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August 17, 2010

Local EMTs alerted to drug shortage

By Denise Richardson Staff Writer

Local emergency crews are on alert about a national drug shortage that could impact how they treat patients.

But to date no adjustments have been made in drug administration, officials said Monday.

"It has not currently affected us _ as of yet," said Shawn Kauffman, an emergency room nurse at O'Connor Hospital in Delhi and a paramedic with the Delhi Fire District. "Currently there is no risk to the public." The Institute for Safe Medication Practices issued a safety alert in July about a national shortage of critically important medications.

On Thursday, the state Department of Health notified regional emergency officials that drug shortages that have persisted since spring continue "without a clear end in sight to the problem."

The state urges Regional Emergency Medical Advisory Committees to monitor supplies and drug use and develop regional alternative plans.

The state noted critical shortages of certain epinephrine and dextrose dosages in manufactured pre-loaded syringes and said several EMS agencies already have implemented alternative plans.

The state also said that other medications used in pre-hospital situations, such as atropine, furosemide and naloxone, are in short supply.

However, volunteer emergency crews in Delaware and Otsego counties haven't had to use alternative treatments, officials said Monday, nor have crews with the private Cooperstown Medical Transport, which serves those two counties and Chenango County.

Lyle Jones, Otsego's emergency services coordinator, and Steve Hood, Delaware County EMS coordinator, said they have passed the state's alert on to volunteer squads.

The issue is whether current supplies can be restocked by hospitals according to current practice, they said, as well as preparing to use alternative drugs.

"There certainly are options," Hood said. Delaware has 21 volunteer EMS districts, he said.

Beth McGown, director of operations for Cooperstown Medical Transport, said crews haven't had to substitute drugs yet.

Any alternative approaches will be developed in consultation with medical personnel and the regional Adirondack-Appalachian Regional Emergency Medical Services Council, a governing body, she said.

CMT buys medications through vendors, McGown said, and recently sellers have gone out of their way to fill orders.

"At this point, it's something that we're monitoring," McGown said.

CMT has 15 ambulances and about 100 employees, she said, and the business works closely with county dispatch centers.

Oneonta ambulances are fully supplied with drugs, but one cardiac arrest and use of epinephrine could take the situation to critical levels because the department is supplied by Fox Hospital, which is on back order for epinephrine, said Brian Knapp, advanced emergency medical technician -- critical care with the Oneonta Fire Department.

"If there is a shortage of supply, there is a shortage of supply," Knapp said.

"There is some concern, but we deal with these medications all the time," he said. Knapp, a representative with Adirondack-Appalachian Regional Emergency Medical Services Council, said he talked to the fire department chief on Monday about the situation and the need to develop options. AAREMS representatives, physicians and EMS providers will be addressing the drug shortage situation at its meeting next month, Knapp said.

"There are some shortages in the re-ordering process," Kauffman said. Fox, O'Connor and Bassett hospitals re-stock volunteer squads and have been reporting shortages and providing other options, he said.

However, Kauffman said he hasn't heard of any agencies in Delaware County that have had to remix drugs or use optional treatments.

The Institute for Safe Medication Practices said shortages occur for a host of reasons, including availability of ingredients, a change in product formulation and regulatory actions. The Federal Drug Administration keeps a list of drugs in short supply.

Officials with area hospital said the drug shortage hasn't had an impact on patient care.

"We're aware of the situation, but it has not impacted Bassett Medical Center or affiliate hospitals in the Bassett Healthcare Network in any major way or in a way that would affect patient care," said Karen Huxtable, spokeswoman for Bassett..

"A.O. Fox has not experienced any critical shortages of necessary medications," Alisha Barbera, spokeswoman for A.O. Fox Memorial Hospital in Oneonta, said. In accordance with The Joint Commission standards, the hospital has a process in place to deal with potential shortages, she said.

Barbera said, if needed, Fox would identify shortages, communicate about the shortages to providers, and offer appropriate and acceptable alternatives.

Joan Cronauer, an advanced EMT -- critical care with the Franklin Fire District, said she is concerned about extra time that would be needed to remix drugs and respond in an emergency.

"I think it's going to be difficult," she said. "I haven't had to do it _ I hope I don't' have to."

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