Pa. Agencies Face Medication Shortages

Jan. 26--Anthony Tucci and his ambulance crews have never been able to do anything about the bumpy roads that make it tougher to administer lifesaving medicines to patients heading to a hospital.

Now, they can't do anything about shortages of those medicines.

In the Berks region and across the nation, some medicines frequently used in ambulances are in short supply. The situation has caused the state Department of Health to issue a standing policy under which ambulance companies can seek to use expired emergency medications during a critical shortage.

"It's potentially a life-threatening thing if you can't get the right medications. Epinephrine, Atropine, and the 'D50,' " said Tucci, deputy chief at West-Lawn based Western Berks Ambulance Association, ticking off emergency medicines that have been in short supply at one time or another and are used to treat anaphylactic shock, heart conditions and diabetic shock, respectively.

The situation is not unique to Berks.

A recent research paper published by the Des Plaines, Ill.-based Society for Academic Emergency Medicine found that prescription drug shortages have become longer and more severe and are caused by a variety of factors, including raw materials shortages, shipping problems and increased demand.

The hard-to-get medicines typically are a specific, preferred delivery form of a generic drug. If the preferred method is not available, area emergency service managers said, they find an alternate, less-preferable drug or delivery method.

For instance, the 'D50' mentioned by Tucci referred to a "prefilled syringe" of Dextrose 50 percent solution, a tube containing 25 grams of sugar in 50 milliliters of water that can quickly be injected into the IV of a diabetic patient.

This month at least one manufacturer was short in supplies of D50.

Tucci and his boss, Western Berks Ambulance Chief Ed Moreland, said it is easier and quicker to use a prefilled syringe than to undertake the laborious process of extracting medicine from a vial with a needle and shooting it into the IV.

"Did I mention we are doing this in the back of a moving vehicle?," said Moreland, outlining the extra difficulty of using the backup product. "And, I have a needle. The preferred method for us is always a prefilled device."

Moreland said that five years ago obtaining a needed medicine simply meant seeking an overnight delivery.

Now, he said, "Depending on the product, it may take months and months."

The shortages have not had a significant impact on patients in the Berks region, according to Dr. Duane D. Siberski, an emergency physician at Reading Hospital. Siberski, who also is regional medical director for the Eastern PA EMS Council, said emergency personnel can turn to a backup medicine or device to do the job.

Council Deputy Director John Kloss said he began to notice an increase in the number of emergency medicine products that were in short supply about a year ago. Since then, the council has set up a communications link with the state to monitor shortages.

An EMS bulletin issued by the state Department of Health in July 2013 said many emergency medications used by emergency personnel were in severe shortage and outlined a policy for the use of expired medications.

Jon Herbsleb, chief of operations for the Exeter Ambulance Association, said he ordered a batch of 20 delivery devices of epinephrine -- a generic drug used to treat allergic reactions -- and received only two.

"By Pennsylvania EMS law and licensure, I have to have six of those on a vehicle," Herbsleb said.

Herbsleb and others said many emergency organizations get their pre-hospital medications directly from a hospital, which usually has a larger supply on hand and has greater purchasing power.

"We buy all of our medications -- the ones that we do buy -- from Lehigh Valley Hospital," said Dave Babb, executive director of Boyertown Lions EMS. "The only thing we really had an issue with is dextrose."

A related issue is sudden spikes in the price of generic medications. Some manufacturers have implemented sharp price increases, overnight, on certain medicines.

"We see it," said Siberski, the emergency room doctor. "We are working in the free-market economy. If there is, basically, an increase in demand, we are going to see a spike in price."

A form of naloxone, a generic drug used to reverse the effects of a heroin overdose, recently doubled in price.

Moreland said emergency service chiefs have to do more planning than in the past.

"You have to know your usage and volume," he said.

Contact Ford Turner: 610-371-5037 or fturner@readingeagle.com.

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