TREASURE VALLEY -- It's a crisis sweeping the country, and one that some first responders and hospitals right here in Idaho are dealing with.
There has been a shortage of many types of emergency medications for the past several years. In addition, prices have been skyrocketing.
"These medications that we're facing a shortage of are life-saving medications," Canyon County Paramedics Deputy Chief, Steve Blados, said. "There's no ifs, ands or buts about it. These are very important medications for any hospital or EMS system to carry."
KTVB wanted to find out how this crisis is impacting providers in the Treasure Valley and how they are combating the problem. The different agencies we spoke with told us, fortunately, this issue is not impacting how they care for patients, so you are safe.
It is debated why this is happening and there are many factors that contribute, such as supply and demand, manufacturers halting production of less profitable medication to produce more profitable ones, and the recent acquisition of one drug manufacturer by another major manufacturer. The U.S. Food and Drug Administration cites manufacturing and quality problems, delays and discontinuations.
Based on our research, the root cause is disputes over "safe manufacturing and quality processes" between American manufacturers of intravenous medications and the federal government agencies (FDA and Drug Enforcement Administration) that oversee them.
"A lot of these medications that we're needing are for cardiovascular and blood pressure support, like epinephrine and dopamine, as well as sodium [bicarbonate], which we need for some of those emergent metabolic disorders," St. Luke's Treasure Valley Pharmacy Interim Senior Director, Brian Dotter, said.
The Journal of Emergency Medical Services reports as of June 2017, there are 69 preparations of 28 emergency care preparations in short supply, "including most forms of adenosine, atropine, bicarbonate, calcium, dextrose, dopamine, epinephrine, fentanyl, labetalol, magnesium, and lorazepam".
"It's been a struggle and it's caused a lot of worry," Blados told KTVB. "It's been something that has taken us and organizations across the United States by surprise."
Worry, Blados says, that this emergency drug shortage issue could get worse and have a wider impact.
Canyon County Paramedics are among many facing this problem.
"It's been variable. The medications we are having shortages of have been different over the last seven years," Blados added.
The organization has hit road blocks when ordering normal saline intravenous fluids in the sizes they need.
"It is our suppliers and it's pretty much all the suppliers we get medication and IV fluid from," Blados added.
But within the last several months, Canyon County Paramedics has been dealing with a lack of a concentration of epinephrine used on patients suffering cardiac arrest, which is 1:10,000 or 1 mg/10 mL. This is a drug first responders absolutely must have, Blados says.
But they found a solution: currently, their paramedics are making the formula themselves by using a different concentration used for allergic reactions (1:1,000 or 1 mg/mL) and diluting it.
"Luckily, we've received training on this and paramedics understand how to do this sort of thing and they're pretty good at adapting and overcoming. It makes their job harder to have to do this midstream when you're taking care of a very sick patient."
Ada County Paramedics say there have been delays with getting this form of epinephrine; while they haven't taken the hit as hard, they're ready if they do.
"We've already developed a protocol, we already pre-packaged a solution on how we would take care of the problem if it does arise, and we've also educated our entire agency on if we do run out of the pre-fill, this is what you're going to do in place," Ada County Paramedics Training Captain, Dina Hardaway, said. "All of our ambulances are stocked with [pre-filled epinephrine] and because there was this shortage that was announced, we went ahead and proactively prepared kits that our paramedics and field personnel will utilize in the event that we do run out of the pre-filled."
Those pre-packaged kits will make it quicker and easier for paramedics to make the right solution to treat cardiac arrest.
Like Canyon and Ada county paramedics, St. Luke's Health System is aware of the issue and has a game plan.
"Our pharmacy buyers do a great job of monitoring our supplies, our supply lines and our usage to identify if we're going to have any supply issues," Dotter told KTVB, "If we do have any supply issues, our pharmacists and physicians work well together to develop alternative therapy recommendations so that we can reserve these medications for those who need it most."
Dotter says the health care system works with their buyers and wholesalers and contracts with compounding pharmacies to try to get other formulations of these medications, as well as develop safe, effective and cost-effective alternatives.
In addition the drugs previously mentioned, St. Luke's has also seen a shortage of sodium bicarbonate, but the FDA has temporarily authorized the import of Australian medication.
On top of shortages, prices of many IV medications have gone up dramatically.
"Where we were paying $33 for a box of 1:1,000 epinephrine, the price has gone up to $491 for us," Blados added.
According to Blados, a box of ten epinephrine 1:10,000 vials has increased from $26.50 to $58.00. In addition, for example, a pre-load single dose syringe of Narcan 2 mg has increased from $12 to $52 and a box of 10 vials of atropine has increased from $34.80 to $133.60.
Those price hikes are reflective on budgets.
"It does lead to increase costs and it's something that we try to minimize and make sure we're using this only when we do need to use this," Dotter added. "It does lead to increased spending. That does stress and affect our budget."
Canyon County Paramedics say a greater portion of their budget is going to these increased costs. But the shortage and price increases haven't made an impact of user fees, Blados says.
"We're a large enough organization that it doesn't sting quite so much to have the cost go up, but it does hurt."
The Journal of Emergency Medical Services reports the FDA has taken a couple actions in response to different shortages: the agency has worked with a manufacturer to extend expiration dates of some batches of epinephrine, atropine and dextrose.