Storage temperatures of medications on an air medical helicopter

Szucs, Paul A.; Fields, Laura Ashley; Grabiner, Frederick R.; Lavery, Robert F.; Prusik, Thaddeus; Tortella, Bartholomew J.

doi:10.1016/s1067-991x(00)90087-7

Cited by 10 publications

(9 citation statements)

References 3 publications

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“…Storage temperatures for drugs have been studied in human medical emergency service vehicles [ 4 – 7 ], medical helicopters [ 8 ], as well as medical bags [ 9 ], and storage container temperature frequently falls outside of label ranges. In a model of stock rotation based on actual measured temperatures in ambulances in five U.S. cities (Topeka, Orlando, Mesa, Portland and Syracuse), excessive heat occurred in all, including the northern cities [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Temperatures of storage areas in large animal veterinary practice vehicles in the summer and comparison with drug manufacturers’ storage recommendations

2015

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BackgroundLarge animal veterinarians carry drugs in their practice vehicles in storage areas that are not typically refrigerated. The most common upper limits of manufacturers’ storage temperatures for United States (U.S.)-approved non-refrigerated drugs are 25 or 30 °C. Because ambient temperatures in many locations in the U.S. exceed these temperatures during the summer, we measured storage area temperatures over 4 months in the summer of 2013 to evaluate the extent to which labeled storage temperatures are exceeded.MethodsA convenience sample of 12 vehicles from 5 central Texas practices and 12 vehicles from 4 south central Nebraska practices was used. Temperatures were recorded in one drug storage compartment in each vehicle from May 15 – September 16, 2013, at 15-minute intervals using a self-contained, battery operated temperature recording device.ResultsThe highest temperatures recorded in a storage unit were 54.4 and 47.7 °C in Texas and Nebraska, respectively. The mean temperature recorded across all 24 storage units was 29.1 °C, with a mean of 26.9 °C in Nebraska and 31.4 °C in Texas. In Nebraska, at least one temperature over 25 °C was recorded on a mean of 111/124 days and a mean of 63 % of total logger readings. In Texas, temperatures over 25 °C were recorded on a mean of 123/124 days and a mean of 95 % of total logger readings.ConclusionsTemperatures in storage units in participating veterinary practice vehicles exceeded labeled drug storage temperatures a significant portion of the summer of 2013. More research is needed to determine whether these excursions above the manufacturers’ recommended storage temperatures alter efficacy of stored drugs.

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Section: Introductionmentioning

confidence: 99%

Temperatures of storage areas in large animal veterinary practice vehicles in the summer and comparison with drug manufacturers’ storage recommendations

2015

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“…These temperatures were chosen based on previous studies which tested drugs at extreme temperatures, known prehospital temperature derangements, and presumed wilderness expedition extremes. [11][12][13]15,16 The seven-day time period and 12-hour temperature cycles were based on a previous study which assessed the effects of freeze/thaw cycles on epinephrine and was meant to reflect the conditions likely encountered in a one-week expedition. 17 After the seventh day, aliquots of TXA were diluted to 1mg/mL with water and an internal standard of stable isotope-labeled TXA (C 6 13 C 2 H 15 15 NO 2 ) was used (Toronto Research Company; Toronto, Canada) for comparison.…”

Section: Methodsmentioning

confidence: 99%

“…Multiple studies have already shown large fluctuations in storage temperatures of prehospital medications. [12][13][14] Medication storage temperatures within air-medical helicopters may range from 13ºC-31ºC. 12 Ambulance storage temperatures can reach greater than 40ºC in summer and as low as -14ºC in the winter.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] Medication storage temperatures within air-medical helicopters may range from 13ºC-31ºC. 12 Ambulance storage temperatures can reach greater than 40ºC in summer and as low as -14ºC in the winter. 13 A one-year-long observational study of Emergency Medical Service vehicles in Arizona, Florida, Kansas, Oregon, and New York (USA) found that medication storage temperatures in all five locations reached temperatures outside of the United States Pharmacopeia (USP; Bethesda, Maryland USA) controlled room temperature standards.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Fluctuating Extreme Temperatures on Tranexamic Acid

Loner

Estephan

Davis

et al. 2019

Prehosp. Disaster med.

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Introduction:Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce morbidity and mortality in hemorrhagic shock. It has potential use in prehospital and wilderness medicine; however, in these environments, TXA is likely to be exposed to fluctuating and extreme temperatures. If TXA degrades under these conditions, this may reduce antifibrinolytic effects.Problem:This study sought to determine if repetitive temperature derangement causes degradation of TXA.Methods:Experimental samples underwent either seven days of freeze/thaw or heating cycles and then were analyzed via mass spectrometry for degradation of TXA. An internal standard was used for comparison between experimental samples and controls. These samples were compared to room temperature controls to determine if fluctuating extreme temperatures cause degradation of TXA.Results:The coefficient of variability of ratios of TXA to internal standard within each group (room temperature, freeze, and heated) was less than five percent. An independent t-test was performed on freeze/thaw versus control samples (t = 2.77; P = .17) and heated versus control samples (t = 2.77; P = .722) demonstrating no difference between the groups.Conclusion:These results suggest that TXA remains stable despite repeated exposure to extreme temperatures and does not significantly degrade. These findings support the stability of TXA and its use in extreme environments.

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“…Propofol should be stored between 4°C and 22°C [15]. A study of a US helicopter drug box found that the temperature exceeded 25°C for 37% of the time during the summer [16]. One author's experience (SJ) during Operation TELIC was that a stock of propofol had almost solidified during its presumably unmonitored journey along the supply chain at the height of an Iraqi summer.…”

Section: Propofolmentioning

confidence: 99%

Total Intravenous Anaesthesia for War Surgery

Lewis

Jagdish

2010

J R Army Med Corps

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Total Intravenous Anaesthesia (TIVA) and Target-Controlled Infusion (TCI) of anaesthesia are techniques that have benefited from recent advances in microprocessor technology and drug design. Though dependant on technology, they offer significant clinical benefits and logistic advantages. Manipulation of complex data derived from population pharmacokinetics has enabled greater understanding of drug handling models, thus enabling individual patient titration of anaesthesia. This has also informed manual techniques of intravenous anaesthesia. These approaches constitute a useful and logical alternative in the field, both in austere circumstances as well as the more established deployed setting. The pharmacodynamics and pharmacokinetics of potent intravenous anaesthesia agents in the complex combat trauma patient require continued examination.

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Storage temperatures of medications on an air medical helicopter

Cited by 10 publications

References 3 publications

Temperatures of storage areas in large animal veterinary practice vehicles in the summer and comparison with drug manufacturers’ storage recommendations

Temperatures of storage areas in large animal veterinary practice vehicles in the summer and comparison with drug manufacturers’ storage recommendations

Effect of Fluctuating Extreme Temperatures on Tranexamic Acid

Total Intravenous Anaesthesia for War Surgery

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