Drugs in Ambulances Not Stored at Proper Temperatures

Medications carried in ambulances to be given to patients in need of emergency care were found in some cases to be stored at unacceptable temperatures, according to a study conducted by researchers at SUNY Upstate Medical University.

The studyis published in the March/April issue PharmacopeialForum.

"Everywhere we looked temperatures were outside acceptable ranges, whether on the shelves in the ambulance, in medication bags or in small insulated coolers," said the study's principal author, Lawrence Brown, EMT-P, director of research in the Department of Emergency Medicine at SUNY Upstate Medical University.

The study shows that none of the ambulances or systems studied had medication storage practices that were compliant with current U.S Phamacopeia (USP) drug storage standards. The required storage temperature for many pharmaceutical products is "controlled room temperature," generally defined as between 20 C and 25 C (68 F to 77 F). Medications commonly found on ambulances include lidocaine, amiodarone and epinephrine, all of which are used for cardiac arrest.

Researchers recorded temperatures for one year in ambulances in Mesa, Ariz; Orlando, Fla.; Portland, Ore.; Syracuse, N.Y.; and Topeka, Kan. Three ambulances from each city were selected for the study and temperature-monitoring sensors were placed in each ambulance's medication storage compartment, drug-bag/box and in an insulated container. Temperatures were recorded every 32 minutes.

All sensors (45) recorded drug storage temperatures above USP standards. In Mesa, all nine sensors placed in ambulances recorded average temperatures for drug storage, whether it was on shelf, in drug bag or box or in cooler, in excess of 28.23 C (82.8 F).

According to the study, the highest temperature-- 52.9 C or 128 F--was recorded inside a Mesa ambulance.

The maximum drug storage temperatures recorded in other cities were:

Orlando 43.7 C (110.66 F)

Portland 36.4 C (97.52 F)

Syracuse 38.3 C (100.94 F)

Topeka 42.8 C (109.39 F)

All sites noted temperature spikes of between 30 C and 40 C (86 F to 104 F) that exceeded 24 hours, the study showed.

Not only was heat a concern, but so was the cold. Sensors in every ambulance recorded temperatures far below USP standards. The lowest temperature reading--minus 2.9 C (26.78 F)--was recorded in a Syracuse ambulance.

The minimum drug storage temperatures recorded in other cities were:

Mesa 2.2 C (35.96 F)

Orlando 3.4 C (38.12 F)

Portland 3.7 C (38.66 F)

Topeka 4.8 C (40.64 F)

Even using USP's "cool place" storage standards, which defines storage as 8 C to 15 C, 11 of 15 ambulances had temperatures below 8 C (46 F).

More than one-third (17 out of 45) monitors recorded average daily temperatures that were not in compliance with USP recommendation.

"The evidence is clear: Medications on ambulances that we monitored are not stored in environments consistent with pharmaceutical industry standards," Brown said. "The Emergency Medical Services (EMS) industry needs to address this problem not only to comply with these important standards, but more importantly to ensure that patients receiving emergency care form an EMS professional are receiving optimal care."

The study did not address the effectiveness of drugs that are subject to temperatures outside USP guidelines.

USP, SUNY Upstate Medical University, Rural Metro Corp., the American Ambulance Association provided staff time and materials for the study. Sensitech Inc. provided the temperature sensors, data management and analysis.