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

- Rogue Medic

Medication Storage and the Heat

It has been hot with no real expectation of a cool rest of the Summer or even the Autumn.

What do we do to keep medications in the recommended storage range?
 


Image credit.
 

Do we need to refrigerate our drug boxes/bags?

According to these recorded temperatures in a cooled drug compartment, an uncooled drug compartment, and ambient temperature, the answer is that we do need to cool our drugs.
 


Click on images to make them larger.

The results indicate that drug storage temperatures in some prehospital rescue vehicles exceed USP guidelines.[1]

Without cooling, we are not protecting our medications from the harmful effects of high temperatures.

Mechanical cooling of the storage compartment results in drug storage temperatures within the USP guidelines.[1]

 

Mechanical cooling of drug storage compartments on vehicles is technologically and financially possible.[1]

Do we refrigerate/cool our drug compartments?

Do we monitor the temperature in the drug compartments, or the temperature of the individual drugs?

There is an excellent presentation on the topic at Free Emergency Medicine Talks.[2]

The medication most notable for needing refrigeration is insulin. Fortunately, insulin is not often used in EMS. The EMS drugs most often refrigerated are succinylcholine (suxamethonium in commonwealth countries, brand name Anectine) and lorazepam (Ativan). One alternative to refrigeration is to rotate stock every 30, or 60, or 90 days.

This seems as if it would be the most practical and affordable, but depends on having a hospital to exchange stock with. If we keep a medication on an ambulance for 30 days, then exchange it with the hospital, it is because we are expecting the hospital to use the medication quickly.

Lorazepam should be used frequently in an ICU – as long as there is not a drug shortage. The lorazepam drug shortage continues.[3]

Footnotes:

[1] Drug storage temperatures in rescue vehicles.
DuBois WC.
J Emerg Med. 2000 Apr;18(3):345-8.
PMID: 10729674 [PubMed – indexed for MEDLINE]

[2] Prehospital Medications – How Well Do They Store – Brian Walsh (New Jersey)
Brian W. Walsh, MD FAAEM
Free Emergency Medicine Talks
September 13, 2011
MEMC-VI (Sixth Mediterranian Emergency Medicine Conference)
Kos, Greece
Page with link to Mp3 Download

[3] Lorazepam
FDA
Current Drug Shortages
Drug shortage information page

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