This poster explores the available literature/evidence with regards to the most appropriate storage temperatures for emergency care drugs in the pre-hospital setting and how they should be stored to reduce the likelihood of reduced efficacy

Phillips, Peter

Schroth, Christoph

Bournemouth University Research Online

05101520253035Degrees CelsiusMaximum Recommended Storage Temperatures75%80%85%90%95%100%105%Start 1 2 3 4 5 6 7EfficacyTime in MonthsAverage Deterioration of Drug Concentrations at Constant Ambient TemperaturesDiazepam (Gottwald)Lorazepam (Gottwald)Recommendations & Solutions  Commercially available, temperature regulated storage methods are the ideal solution, but even recreational   cooler bags or the use of Styrofoam containers to store  drugs, could provide more stability in extreme   temperatures (DuBois 2000).   High temperatures are likely to minimise efficacy or even entirely diminish it.   Low temperatures do not affect most drugs and they will be fully functional upon being defrosted.   Drug choice is dependent on the environment they are used in.   Further research is needed in this area, due to lack of high quality data and common protocols. The Impact of Drug Storage  Temperatures on their  Efficacy in Extreme  Environments An Evidence-Based Approach By C.Schroth & P. Phillips, Bournemouth University, 2017 Limitations  Studies did not all compare the same drugs or took place under the same conditions.  Insufficient data to adequately compare common drugs   (e.g. adrenaline, amiodarone, GTN)  Quality of studies often poor   (e.g. design, outcomes, secondary data use)  Not all manufacturers specify temperature ranges in their   documentation Background Pre-hospital care is delivered in almost every environment on earth and practitioners may encounter extreme heat, extreme cold or rapid changes in temperature, which can also affect their equipment and drugs. Practitioners may be operating in unfamiliar climates when, for example, providing humanitarian aid, on expeditions or providing  medical cover for oil exploration. In a medical emergency, it is crucial that practitioners know that the drugs administered have not degraded due to storage conditions.  Challenges  Drugs can degrade or become unusable outside certain temperature ranges  Ambient temperature variations  can be significant, even in the United   Kingdom  No clear guidance on best practice for drug storage in pre-hospital care exists  Temperature management technology is often impractical or unavailable Bibliography Brown, L. , Wojcik, S., Bailey, L., Tran, C. 2006. Can stock rotation effectively mitigate EMS medication exposure to excessive heat and cold? American  Journal of Emergency Medicine, 24 (1): 14-18. De Winter, S., Vanbrabant, P., Tuong Vi, N., Deng, X., Spriet, I., van Schepdael, A., Gillet, J. 2013. Impact of temperature  exposure on stability of drugs in a real-world out-of-hospital setting. Annals of Emergency Medicine, 62 (4): 380-387. DuBois, W. 1999. Drug storage temperatures in rescue vehicles. Journal of Emergency Medicine, 18 (3): 345-348. Gammon, D., Su, S., Jordan, J., Patterson, R., Finley, P., Lowe, C., Huckfeldt, R. 2008. Alteration in prehospital drug  concentration after thermal exposure. American Journal of Emergency Medicine, 26: 566-573.  Gottwald, M., Akers, L., Liu, P., Orsulak, P., Corry, M., Bacchetti, P., Fields, S., Lowenstein, D., Alldredge, B. 1999. Prehospital stability of diazepam and lorazepam. American Journal of Emergency Medicine, 17 (4): 333-337. Hogerzeil, H., Walker, G. 1996. Instability of (methyl)ergometrine in tropical climates: An overview. European Journal of  Obstetrics and Gynecology and Reproductive Biology, 69: 25-29. Szucs, P., Allegra, J., Fields, L., Grabiner, F., Lavery, R., Prusik, T., Tortella, B. 2000. Storage temperatures of medications on an air medical helicopter. Air Medical Journal, 19 (1): 19-21. Contact details: Christoph Schroth, cschroth@bournemouth.ac.uk; Peter Phillips, pphillips@bournemouth.ac.uk; Bournemouth University, United Kingdom (www.bournemouth.ac.uk) 

The impact of drug storage temperatures on its efficacy in extreme environments: an evidence-based approach.

http://eprints.bournemouth.ac.uk/30790/1/Poster_Extreme_Medicine_Expo2017_Final.pdf

The impact of drug storage temperatures on its efficacy in extreme environments: an evidence-based approach.

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