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Drug shortage a risk for patients in emergencies

Paramedics are being forced to change which drugs they use, and how they use them, by drug shortages.

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By Rikki King
Herald Writer
CLEARVIEW -- A national shortage of drugs is forcing paramedics to change the medicine they use, and the way they use it, in emergencies.
Emergency crews worry the constant switch-ups could lead to a paramedic making a mistake that could cause a patient pain, injuries or even death. Without careful planning, they also potentially could run out of the drugs they need to help people as they're taken to the hospital.
"In the meantime, we're just having to really be on our toes and adjust on the fly," said Scott Dorsey, acting deputy chief and medical services administrator for Snohomish County Fire District 7 in Clearview.
Drugs commonly administered by paramedics that have been affected by shortages include medicines for people having seizures or who are suffering from cardiac or respiratory trouble. In addition to treating pain, paramedics often need to sedate or anesthetize patients as well.
In Snohomish County, fire departments and their medical supervisors are working to find solutions while they wait for a federal fix, they said.
"Our personnel are having to rethink what they do on a real routine basis," Monroe fire Capt. Cindy Coker said.
Drug shortages have been making national headlines for about two years now.
Hospitals and emergency rooms have faced similar issues with shortages, as have cancer treatment centers.
The shortages vary by type of drug and duration, but happen largely because of problems with product quality, drugs being discontinued and companies not having enough room or resources for production, said Steve Saxe, executive director of the state pharmacy board and a licensed pharmacist.
State officials are monitoring the issue.
"We are concerned with the impact it ultimately has on patient care and patient safety," he said.
The shortages are expected to ease up in the next year to 18 months, officials said. New federal policies were passed that eventually will require drug manufacturers to announce their plans to stop making certain drugs, or significantly change those drugs, months in advance.
Locally, paramedics say they haven't seen any serious problems arise from switching to other medicines while treating patients. Still, they worry.
"We don't want to see patients in pain," said Lynnwood fire Capt. Larry Hadland, who runs medical services for the Lynnwood and Mukilteo fire departments.
They can't count on the next shipment coming in, so they have to be careful about how much medicine they administer and when, Hadland said.
"We're not sending people to the hospital in pain, but we're thinking about every milligram of pain medication we're giving," he said.
For now, fire departments like Clearview's are focusing on bolstering training to make sure crews know how to use the varying kinds of drugs, Dorsey said.
Paramedics also have to slow down their decision-making during emergencies as they adjust to new packaging and potencies, Coker said.
Emergency medical services administrators in the county are meeting regularly to talk about the shortages and what they can do, Coker said.
For the most part, it's illegal for fire departments to trade medicines, some of which are considered controlled substances.
"We have to be aware that the stock we have in our rig is all we can get, and use our medications judiciously," she said. "We have to be really aware of what we've got and what we can or can't get, and what we can use as substitutions."
Drug manufacturers also are working with the Food and Drug Administration to reduce shortages, said David Gaugh, a senior vice president with the Generic Pharmaceutical Association.
"It's not going to solve the drug shortage, but we might be able to find critical drugs that could be solved, one at a time," he said.
Gaugh also noted that sometimes shortages are out of manufacturers' hands -- such as when the FDA finds production problems that manufactures must address.
Profit is rarely the reason a drug gets cut off in production, he said.

Rikki King: 425-339-3449;
Story tags » ClearviewFirefightingHealth treatmentMedicines

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