FDNY- Bad Meds Too Hot To Hand Out

[WAS967 97]

http://www.nypost.com/seven/01112009/news/..._out_149604.htm

BAD MEDS TOO HOT TO HAND OUT

By GINGER ADAMS OTIS January 11, 2009

A piping-hot radiator placed next to a locker full of drugs in a Harlem EMS station made a state health inspector's blood run cold last week.

The ambulance unit's entire narcotic supply - 20 vials each of morphine, Valium and midazolam - was tossed after it was discovered that temperatures inside Station 16 had reached a steamy 92 degrees and were likely higher inside the metal locker, sources said.

The narcotics start to lose their potency - and run the risk of altering their chemical compositions - when temperatures top 86 degrees, according to the manufacturers' guidelines.

When a drug's chemical compound alters, "severe allergic reactions could occur," a Manhattan doctor told The Post.

"Heat changes the composition, and you don't know who's going to have a bad response," said Dr. Tom Bolte, a Midtown physician.

"It could be life-threatening for some patients."

Medics told The Post they've been complaining for years about the ancient heating system at Station 16 in Harlem Hospital and how it routinely bakes the facility - and the lock box - during the winter.

All Station 16 ambulances were taken out of service Thursday morning and sent to a neighboring EMS house to switch out their potentially tainted meds with new ones, sources said.

Edited January 13, 2009 by EMTbravo

[WAS967 97]

As a point of discussion (and my main reason for posting this article): What does your agency do (if anything) to ensure that the medications in your drug box are kept at the proper temperatures?

Most agencies I have worked for keep a heater in the truck near the gear to keep the stuff warm in the winter, but there is no thermometer that is monitored to make sure the temperature limits of the drugs are not exceeded. This can be especially important in the summer when a flycar can remain parked for extended periods and the gear could be baking in +100F temperatures.

[SRS131EMTFF 471]

I thought that some agencies were placing coolers in their rigs for cold saline, could you also place ALS meds in a cooler like that to protect against the temperatures?

[helicopper 1,050]

Don't most agencies have their paramedics carry the narcotics on their person or am I just dating myself again?

Most medics I know don't hang out where it's 92 or hotter for very long so the meds ought to be more temperate.

[ny10570 745]

Narcotics are carried on our persons, but our restock is in lock boxes at the station. Its these restock and securement lockers where the heat was an issue.

[NJMedic 96]

In my department we have heated (forced air) compartments for all medications and IV fluids. We also carry a temperature probe that records the trends in temperature in each of the med kits. The probe data is downloaded weekly to indicate temperature ranges.

[Union241 3]

It is a shame that the medics have been complaining about this serious issue for a while now and nothing had been done until the Department of Health came in. Our medics carry their narcs in what essentally amounts to a secure pencil box attached to their hip with a carabener. When they need to restock or switch out old meds for new ones they go to the hospital pharmacy, where I hope the meds are kept under proper conditions. Non narcotic meds are kept in a secure locker inside the ER in a room that I would be surprised if the temperature ever reached above 50 degrees. Our newer Medic Squads have temperature controlled lock boxes, but on the older ones in terms of temperature control, it is hit or miss as to the temperature control of the narcs/meds.

[STAT213 332]

As for carrying narcotics on your person, that is downstate thing. I've never seen that practice anywhere else. My narcs now are in a safe in the ambulance with a combination lock on it. At STAT they were in a locked drawer and a locked container.

As far as meds go, we have a policy to keep the ambulance running when outside if temps inside will be either above or below acceptable limits. In addition, in NH, each ambulance must have garage space, you cannot store your rigs outside.

[Guest alsfirefighter]

Being I carry them on me (which is the way I prefer it and think its more efficient) they are always good to go on temp. Even if they are below or above the given temp it isn't for an extended period of time where the medication would actually reach those temperatures in that time frame. As far as the agencies I've worked for where they were in the bags...can't comment on that, I'm sure the bag insulated them and the vehicles weren't generally stationary long enough again where I would think it was ever an issue.

Our restock safe is in the same room that the hospitals meds and narcs are stored and if I remember correctly the room has its own thermostat for climate control.

[Medic5274 45]

As for carrying narcotics on your person, that is downstate thing. I've never seen that practice anywhere else. My narcs now are in a safe in the ambulance with a combination lock on it. At STAT they were in a locked drawer and a locked container.

As far as meds go, we have a policy to keep the ambulance running when outside if temps inside will be either above or below acceptable limits. In addition, in NH, each ambulance must have garage space, you cannot store your rigs outside.

As an old no longer practicing Paramedic from Harlem I have a question about carrying or not carrying narcotics on you. In the area I worked in we frequented alot of housing projects that had mutiple buildings 10-20 or even 30 stories tall. It is no exageration that it could take 20-30 minutes to get a patient out of one of these buildings due to the lack of working elevators. Without carrying the narcotics on our belts I believe some of my patients would have died or at a minimum would have taken a turn for the worst. Having the narcotics down in the ambulance seems like a long way away when you need them right away.

In the upstate community do you routinely experience this type of patient transport delay. If you routinely experience delays in transport has there been consideration to carrying the narcotics on your belt.

Not trying to say one part of the state does it better. In New York city we adapted our narcotic securement to the environment we worked in. Are there other considerations that are factored in to the decision of whether to carry or not carry the narcotics in the area you work.

On a side note a miss being a Paramedic and the excitement of working the streets.

[WAS967 97]

Most medics I know don't hang out where it's 92 or hotter for very long so the meds ought to be more temperate.

MY question wasn't meant to specifically address the storage of narcotics but our medications in general. The agencies at which I am presently employed have the narcs on their hips and the substock in temperature controlled areas so thats a nonissue. My main thought was towards the meds in the drug bag/box/whatever you keep em in that is typically stored in the truck. Some units can sit idle for extended periods on a hot day where the temperature inside a vehicle (according to anti-keeping-your-pets-in-a-parked-car people) can easily exceed 100F in the sun.

In my department we have heated (forced air) compartments for all medications and IV fluids. We also carry a temperature probe that records the trends in temperature in each of the med kits. The probe data is downloaded weekly to indicate temperature ranges.

This is made of Win.

[Guest]

The storage facility for our non narcotic medications is a locked metal cabinet in the "locker room" office area. Its room temp. and rarely gets above or below in respect to any extremes... As for the narcotics they are kept in the ED in a safe again at room temp. It would be interesting to see how other agencies do their storage. I saw above in respect to a cooler for saline and etc. This has long been talked about, and was just implemented within the NYC region for cardiac arrests, now if there was only room for my diltiazem and iced tea we'd be in business!

[NYMedic37 22]

As for carrying narcotics on your person, that is downstate thing. I've never seen that practice anywhere else. My narcs now are in a safe in the ambulance with a combination lock on it. At STAT they were in a locked drawer and a locked container.

As far as meds go, we have a policy to keep the ambulance running when outside if temps inside will be either above or below acceptable limits. In addition, in NH, each ambulance must have garage space, you cannot store your rigs outside.

If you're up on the 12th floor, what good are the narcs if they are locked up inside of the ambulance?

[x635 4,066]

As for carrying narcotics on your person, that is downstate thing. I've never seen that practice anywhere else.

It's done at several agencies in Texas, too. One agency I know of. Restock is accomplished via a dedicated EMS restick Pyxis in the ED, and each medic has a set of narcs in a small plastic box that's in a somehwat bulky nylon pouch on your belt. Each medic is assigned their own set of narcs, for which they are completly responsible for, every medic has a mini safe that's controlled by a central computer for storing off duty. Carrying them with you is a neccesity, as sometimes you may not be near the ambulance, or may get put on someone else's ambulance, etc.

In the summer heat, most agencies have A/C units that run on shorline power to keep the drugs cool, or warm sometimes in winter. Also, some agencies are spec'ing fridges or space for coolers for when pre-hospital cooling gets implemented.

[Goose 188]

It's done at several agencies in Texas, too. One agency I know of. Restock is accomplished via a dedicated EMS restick Pyxis in the ED, and each medic has a set of narcs in a small plastic box that's in a somehwat bulky nylon pouch on your belt. Each medic is assigned their own set of narcs, for which they are completly responsible for, every medic has a mini safe that's controlled by a central computer for storing off duty. Carrying them with you is a neccesity, as sometimes you may not be near the ambulance, or may get put on someone else's ambulance, etc.

In the summer heat, most agencies have A/C units that run on shorline power to keep the drugs cool, or warm sometimes in winter. Also, some agencies are spec'ing fridges or space for coolers for when pre-hospital cooling gets implemented.

That and i guess they can now now can carry cardizem without having to replace it every 30 days.

[Guest alsfirefighter]

That and i guess they can now now can carry cardizem without having to replace it every 30 days.

Wouldn't that be nice. Talk about throwing money down the drain. We probably use it only once every 2 to 3 months.

[x635 4,066]

I must ask what else the state inspector found, and how many other EMS "Stations" have this issue?

I'm sure that there are more drugs then just narcotics that aren't being stored properly. I still don't understand why "FDNY"*EMS doesn't have the funding for better support services?

And also, I put EMS station in quotes, because the only time FDNY EMT's and Medics see them are at shift change, because they're either sitting at a CSL or on a call.

[ny10570 745]

We did pretty will this time around. The only violation found to potentially harmful to patient care was the Harlem narc lockers. Queens took a few hits on vehicles and facilities, but nothing more than warnings for things like O2 storage and a few expired catheters in needle trache kits. I believe the Bronx had no violations. But in the defense of Queens, they were inspected first. The issue at the harlem station was 2 steel boxes about 8"x12" mounted on the wall of the lieutenants' office. One is used for the station's narcotic restock and the other is used for securing narcotics pouches between tours. This HHC facility that FDNY*EMS uses after the brand new station 16 was demolished for hospital expansion has a history of roasting the members and the locker just happens to be located above the radiator. It has since been relocated and the problem solved. All of the other drugs and patient care equipment is stored in BLS and ALS supply rooms that are not subject to nearly as much heat and are within DOH guidelines. All of the results are public info, and I'm sure would be easy to get from DOH.

We have plenty of problems but the members do a pretty good job of insulating our patients from the departments foul ups (like expired meds in our sealed inserts).

Edited January 30, 2009 by ny10570