Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study.

Pietsch, Urs; Moeckel, Johannes; Koppenberg, Joachim; Josi, Dario; Jungwirth, Arne; Hautz, Wolf E; Wenzel, Volker; Strecke, Stephan; Albrecht, Roland (2022). Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study. Annals of emergency medicine, 80(4), pp. 364-370. Elsevier 10.1016/j.annemergmed.2022.05.038

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STUDY OBJECTIVE

Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year.

METHODS

A prospective, longitudinal study measuring the temperature exposure and concentration of drugs stored on 2 rescue helicopters in Switzerland over 1 year. The study drugs included epinephrine, norepinephrine, amiodarone, midazolam, fentanyl, naloxone, rocuronium, etomidate, and ketamine. Temperatures were measured inside the medication storage bags and the crew cabins at 10-minute intervals. Drug stability was measured on a monthly basis over the course of 12 months using high-performance liquid chromatography. The medications were considered stable at a minimum remaining drug concentration of 90% of the label claim.

RESULTS

Temperatures ranged from -1.2 °C to 38.1 °C (29.84 °F to 100.58 °F) inside the drug storage bags. Of all the temperature measurements inside the drug storage bags, 37% lay outside the recommended storage conditions. All drugs maintained a concentration above 90% of the label claim. The observation periods for rocuronium and etomidate were shortened to 7 months because of a supply shortage of reference samples.

CONCLUSION

Drugs stored under the real-life conditions of Swiss HEMS are subjected to temperatures outside the manufacturer's approved storage requirements. Despite this, all drugs stored under these conditions remained stable throughout our study. Real-life stability testing could be a way to extend drug exchange intervals.

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