer treatment or some
other treatment for a disease that brings in mega bucks for the drug companiesand is effecting just a small fraction of the population. In EMS we areexperiencing shortages of drug and medications that cost less than $1 a doseand are needed to treat perhaps the most common life-threatening conditionsthat we, in EMS try to manage.I receive a weekly report on what drugs are onbackorder from my vendors and they reveal shortages ofMorphine,Fentanyl,Midazlam, Mag-Sulfate,Lidocaine, Versed, and Ketamine. This is a big problem for us in EMS. We are trying to treat children and the elderyfor falls and traumatic injuries and may not have the medications on board tomanage their excruciating pain from the fractued femurs,fractured hips, andarms. It is most definitely a major and a growing problem for us in EMS.
There have been increased pain and suffering from lack of analgesics. Valium
has been the most difficult for us to deal with as other injectablebenzodiazepines options need refrigerated of were not approved for treatment ofseizures by the FDA. With the different concentration it takes to keeppharmaceuticals in stock, it has increased our risk for dosage errors.
Cost of alternative drugs are often greater than that of origianl drugs. In an
industry that is facing many declines in reimbursment, this rising cost has an
Q11. Please share any other comments on the EMS drug shortage issue here.
adverse affect on providing patinet care.
It is what it is, and I would just like to know that expectations are lowered by all
I feel the shortage is an attempt to drive up the cost of medication!
The shortage has also drove the cost up for EMS Providers to purchase what is
needed to properly care for our patients.
i truly feel that things will continue to degrade as epdemic continues due to the
fact that we, as ems, do not ever get the recognition that we deserve. If thehospitals are in short supply of necessary and lifesaving drugs, then we mostdefinetly are the worse off.
Drug shortages for EMS and ERs is unexceptible. Thank you for taking on this
Difficulty in obtaining Zofran causes patients with nausea to go untreated.
We needed to purchase compounded medication at a very expensive price with
a very short expiration date in order to have critical medication available forpatient care.
It is a sad commentary on our health-care system when it is to the point that
medications cannot be obtained in a timely manner. It makes it worse, too, inthat the alternative concentrations we were forced to change to results in more ofthe drug wasted due to single-dose usage requirments.
This is getting out of hand. I don't know who all to blame but I believe that there
is plenty of blame to go around. The patient are the one's suffering and no oneseems to care. Hopefully things will change and the government and the drugcompanies will step and do there part. If not then the healthcare industry needsto send a clear message this fall.
The last drugs to be shorted are medications used in emergency medicine. This
following drugs unable to obtain - fentanyl any form, Brethine, Versed, Mag.
The shortages create great confusion for the EMS sytem. When a drug becomes
unavailable, great efforts are spend locating any stock that can be found. Thenthe search for alternatives begins. When an alternative is found, the crews mustbe trained on the new drug. In South Florida, our biggest issue is withbenzodiazapines.
We currently are using Morphine and do not have a alternative analgesic if the
pt. is allergic to to MS. Our other medication is Fentanyl that has beenunavailable for months.
More times you have to put interim treatment guidelines in place more likely an
error with bad outcome will occur. We've been lucky so far. Q11. Please share any other comments on the EMS drug shortage issue here.
We cannot effectively treat our patients without the propper medication!
The amount of drugs that agencies can not get is growing and making it
extremely difficult to treat patients appropriately. Something needs to be doneimmediate to make these drugs available.
Our pharmacy has reported getting low on several medications but it has not
been to the point of changing prtocol or having any adverse effects on patientcare. We have identified back-up medications if we have to use them; but evensome of them are in short supply. I guess we will cross that bridge when wecome to it. Are you going to send out a report from this survey to give us ideason how to best handle this situation? Maybe the services who have notexperienced this yet will get some tips from those who have. Thanks
Pharmaceutical companies should not be allowed to abruptly discontinue
manufacturing medications. I have been a practicing paramedic for 18 yearsand never in my career have we had to deal with a drug shortage as broad andalarming as the current shortage. I feel that the FDA did not think this onethrough and the pharmaceutical companies are only concerned with their bottomline. Meanwhile, we are caught in the cross fire and no one so far is being heldaccountable for this. While it has not happened here yet, I am sure that thereare numerous advserse outcomes as a result of this shortage, not to mentionthat patients are at risk for not receiveing pain management in the prehospitalfield because there are no narcotics available to give them. As a supervisor ithas occurred to me that rationing the pain medications is definately an optionuntil the medications are no longer on backorder. Heads should roll over thisone!
This issue has become one of life and death. We are being forced to make
serious concessions due to a lack of supply. It is only a matter of time beforethis will be a direct factor in the mortality of patients.
Quit shipping Meds to 3rd world countries when we need them here
It make consistancy in training and patient care difficult
It doesn't make sense why the FDA isn't extending expiration dates for critical life
sustaining medications similar to what they have done with Antiviral and SNSmedications. It doesn't make sense that EMS providers are disposing ofmedications due to expiration dates, that were good the day before, to then findout that they can't receive a replacement due to medication shortage.
Presently receive drugs through hospital Shortages noted and have been able to
Lasix had to use Bumex Diazepam had to use Versed
WHY? Other countries don't have this problem!
We have not had an adverse event yet but this has just started for our area.
On several occasions in the past few months we have had difficulty obtaining
Q11. Please share any other comments on the EMS drug shortage issue here.
From discussions with our Medical control Director and liason the problem is
expected to become much worse before it gets better. Hospitals are sufferingfrom these same issues!
I find it hard to fathom that in this day and age that the phamaceutical companies
can not keep up with the demands of daily used drugs. They should have yearlyprojections of usage and adjust accordingly. The shortages are not new marketdrugs, they are industry wide standard drugs. It makes you wonder if the thephamaceutical companies are more focused on the new generation of overpriced drugs rather than these lower priced drugs that we need daily.
We have been unable to get anything to replace the drug that is used for seizure
patients. We have no alternative medication for field use on these patients.
With benzodiazepenes forcast as shortly being unavailable, we will not be able
to treat seizures, agitation, RSI our patients, or keep them sedated. We cannottreat pain pharmacologically or nausea. Crews cannot keep up with protoco;changes and it seems the County is shortsighted in anticipating shortages.
THis shortage has compromised our ability to provide the proper and consistant
patient care that our community has come to expect. We are here for thecommunity and if we cant make them comfortable when they are in distress, itcompromises their outcome and it will have an effect on our service
We are a small agency with minimal inventory and find it very difficult to keep our
inventory up to date in a cost effective manner.
This needs to be addressed as soon as possible or patient care will be greatly
we are not able to use the present AHA changes in ACLS because of the lack of
obtaing amiordorone in pre hospital doses
We are being hardest hit on Fentanyl, Morphine, Magnesium and at one point
it seems that the hospitals have plenty of the drugs we need and yet our pts
have to suffer due to the lack of drugs that we have or have run out of making uslook like the one who are the incompetent paramedics and the er is the savinggrace of medicine people are starting to say they should just try to drivethemselves to the er once again instead of calling 911 this is not helping pt careone bit it is accually a delay in the tx of the pts we serve every day
State of Arkansas has a "must carry" list of medications, Some have been in the
shortage and have affected some services from being in compliance withamounts and accepted administration methods.
IV Benzodiazepines & Furosemide are our main issues. We need these issues
corrected as soon as possible to avoid medication errors due to changes inconcentrations of medication available. Thank You. Q11. Please share any other comments on the EMS drug shortage issue here.
In NYS only EMT-CC or Paramedics are allowed to administer medications. This
is a very select group in Suffolk County NY EMT-B's are not even allowed to getGlucose Levels as this is considered an invaseive act that can only be done byEMT-CC's or Paramedics. This has been under testing only in one area of thecounty and they have just started another research program that is suppose toallow EMT-B's administer NARCAN via Nasal application but their is alwayssome shortage and as a EMT-B and 2Lt. on the the ambulance I would receivenotificatiions of drug shortages for one reason or another either from the countyor our supplier. this was never a problem for me but for the EMT-CC's. I belongto a volunteer FD ambulance.
FIX IT NOW! We have been lucky and have an agreement with our local
hospital. But without them we would have had to change numerous protocols. FIX IT NOW!
Please fix this problem. It is not fair to our patients that they have to go thru this
This is becoming increasingly disturbing. It is causing stress about our ability to
deliver care to the standards we have established.
We have had to use Ativan for siezures instead of Valium due to shortage. Also
we have had to do additional training to make staff aware of different volume fordose and method of delivery to avoid medication erros for pts.
We are having a very hard time with our controlled meds being unavailable.
Each time we change a drug or concentration we have to change protocols,medical director signatures are needed, new DEA forms are needed, training indispensing meds is required, and field training is required.
The drug companies should be producing these drugs more quickly instead of
While nothing serious has happened yet, the situation is still ripe for problems.
We are just starting to have problems with rapid sequence intubation drugs, epi1:1000 anaphylaxis, and valium. It is only a matter of time.
It is not just the drug shortage effecting us, but equipment shortages as well. We
have been informed of a shortage of vital capnography equipment that allows usto monitor EtCO2 during intubation. Since capnography has become to goldstandard during intubation, this can seriously compromise patient outcomeshould a tube be incorrectly inserted.
more questions will be answered "yes" in the near future
We do have some options, but changeing the concentrations in the protocols
and expecting all medics to suddenly be able to adapt to the change - isunreasonable and potentially dangerous. We need more consistency in thesupply of these commonly used medications!
Shortage in medications are not involving uncommon pre-hospital one's, but the
more commonly used one's. Then when they become available the prices seemto inflate rapidly. Hard to believe that dextrose, epinephrine and Lorazepam are
Q11. Please share any other comments on the EMS drug shortage issue here.
We have been working on a state level to come up with solutions from many
different angles.too many to list. I would be glad to discuss in a forum or oneon one. Chuck Burnell, MD (337)291-1555.
absolutely appaling that congress does not care for the citizens that elected
Hardest drugs at this time for us to obtain are Morphine, Demerol, and valium.
Pain management is a huge priority. Very unsatisfied about this.
Call volume and large internal stocks have allowed us to continue business as
normal. However it is impossible to get Valium , morphine or versed
Confusion in medication dosage due to the changes of concerntration. I feel that
It is really scary to think that EMS providers and emergency departments are not
able to take care of patients to the best of their ability due to medications notbeing available. I know of one ED that has had to use alternative medications forRSI and another ED that can't get medications that we have on our trucks! Whatwould the drug manufacturers and members of legislature think if they or thereloved one couldn't get proper care due to a medication shortage? Last year wehad to use an epi we had to mix ourselves during cardiac arrest due to ampulesbeing unavailable!
Feel like Obamacare is having desired outcome as the US sinks into third world
I answered no to #8 and #9 but it is only a matter of time until the answer
We are a very large system (140K transports per year) and have expended a lot
of time and energy in our efforts to address drug shortage issues. Because ofthat, we've been very lucky and now, with the exception of fentanyl and magsulfate, up to at least 6 month supplies of our medications. Our number 1 priorityin examining alternative concentrations/formulations/formats has been patientsafety. We've had to spread orders across multiple vendors, deal directly withmanufacturers when permitted, and access compounding companies foressential drugs. The latter results in paying from 2 to 4 times as much as usualfor a drug and is complicated by mandatory 6 month expiration dates, but hasbeen a virtual lifesaver for us.
If the shortage continues it is only a matter of time before we do have a bad
outcome becasue we do not have the medications we need in the field.
This shortage is ridiculous and hurtful to the public.
Tell the drug companies their lack of action is hurting people and decreasing the
Q11. Please share any other comments on the EMS drug shortage issue here.
effectiveness of our EMS system nation wide
I have been more judicious with use of certain medications, knowing there is a
shortage. For example, I will use a sedative, Ativan, instead of a sedativehypnotic, Versed. Now, Ativan is short too. We are also short on painmedications and have changed our patient care guidelines multiple times. Luckily, Ketamine is still available. When we experience shortage of Ketamineand Etomidate, patients will surely suffer the consequences. We need drugs thatpromote cardiac stability in patients with risk for hypotension. If Ketamine andEtomidate remain in short supply, patients will have negative outcomes. Thanksfor listening! Aaron Friel, Life Flight Network Clinical Educator.
I am an EMT, so I do not administer medication.
Unacceptable, period and the lawmakers and manufactures lives can be directly
affected if they fall in need of emergency care
everytime drugs are ordered lately something new is backordered. sometimes
these have very long delivery dates if they even have one.
I have not yet experienced any of the questions asked above but due to our
protocols we are going to need to have a similar medication available to us whenand if this happens, and have our protocols meet that situation. such as usingthe drug ativan due to the shortage of valium.
This is for question #9. It is only a matter of time before there is a bad outcome.
We are running out of meds and dont have any on hand restock. W e are veryrural and never know when there will be multiple calls and lack of restock.
The fact that patient care is being negatively affected due to pharm. companies
trying to gouge prices is totally unacceptable and any deaths that WILL followshould be criminal.
One asspect that needs to be addressed is the hording of the medications by so
called "Brown Market" compainies. Many of these companies are getting someform of insider information that allows them to buy up complete lots ofmedications with the knowledge that there will be a shortfall due to productioncutbacks coming up. I don't have a cyrstal ball but they sure seem to have one. These companies are selling back meds w/ up to 4,000% mark-ups. I have seenvery few articles out there bringing this "legal" practice to the forefront. There isprofitering being done here. According to one article I read many of thesecompanies operate out of Florida due to it's weak consumer protection laws. Somuch for the idea that without government regulation people and companies willstill always do the right thing.
I'm not sure of the reason for the drug shortage but since the country is in such
disaray at this time I'm not suprised. The government officials need to step upand look at what is happening to this country and fix it so we can provide thebest care possible to those patrons that voted them into their respectivegovernmental positions. The US can be short in alot of areas but medications isnot acceptable. Q11. Please share any other comments on the EMS drug shortage issue here.
this is all a matter of the drug companies squeezing america.for more money
I am continually amazed that we are experiencing medication shortages in this
era of lightening fast communication. The fact that life altering medications areunavailable is utterly facinating to me.
We are having to carry different volumes and concentrations of the same
medications on some of the ambulances. We have lost uniformity and aregreatly concerned about administering an inappropriate dosage.
This needs to be corrected as soon as possible since we are almost all of all of
I believe this is a contrived shortage on the part of drug manufacturers to drive
the price of medications up. This is certainly true of IV Fentanyl which has comeoff of patent protection and we now have to new forms of the medication whichare under patent protection.
so far the only medication I know there is a shortage of is valium.
This very simply is an unacceptable situation. While of government is wasting
billions of dollars fighting wars they have completly forgotten about theirresponsibilty to the american public
Directly affecting pt care. This is nonsense
It is very hard to take care of patients with out the needed medications.
changes in concentrations, are potential for mistakes increasing.
Seems to me that the drug companies only want the supply low so the demand
is high and they can charge us more for what we really need.
The issue of administering out dated meds came up in a recent meeting and if
we found ourselved in a situation where that was our only choice, my medicaldirector must give permission.
1. At my place of employment we have been instructed not to administer certain
medications unless absolutely necessary. 2. Getting certain medicationsreplaced at the local ER has become difficult.
I receive expired medications from various ambulance providers (public and
private) for training use at our Paramedic Program. Efficiency in ordering is aserious problem also since I receive overflow of atropine, lidocaine, 14/16 gaugeangiocaths, epinephrine multi dose vials, epinephrine 1:10000 preloads,furosemide, oxytocin, diphenhydramine and other equipment and supplies thathave expired. I am fortunate to have them for practice, but sometimes there is somuch that I have to turn them away. Ordering efficiency is a PROBLEM. Q11. Please share any other comments on the EMS drug shortage issue here.
The Paramedics are not pharmacists and at risk of licensure?
This undermines our effectiveness and public/professional appearance in what
The issue has caused much frustration in a profession that already can be quite
stressful. Month to month changes with drugs and doses is a danger to patients!
The lack of benzodiazepines has not yet affected me personally. But the day will
come when a seizure, combative, or patient needing sedation will come and I willhave no option for treatment as some of my other co-workers have had to do.
Protocol changes were to change order or order of preference for certain pain
medications to preserve current stock.
In the field time is everything, When having to always find a substitute or the
same drug coming in many different containers the opportunity for errorincreases.
My patients havent had any adverse outcomes yet but Im sure it will if we have
to continue to play around with other medications we are not very familiar withand plus most of these interact with more medications. I cant believe we are inshortage of medications that help people and saves lives. It makes you thinkabout ethics and morales.I think we need to get back to doing whats rightand not what will make us more money.
Our country has typically enjoyed a wealth of resources until recently. Shortages
are occurring at many levels, but healthcare should be one of the last areas tofeel the impact. The lack od appropriate medications jeopardizes the health andwell-being of citizens across a broad spectrum of clinc and community basedmedicine, pre-hospital care and the inpatient environment with the hospitalsetting. It is imperative that meds are readily available to treat and resolvecritical, life threatening diseases or events.
I wouldn't say any of my patients experienced an "adverse outcome", however a
recent pt. of mine would have been more comfortable if IV zofran would havebeen available. The pt. was given PO zofran and vomited shortly therafter. Thereare no alternate antiemetics on our units so the pt. endured a 20 minuteambulance ride without benefit of the medication.
It is a sad state of affairs our country is in right now. We are spending so much
on health care with little result. WE need to concentrate more on prevention andimproving life styles and diet.
RSI has been suspended due to lack of Amidate. very limited pain relief
EMT,s in NJ only administer eppy & O2
This could result in a bad outcome and an increased amount of mistakes on
Q11. Please share any other comments on the EMS drug shortage issue here.
medication administration since most ALS providers are used to a certainconcentration/medication under stressful circumstances this may prove to bedetrimental to a patient
Lack of familiarity with the protocol/routine due to these changes is likely to delay
and hamper appropriate patient care.
Increasingly difficult to give quality patient care when faced with lack of
medications to help with patient's symptoms. We have a 25 minute transporttime to our nearest facility and that is an eternity when a patient is in crisis andcan not receive medications needed. Hard to explain to family -sorry there is anational shortage, so your loved on has to suffer.
Some meds (diazepam/lorazepam) are being replaced with meds(midazolam)
that may be effective at treating the current issue, may have after effects that arecausing issues. In this particular case, while the midazolam i effective at treatingthe seizing patient, it does not last last as long in the theraputic window thereforerequiring multiple doses.
I think this issue is pathetic. Unable to get valium for seizures, zofran for our
nauseated pts, at one point succs for RSI, and epi also at one point our supplierwas critically low to the point one of the services I work for was concerned if wehad a period with code blues we would run out. This is rediculous and needs tobe fixed. I am not a fan of more government oversight but if things dont changewe may as well get rid of advanced care and just run emt basic crews. Fix theproblem, please!!!!!
These chortages are a travesty. There is no valid reason they exist other than
politics and manufacturer;s poor planning and greed.
On the opposite end of the EMS drug shortage spectrum, I have also had to
administer medications to some patients whom I'd normally not administer themto because the local hospitals were out of the same medications. There weresome cases where a single ambulance in our city had more Valium and Ativanthan an entire hospital (a fully accredited primary stroke and STEMI center, not asmall outlying facility).
Our patients rely on us to be able to take care of and treat their conditions. The
shortage on medications has caused some conditions to go untreated untilarriving at a hospital, when just months ago, we as EMS could care for the issue.
Providers really, really consider administering a med that is/has been in short
supply. Specifically Zofran, Mag, and adenocard are in short supply in oursystem.
So far, we've been able to scramble to cover shartages. Alternative
concentrations obviously increase the risk of over/underdose. Medical director isready to okay the use of expired medications, and has prepared protocolchanges to accomodate alternative medications. Maintaining normal inventoryon ambulances and supply rooms has been impossible
Q11. Please share any other comments on the EMS drug shortage issue here.
the shortage of medications has hindered the ability to treat. by law, by protocol
this inabilty is wrong. without correcting the issue some EMS organizations arebeing pushed to the brink of failure to comply with protocol or follow federal andstate laws. this is a horrible catch 22 that seriously needs correction
If the shortage situation isn't taken care of soon we will start to experience
Stock is good, but refilling units has taken a delay. Once a unit is completely out
of a medication, then the unit get stock. We had medication pull from the unit toback fill command Hospital. Changes in medication due to cost cutting.
If not corrected, this shortage will lead directly to patient suffering, injury, or
death. Switching drugs and doses can result in increased errors in dosing ordrugs used when contraindicated.
Frequently changing medications is a pain and could lead to mistakes.
Our department has been relegated to finding alternative manufactures who will
produce the necessary drugs for us at a price 10 times the previous cost. Additionally, these products routinely have an usage date of no more than 60days and usually provides for a large waste of the medication both in productand fiscal cost to the tax payers as we are a City/County municipally fundedagency.
It's hard to keep.changing drug doses and concentrations.
I'm dumbfounded by the letter to Congress. As Professionals, EMS lacks in their
ability to put together sentences that are not run-on and that stick to a present orpast tense without the use of both. Take the following sentence: "We haveparticipated in the development of two complementary letters to Congress thatoutline the drug shortage problem from the EMS perspective and providesuggestions for consideration by the Senate and House committees chargedwith crafting legislation to address the problem." First, where are the commas?Second, 'You have participated in the development of two complementary lettersto Congress'? Are you kidding? Why not put it straight forward, 'We have writtentwo letters to Congress, expressing our concern of the drug shortage crisis thatEMS is currently facing with critical patients.' Also, Congress is inundated with aton of letters and paperwork; it would be better if you actually named the specificdrugs you wanted Congress to consider, and then put your concerns in bulletpoints. Anyone can write a letter, but it takes someone who has the ability to stayfocused that will do the job well. Your letter was all over the place with additionaladd-ons and it was so difficult to read that your meaning was lost in many of thelines. Maybe you should try to write the letter and have only one other personassist with the editing. In EMS, we simplify everything - try the bullets and KISS itand Congress will honestly read what you have to say. Oh, and maybe youshould not try to put different forms of the same word, three times in onesentence. There are literally tens of thousands of words to choose from, maybeyou could try not to repeat the same words in your sentences, the next time youwrite to Congress. It's just a suggestion. Q11. Please share any other comments on the EMS drug shortage issue here.
many locally have said if we have to pay more so these companies can make
MORE money then fine increase the price, but we need these medications. Someday we may be treating/transport their family and how do we provide leelcare if we dont have to tools to do our job?
Due to the shortage of Narcotics, it has been difficult for patients that require
pain management. I have also heard of other Medics having trouble withdiabetic patients and not having any glucose to increase blood sugar levels. Asthe current drugs that we carry expire it will become nearly impossible to treatpatients. This problem will have a trickle down effect and the Medic will beblamed by the public because of lack of knowledge.
Please do your best present and resolve these drug shortage issues for our pts
who are totally dependent on provision of care/medicinalinterventions/treaments. Thank you
I have not seen any adverse impacts, yet. Could happen if this keeps up
Although my departmenr has not been directly effected, I am concerned for
those who are both as an EMS provider and a potential patient. This is a bigdeficit in the EMS community as a whole.
This drug shortage is forcing EMS agencies to focus on issues that detract from
other aspects of operations as so much time has to be dedicated to just-in-timetraining, protocol administration, and protocol meetings. Furthermore, there willbe an inherent cost increase thanks to macroeconomics as demand is high whilesupply remains low. This will have a significant impact on budgeting and willcause other operational areas to endure an impact from the medicationshortage.
Why the shortages? Please get the word out to the field "why" other than there
I think it's time to look at the entire drug box we carry and see which drugs we
"like" versus what we "need".
So far we have not had to administer expired Valium but we had to change the
protocol to allow use of versed IV. We are holding expired Valium and will issueit to the filed medics for use when we run out of versed.
Getting more common. We had the D-50 shortage and used D-10 instead. I
actually preferred this treatment method over D-50. It gave a more steady andgradual rise in blood sugar. We now have the Fentanyl shortage. We do havemorphine as a back up but it was nice to have alternative treatments. Forexample, I had a patient today that laid down his motorcycle and had severeroad rash all over his arms and legs. Very painful injury. He was allergic toMorphine. 2-3 weeks ago I could of treated his pain. We are currently out ofEtomidate as well. I have not had to do a conscious sedation since shortage butI could see this being an issue if this treatment is needed. Q11. Please share any other comments on the EMS drug shortage issue here.
If drug manufacturers would put advertising monies into producing back ordered
products, then this situation would be helped.
The local region has moved to follow AHA protocol (not the additional AHA
literature allowing for lidocaine) in ventricular tachycardia/fibrillation and removedlidocaine from the protocol. This has presented difficulties in that amiodarone isin short supply and there is no secondary option.
These changes are recent. I anticipate adverse outcomes as more patient
contacts are made. Particularly with the increase in times between repeatdoses.
I sure hope I don't run into any pediatric seizures
We have also had to accept medications with a very short expiration date.very
expensive to replace drugs only to have to replace if able in a month! Veryfrightening!
We have experienced costs to replace medications that hospitals can't restock
as we have a restocking agreement within eastern pa
This shortage has significantly effected ems as a whole and is unacceptable.
The medications that are in national shortage are cheap and easy tomanufacture. There is no significant reason that these medications should be inshort supply. Ultimately when, not if, patients begin to suffer the blame will fall toems providers which is also unacceptable.
Valium shortage makes it more difficult to treat seizure patients
EMS providers should have an unlimited supply of medications to use in
treatment of the public. They are the ones that will always pay for our lack ofadequate preparation and constantly changing treatment protocols due tomedication shortages. Immediate attention is vital. Our next patients might verywell be our family or friends whose lives depend on our ability to help them whenthey need us most. If this issue isn''t remedied soon, it could cause unnecessarydeath.
I do not administer drugs/meds directly to the patient, however the Medics &
RNs that I work with have experience this problem.
Ems can not let our patients suffer due to the lack of medications, we need to
know in advance of any shortage and should get first chance to receive thedrugs first when they become available.
Maybe we should buy from over seas because are place dont care about pts it
is the dollar sign. Knowing that you are short praying that you dont have a callthat needs that drug. Put the boss of these companys family members on theother side,(ie) being the pt that needs these meds and you can only watch anddo nothing. Stop thinking about dollars and worry about the pts
What exactly is being done to correct this issue, and prevent it in the future?
Q11. Please share any other comments on the EMS drug shortage issue here.
More lead time in time from notification to predicted shortage time . More
flexibility in pre hospital medications.
Magnesium we have not had a call that required it. Vasopressin and
Amiodarone have alternatives. Lasix we can utilize alternate treatments (CPAP& NTG)
I am an EMT Basic and do not administer drugs.
The most serious concern I have with these drug shortages, is in the Rapid
Sequence Induction setting. We are out of Etomidate, which we use as a shortterm sedative, just prior to administering a paralytic to facilitate intubation inpatient's with severely decreased level of consciousness. These patient's cannot protect their airway, and can die when they aspirate prior to having aprotected airway via a Endotracheal Tube. Our current plan is to use old schoolVersed, which is a step backwards in terms of standards and patient care. I feelsorry for the next RSI patient that we have.
These drugs are needed to save lifes, future patients very well may be affected if
this matter is not resolved quickly, what if it was you that needed a certainmedication in a life threatening situation, but the medication that could save youwas unavailable? I bet you'd try and resolve the problem it it hit close to home.
It seems to me that the drug a shortage is being created by the manufacture ie
morphine can only be suppied in multiple dose or odd concentration. It is not thelack of Orphan for example it is how is package or the concentration.
It's ashame that we can't have access to what we need and have to deal with
what's available when it comes to treating patients
I believe that the drug companies are manipulating the market, and this needs to
It's pretty bad, that the largest nation in the world can't provide medication for it's
people and first responders. It is sad, very sad.
The changes that have to be put in place to accomodate the shortages can
create confusion and may result in adverse outcomes.
My company, a nationwide private ambulance service, will not allow use of an
expired medication under any circumstance. They have been unwilling tocooperate with local operations during the shortage.
Currently in our system there is a shortage of valium in the prefilled tubex
syringes and we haven't had procainamide for sometime. We have had toreduce the total amount of valium we have in our drug boxes due to theshortage.
We are currently operating all of our ALS Ambulances without any medication for
seizures. We normally carry Valium and Versed for seizures. It is my fear thatone day soon we will respond on a pediatric or adult status seizure and not beable to provide them the medications that they need and this will lead tosomeone's death. Our local medical director has written a letter to the GA
Q11. Please share any other comments on the EMS drug shortage issue here.
Attorney General and we have also addressed the drug shortage with our StateEMS Office. All are in agreement, this is a health care emergency that requiresimmediate attention.
We are now using a compounding pharmacy locally rather than just ordering
I think it's interesting that the hospitals aren't having the same problem & get
upset when a medication isn't given because they don't understand.
Such shortages are scandalous, usually provoked by poor speculation, or low
profit margins, a ploy often used by pharmaceutical companies. The governmentneeds to step in and put a stop to these tactics.
The medication shortage is getting very close to critical conditions in my
organization. Medications are being moved from truck to truck in an attempt tokeep at least one vial per unit. Protocols have been changed in anticipation ofthe lack of availability on the trucks. If this shortage is not fixed soon the citizensof my county will suffer and all i can pray for is that there won't be any loss of lifeor quality of life.
It is unacceptable that the nation is experiencing this shortage. One medication
may be okay but not the many drugs that emergency medicine has to face. Thisday and age it is total unacceptable. Some of the medication that are affect forserious indications such as respiratory and seizures disorders.
Why is there a shortage? We have so many drug manufacturers available I do
not understand why there would be a shortage.
It is imperative that thorough education needs to be disseminated about
alternates drugs and appropriate dosages.
We cannot preform our jobs without the necessary equipment. Hope this will end
soon, our citizens deserve better. What if it were your family that had to sufferbecause of the shortage. Ask the overpaid that sit high on the pedestals that forme.
This is a very serious issue for sub frontier rural areas, our closest hospital is a
minimum of 2 hours away, so medications we carry can make a huge differencein patient comfort, outcome and care
The shortages are probably , in part, due to the fact that these drugs are
generics. As such, drug manufacturers place not priority on their productionwhen meds with higher profits margins can be made.
Our needs are quite small and still, our hospitals cannot spare the drugs needed
Should be used as a opportunity to expand the current list of medications
available to EMS providers nationwide and set a new standard of alternate drugsthat are good for everyday EMS use
No relief in site to the problem with persistant back order and no suitable
Q11. Please share any other comments on the EMS drug shortage issue here.
These are essential medications. There needs to be a process for ensuring an
adequate supply for national EMS and hospital services, governmental orotherwise.
This will continue to be an ongoing problem if something isn't done soon. These
medications do not produce the revenue that others do per dose, but they areessential for good patient care and good patient outcome.
Goto, G.H. Katayama, H. Tanigaki, Y. Fushiki, S. Nishizawa, Y and Nishizawa, Y. (2008) Methylcobalamin inhibits fibroblast growth factor-8 stimulated proliferation and induces apoptosis in Shionogi carcinoma cells. Int. J. Vitam. Nutr. Res., 78, 21-26 Kataoka, T. Tsukamoto, Y. Matsumura, M. Miyake, A. Kamiura, S. Ishiguro, S. and Nishizawa, Y. (2008) Expression of p21Cip1/Waf1 and p27Kip1 in s
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