Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Shortage of Lifesaving Drugs Reaches Epic Proportions

I did not come up with the title – Shortage of Lifesaving Drugs Reaches Epic Proportions – that was the title of the article I am criticizing, but not for any lack of hyperbole.

“It’s a perfect storm of conditions with a rapidly consolidating marketplace, a health care system that is trying to control costs, an issue with raw materials and a marketplace that doesn’t have a good redundancy system in place to handle things when a plant shuts down,” says Allen Vaida, executive vice president of the Institute for Safe Medication Practices. “No question about it. It’s a national crisis.”[1]

In EMS, we are worried about a shortage of drugs, when we should see this as an opportunity to improve patient care.

Among the drugs Fox found that were in short supply during 2011 were injectable versions of calcium gluconate, used by first responders to regulate heart rhythm in patients suffering cardiac arrest; succinylcholine, a muscle relaxer used to intubate patients; naloxone hydrochloride, which reverses drug overdoses; and propofol, an anestheticused in emergency surgery better known for causing the death of singer Michael Jackson. Most of those medications are older generic injectables that are widely used in emergency situations. Some of those shortages, among them propofol and succinylcholine, have since been resolved but others continually crop up, creating a gap in emergency drug stockpiles.[1]

calcium gluconate, used by first responders to regulate heart rhythm in patients suffering cardiac arrest

It could be, but that does not make sense. ACLS (Advanced Cardiac Life Support) discourages the routine use of calcium, but in true emergencies we should be using calcium chloride, rather than the slow infusion of calcium gluconate.

Routine administration of calcium for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended (Class III, LOE B).[2]

naloxone hydrochloride, which reverses drug overdoses

Naloxone is only indicated for life-threatening respiratory depression due to an opioid overdose. However, a response to naloxone is definitely not diagnostic for an opioid overdose.

Suppose that EMS has no naloxone (Narcan), so what? The essential treatment for opioid overdose, and for benzodiazepine overdose, is just supportive care.

and propofol, an anesthetic used in emergency surgery better known for causing the death of singer Michael Jackson.

Propofol did not cause the death of Michael Jackson. The lack of airway management by Dr. Conrad Murray killed Michael Jackson. Opening his airway, and maybe some painful stimulus, would have kept Michael Jackson alive.

“Gray market” suppliers, usually small wholesalers or individuals who closely monitor and react to pharmaceutical trends, are scooping up medications as soon as a shortage becomes apparent then selling back the products to drug distributors, other wholesalers or hospitals at inflated prices that can sometimes top more than 1,000 percent of a drug’s original cost.[1]

What is the original cost used for these calculations? Is it the cost to the manufacturer? The list price? The wholesale price to hospitals? The cost per dose to the patient? Why use percentages? Do most people realize that 1,000% as much means ten times as much.


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“We’re not getting any complaints regarding any infringement on care because of the shortages,” she says. “That doesn’t guarantee it isn’t happening, but we usually see that fairly quickly when there seems to be an uptick in problems. What I surmise is that providers are doing what they are supposed to do under the circumstances.”[1]

Is it possible for people to actually do what they are supposed to do?

If we are not doing what we are supposed to be doing, why not?

“Patient access to innovative treatments is the cornerstone of our industry. That is why the critically important issue of drug shortages demands our collective attention to ensure patients can access themedicines they need in the most expeditious manner possible,” says John Castellani, chief executive officer and president of The Pharmaceutical Research and Manufacturers of America, a trade group comprised of pharmaceutical research and biotechnology companies.[1]

 

No.

 

“Patient access to innovative safe and effective treatments is the cornerstone of our industry.

Safe and effective are essential. Innovative is desirable, but not essential.

Dr. Conrad Murray killed Michael Jackson with incompetence, not with any drug. Is blaming deaths on a drug shortage any different from blaming deaths on a drug?

To be continued in Is the Drug Shortage an Excuse for Incompetence – Part I on 01/06/2012.


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Footnotes:

[1] Shortage of Lifesaving Drugs Reaches Epic Proportions
Beverly Ford Source: Telegram & Gazette (Worchester, MA)
December 21, 2011
EMS World
Article

[2] Interventions Not Recommended for Routine Use During Cardiac Arrest
Part 8: Adult Advanced Cardiovascular Life Support
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 8.2: Management of Cardiac Arrest
Free Full Text Article with links to Free Full Text PDF download

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Comments

  1. Only current EMS shortages I’m aware of/ facing is mag sulfate and etomidate. I just got a supply of 4 bricks of D50 in though, yes all that for one ALS unit.

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