- The Washington Times - Wednesday, June 8, 2005

D.C. paramedics say their supervisors directed them to use expired medications this month because fresh supplies were unavailable.

The medications included such lifesaving drugs as epinephrine, which is used to treat asthmatics and allergic reactions, and nitroglycerin, which is used for heart-attack victims.

“Many of the individuals were simply told to disregard the June 1 expiration date and use them through the end of the month,” said Kenneth Lyons, president of the American Federation of Government Employees Local 3721, which represents the city’s medics.

Paramedics received fresh — but insufficient — quantities of medications Friday after Mr. Lyons called the department’s property division, various emergency medical services (EMS) supervisors and the head of EMS operations, the union leader said.

Alan Etter, spokesman for the D.C. Fire and EMS Department, said officials received complaints from two paramedics about expired drugs and quickly replaced their medications.

“On June 1, it was brought to the attention of our property division that they had expired medications, including epinephrine and nitro tablets,” he said. “Why on May 31 they weren’t notified is under review.

“As to the allegation they were told to use expired medication, that is an allegation and that will be looked into as well,” Mr. Etter said.

Using expired medication is an unacceptable practice in emergency medicine, said Paul M. Maniscalco, a board member of the National Association for Emergency Medical Technicians.

Such medications are “front-line” drugs that offer the first — and often best — chance for saving a life, he said.

“If you establish a standard with protocols, you have a moral and ethical responsibility to provide the tools to operate up to that standard,” Mr. Maniscalco said. “Clearly, a professional EMS system that is required to give top-notch care is going to make sure they have those medications.”

Several paramedics told The Washington Times that they questioned superiors or supply personnel about the expired medications and that they were told to continue using them.

One paramedic said he was told on two occasions by supervisors to continue using the drugs. One of the supervisors said the medications were effective beyond the expiration date.

Another paramedic said he was told by a property division employee and by an EMS supervisor to continue using the expired drugs.

“‘You have been authorized to use it for another 30 days,’ is what I was told,” said the paramedic, who asked not to be identified.

A third paramedic said he was instructed to use expired medications by someone in the property division because no unexpired medications were available.

Mr. Etter said it is the responsibility of paramedics to report any expired medications to supervisors, who then notify property division to replenish supplies. Only two paramedics have done so, he said.

Mr. Lyons said it is “absurd” for fire officials to say that only two units were carrying expired medications.

“We all get the same medications,” he said. “It expires at the same time.”

Mr. Lyons said that ordinarily his ambulance carries 20 doses of epinephrine 1:1000, three doses of nitroglycerin and between six and 10 doses of adenosine.

On Friday, his ambulance was stocked with five doses of epinephrine, one dose of nitroglycerin and two doses of adenosine, which is used to slow extremely fast heart rates.

“We have a very limited supply,” he said. “The medicine we do have is not sufficient to carry out for the next month.”

Mr. Lyons said those medications are especially critical at this time of year, when the weather gets warmer and air quality worsens. He predicted that the shortage would lead to providers stealing medications from hospitals or bartering among ambulance crews.

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