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Drugs! We need Drugs!

So it seems EMS agencies in the USA are running out of medications and it’s getting to be a problem. Various agencies around the nation are reporting difficulty in getting medications such as analgesics, ACLS medications and others. Some claim their smaller size and buying power prevent them from exerting enough pressure on pharmaceutical companies to produce more. Some of the drugs that are running short are off-patent and difficult to manufacture or just less profitable to do so.

Some folks are looking to place blame. Some folks are taking action.

James Orsino, the president of the EMS Labor Alliance, Al H. Gillespie, the Chairman of the Board of the IAFC and Dr. Ronald G. Pirrallo, President of the National Association of EMS physicians, William Sugiyama, President International Association of EMS Chiefs and Skip Kirkwood, President National EMS Management Association see an opportunity in this crisis. They decided to write a letter to the President of the United States of America about it. You can find it here:


Now, If you just took a look at that and said, "TL:DR" (Too Long. Didn’t Read) then let me sum up a few things:

  • The nation is running short on EMS drugs.
  • Individual EMS agencies don’t have the ability to stock up or afford alternate sources.
  • That shortage has 2 main areas of impact:

    • We don’t have enough drugs for our day-to day patient needs
    • If (when) a disaster hits us, we’re REALLY screwed. We have no stockpile or surge capacity.

These smart guys decline to get involved in the blame-game. They don’t discuss who’s at fault. They don’t even look too closely at the origin or cause of the problem they cut straight to the point:

"Despite the challenges presented by the current situation, EMS services across the nation must continue to respond to 911 emergency calls every day to treat patients."   

And point out that some agencies are feeling the pinch already:

"Some EMS services have been able to continue providing care, but are operating on an inventory of these products that is below par levels, levels that would be considered prudent during normal times. The availability of these medications becomes the limiting factor in the number of patients that individual EMS services could treat …"

They discuss some of the solutions that EMS agencies are using to meet the day to day drug needs but point out that "…the disruption in normal EMS operations posed by large-­‐scale events will have significant negative affects on an already tenuous day­‐to­‐day EMS landscape." Yep. When another hurricane, earthquake, series of tornados or floods hit (not to mention man-made disasters) it’ll go something like this:

"Once the limited supply of pain control medications are exhausted, all other patients will needlessly suffer. Those in need of other medications in a disaster area will be forced to wait for a supply chain to be established and for it to be functional, which could take days. This assumes that medications are stockpiled and available to be pushed to these affected areas at all."

Not a sunny picture.

510 Medic  plays the blame-game a little bit but he uses the blaming as a tool to point out an opportunity. He calls for EMS agencies to look at alternatives to short medications. This is a good idea unless all of the drugs in that class are short, as seems to be happening. Even so, he does push for us to be the creative problem solvers that we are. To look for the opportunity to improve our industry through this crisis.

The authors of the letter see an opportunity too. They take the crisis and the potential impact is has on the national ability to respond to an emergency and they call on the federal government to act in a manner they are legally able. They point out that many national EMS agencies are lobbying heavily for laws to provide unified support to EMS and to deal with these types of crisis but they also rightly point out that legislation takes time. Congress is necessarily ponderous and slow. The branch of our government that is intended to act quickly (relatively speaking) is the executive branch and the agencies therein.

"The Department of Homeland Security (DHS) is the federal agency responsible for Critical Infrastructure Protection in this nation. ‘Critical infrastructure’ is defined by federal law as ‘…systems and assets, whether physical or virtual, so vital to the United States that the incapacity or destruction of such systems and assets would have a debilitating impact on security, national economic security, national public health or safety, or any combination of those matters.’”

Basically, they are calling this shortage a threat to our homeland security (It is, isn’t it?) and are calling for DHS to step in, wield its administrative and budgetary power to get something done about it.

"… we believe that the Department of Homeland Security and the Department of Health and Human Services have joint responsibility to address the issue of drug shortage for EMS in some manner more timely than through congressional legislative action. The collaborative effort necessary to do so is a legislated relationship in the aforementioned laws."

They are basically saying that the laws are already in place. Once people start seeing EMS as a critical component of our national response and national security, right alongside fire/rescue and police, then we can start supporting EMS in a manner that helps us help our patients.

"It is our belief that the integrated all-­‐of-­‐nation approach outlined in Presidential Policy Directive 8 (PPD-­‐8), coupled with consolidated federal leadership for EMS would produce positive results on the drug shortage issue and its impact on the patients that we serve."

Ok! This is where maddog get’s excited! I’m not a policy or government wonk but there is one thing this nation sorely needs: a federal-level EMS agency. I’m not talking about federalizing all of our EMS agencies. I’m talking about a federal agency that helps define, support and fund EMS throughout the nation. Every law enforcement agency, from the federal all the way down to the municipal and territory can trace it’s support, jurisdiction and methodology to the Department of Justice. All fire departments can count on logistical support, funding and guidance from the NIFC and USFA, both federal agencies at the executive level. Where’s the federal-level EMS agency? Who do we go to for the kind of support, standards and logistical assistance that exists at that level? This crisis and the solutions proposed in this letter are and excellent way to begin to build the foundation upon which a federal EMS agency can be built.

Now is the time. Here is the place. Mr. President. I doubt you’ll read this but I do ask that you use the tools in your "toolbox" to help make sure we put EMTs and paramedics on the street with tools in theirs.


Update: Scott over at "EMS in the New Decade" has weighed in on the medication crisis.