Temperature Control and Epi-Pen's

[dahlio]

At my system, we have epi-pen's on all our trucks (2 Adult, 2 Pedi). We have about 10 trucks, and keep them outside for the most part. What are the risk's keeping these medications outside? Remember it's New Jersey. What are the limits this medication can take before going bad, or maybe the constant warming and cooling hurts. Thanks in advance for the input.

-dahlio

[spenac]

Don't know about epi-pens as even our basics just use a syringe for epi.

Well here is what the maker says:

http://www.epipen.com/pdf/ord.fm.pdf

[web:bcb0718997]http://www.epipen.com/pdf/ord.fm.pdf[/web:bcb0718997]

[crotchitymedic1986]

Most drugs are supposed to be kept at a temperature range of 65-80 degrees, which is problematic for EMS in hot or cold climates. It is also another reason that many trauma patients arrive at trauma centers in a hypothermic state --- you cut all their clothes off, cover them with a thin sheet --- then pump in 1000 cc of 50-70 degree normal saline into a 98.6 degree body. The problem is that the drug breaks down in temperature extremes, so it may not work as well when you need it too. The problem is that most of the heater/coolers that we have tried to use either break down alot, or werent designed for medications (usually food/drink designed). If you take your average meat thermometer to your drug box in summer and winter (even those who house vehicles indoor), you will be shocked at the readings you get.

[Chief1C]

They last for about two years, shelf life. We kept our kit in the "wiring compartment" near the opening between the patient mod and cab. Easy to access, clean, neutral temperature - always around 70F.

[rock_shoes]

Why are you guy's using Epi-pens? That's a huge extra expense when 1mg/1mL epinephrine amps are so cheap. Is your medical director unwilling to let you draw up epinephrine? Our med's stay within a good temp range by default. The cars stay in a temp controlled bay, and they stay running with the climate control on when the outside temp is too warm or too cold.

[dahlio]

Not our medical director, the state's DOH is preventing us from having pre-filled syringes rather then the auto-injectors. So how cold does the inside of the ambulance get in 30-40 degree weather... I'm surprised we still keep them outside.

[crotchitymedic1986]

Unless the ambulance is left running, or you use some type of space heater, the drugs will be 30-40 degrees. Thats why i said, use a meat thermometer on a few random days and you will shocked. When i looked at this, we were specificially looking at IV fluids, and even though our trucks were housed in heated bays, the IV temps were still in the 60-70 degree range. Now you take your person struck by auto thats been laying on cold pavement for 10-15 minutes, in 30 degree weather, then pump 60 degree fluid in the patient.

[JakeEMTP]

When i looked at this, we were specificially looking at IV fluids, and even though our trucks were housed in heated bays, the IV temps were still in the 60-70 degree range. Now you take your person struck by auto thats been laying on cold pavement for 10-15 minutes, in 30 degree weather, then pump 60 degree fluid in the patient.

Yeah, we have a heater that one can place 4 bags of IV fluids on and they are heated to 98 degrees. They work great with the hypothermic patient or anyone for that matter with the colder weather setting in. Great little device. I'm surprised you don't have this on your ambulance in Canada.

[spenac]

Not our medical director, the state's DOH is preventing us from having pre-filled syringes rather then the auto-injectors. So how cold does the inside of the ambulance get in 30-40 degree weather... I'm surprised we still keep them outside.

We don't do pre-filled as they are more expensive and really do not save much time. All levels here just pop the top off the vial, pull up the epi into a cheap 1cc syringe, pop the patient. All done.

Sounds like your service is needing to invest in a controlled temp box for meds.

Another idea is take the drug boxes/bags in with you. 1 or 2 bags are not that hard to carry in/out. Attach the keys to the bag, so if you get toned out you have to get the bag to get the keys.

[crotchitymedic1986]

I live in Canada, but i do not work in EMS any longer, my field experience was all US. We purchased the heaters you are discussing, but the problem was that they didnt last long, and as you stated the heated to over 90 degrees which was outside the range recommended by the fluid manufacturer (too hot is as bad as too cold). The heat/cool units with programmable thermostats were $300-1000 each, which was too costly for our budget. We then went to a heating "tray" (a heating pad on one of the ALS shelves, which also allowed us to heat linens) as part of all new vehicle purchases ($600) as it was easy to hide that in the overall purchase price.