Drug shortages worry Tampa Bay emergency medical providers

A nationwide shortage of some lifesaving drugs has hit Tampa Bay emergency medical responders, forcing them to find other ways to care for their patients.

Paramedics regularly use many of the drugs to relieve pain, to help with a heart attack or to calm combative patients. So far, the EMS systems have been able to substitute one drug for another — for example, morphine instead of the painkiller fentanyl, which is in low supply.

The shortage is hitting especially hard in Pinellas, where most medications are back-ordered, EMS medical director Laurie Romig said. The problem is especially critical for pain relievers, sedatives and heart medications. Pinellas is down to its last doses of fentanyl. And Valium, used to calm combative patients and for seizures and pain management, is back-ordered.

"We're talking lifesaving drugs," Romig said. "I think it's going to get worse before it gets better."

Tampa and Hillsborough also are facing shortages of some commonly used medicines.

"It is problematic, yes, but it hasn't hit critical mass," said Nick loCicero, assistant chief of administration and rescue for Tampa Fire Rescue. "We're all in kind of the same boat."

The Tampa department has seen shortages of such drugs as Terbutaline, which helps asthmatics to breathe; Labetalol, used to regulate heart rhythm; and Cardizem, used for high blood pressure and other heart problems.

Karen Davidson, rescue division chief for Hillsborough Fire and Rescue, said the shortage has not centered on one drug but "changes daily." The department is finding it hard to get Versed, which can be used as a sedative or anesthetic. EMS paramedics frequently use it to make it easier to insert breathing tubes. Also back-ordered is magnesium sulfate, used as a muscle relaxer.

Sporadic drug shortages are not unusual, but the number of reported prescription drug shortages in the United States nearly tripled between 2005 and 2010, according to the federal Food and Drug Administration.

The shortages appear to be caused by several factors, according to a study by the U.S. Department of Health and Human Services. Among those: a lack of production capacity and expiration of patents, which allows other companies to make generics. It takes time, the HHS report said, for manufacturers to gear up to make the drugs.

Complicating the issue, Romig said, are the problems faced by Hospira, the Illinois company that makes many of the generic medications Tampa Bay emergency medical agencies use.

The FDA has criticized the company for inadequate quality controls. Hospira has said it is fixing the problems, but Romig said the situation makes things difficult for consumers.

"Right now, we don't know whether we will be able to continue getting drugs from that manufacturer," she said. "It could be very much worse if Hospira goes down."

In the short term, Tampa Bay area EMS systems have been substituting one drug for another. They also order different dosage sizes that are more readily available.

Romig has created a committee to study creative solutions to the problem.

Romig said no one calling 911 for help should worry: "We're doing everything we can to preserve our ability to treat our patients as we always have."

Reach Anne Lindberg at alindberg@tampabay.com or (727) 893-8450.