Environmental temperature stress on drugs in prehospital emergency medical service

Helm, Matthias; Castner, Thomas; Lampl, L.

doi:10.1034/j.1399-6576.2003.00062.x

Cited by 23 publications

(6 citation statements)

References 14 publications

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“…17 Very high temperatures, such as those of the backpack (above 60°C), may also affect the integrity of the packaging of the medicines. 12 The extremely low temperatures of checked luggage on aeroplanes could affect the physical stability of some liquid preparations, such as solutions, suspensions and emulsions. If temperatures became sufficiently cold for protein-based formulations to freeze, this would very likely lead to protein denaturation.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in other settings have found problems with medicines storage. Temperatures in emergency medical vehicles, such as helicopters and ambulances, were found to exceed recommended storage conditions on hot days, 12,13 as did those in a doctor's bag in two cars. 10 This study was undertaken to investigate where people in New Zealand store their medicines and why, and to describe the conditions (temperature and relative humidity) in such places.…”

Section: Introductionmentioning

confidence: 98%

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Personal medicines storage in New Zealand

Hewson

Shen²,

Strachan³

et al. 2013

J Prim Health Care

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INTRODUCTION: Poor storage of medicines can reduce their efficacy, yet little is known about how people store medicines in their homes and elsewhere, why these locations are chosen, and whether the conditions are suitable for medicines storage. AIM: To investigate where medicines are commonly stored in New Zealand households, why, and the typical conditions temperature and relative humidity in those places of storage. METHODS: Data from a large qualitative study on the meanings of medicines were analysed to explore where people store medicines in their households, and why. A data logger was used to log temperature and relative humidity in common medicine storage places, such as homes and cars. RESULTS: Kitchens and bathrooms were the most commonly reported storage places, with people influenced by convenience, desire to remember to take medicines, and child safety when deciding where to store medicines. High temperatures and humidity were found in kitchens and bathrooms, extreme temperatures in a car and a backpack, and extremely low temperatures in checked-in luggage on a plane. DISCUSSION: Temperature- and humidity-sensitive medicines should not be stored long-term in common storage locations, such as kitchens and bathrooms. Conditions in these places may not comply with the recommended storage conditions given by the manufacturer. Furthermore, medicines should not be left in backpacks or cars, especially if the vehicle is in the sun. Medicines that may degrade upon freezing and thawing such as protein-containing medicines, emulsions, suspensions and some solutions should not be stored in the cargo hold of a plane. KEYWORDS: Drug storage; humidity; New Zealand; temperature

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Personal medicines storage in New Zealand

Hewson

Shen²,

Strachan³

et al. 2013

J Prim Health Care

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show abstract

“…The maximum temperatures recorded in our study did exceed that of a previous study from Johannesburg. 3 Research from Europe 5 and America 6 have reported similar maximum temperatures. Very little is known about medications' stability profile in the pre-hospital setting, especially when subjected to significant variation and high temperatures.…”

Section: Design and Methodsmentioning

confidence: 84%

Medication storage in Emergency Medical Services: Temperature ranges from a South African sample

Wylie

Rambharose

Ebrahim

et al. 2021

SAJPEC

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Background: Pre-hospital emergency care providers working in emergency medical services (EMS) are licenced to administer medication to the acutely ill and injured. In South Africa, there are significant seasonal variations in temperature, sometimes far exceeding the recommended medication storage temperature. The aim of this study was to determine the summer temperature ranges inside select emergency vehicles and storage facilities in four provinces in South Africa. Methods: A prospective, observational study was conducted in four (Cape Town, Western Cape; Johannesburg, Gauteng; Durban, KwaZulu-Natal; Potchefstroom, North West) provinces during the summer (February -March) months of 2019. A continuous temperature monitoring device was placed in the medication storage room, the response vehicle drug bags, and an ambulance at a single private EMS base in each of the provinces. Temperature data were recorded in fifteen-minute intervals. The data were extracted after six weeks and subjected to descriptive analysis. Data were also analysed in sixhourly strata to account for daily temperature variations. Results: A total of 36 002 temperature readings were recorded during the study period. The mean (range) temperature across the four bases was 25.4°C (13.1-56.8) for ambulances, 25.7°C (13.3-49.1) for primary response vehicles, and 24.4°C (17.3-33.9) for medication storage facilities. The highest mean (range) temperatures, of 33.7°C (20.4-47.9), were recorded in a Johannesburg-based primary response vehicle between 12h00 and 18h00. Conclusion: Current medication storage and transportation practices in the pre-hospital setting do not maintain temperatures according to the recommended storage conditions. Further investigation should address the implication of temperature fluctuations on medication degradation, and a sustainable, cost-effective solution should be developed to store medication in the pre-hospital setting.

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“…For summer conditions, maximum inner temperatures up to 60 °C were determined, and for wintertime, minimum temperatures significantly below the freezing point [18, 21]. It became evident that either active heating or cooling systems should be used [18, 22] or other efforts made to maintain the recommended temperatures when passive storage systems are used. However, to the knowledge of the authors, no systematic investigations on the suitability or practicability of passive storage boxes for drug transport in vehicles have been published so far.…”

Section: Discussionmentioning

confidence: 99%

How to transport veterinary drugs in insulated boxes to avoid thermal damage by heating or freezing

2017

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BackgroundThe transport of veterinary drugs must comply with the general standards for drug storage. Although many vehicles are equipped with active heating and/or cooling devices assuring recommended storage conditions, simple insulated transport boxes are also often used. In this study, measurements for typical transport boxes were performed under laboratory conditions by the use of a climate chamber for a temperature of −20 °C and 45 °C to investigate the impact of box size, insulation material, liquid vs. dry filling products, filling degree and other parameters on the thermal performance of insulated boxes. Model calculations and instructions are presented to predict the retention time of recommended drug storage temperatures.ResultsThe measurements and the model calculations showed that the loading of the transport boxes with additional water bottles to increase the heat capacity is appropriate to prolong the retention time of the recommended temperature range of the drugs. Insulated transport boxes are not suitable to store drugs over a period of more than approximately 12 h. For practical use a recipe is presented to measure the thermal properties of a transport box and the related retention time for which the recommended storage temperatures can be assured.ConclusionsThe following principles for drug transportation in vehicles are recommended: (1) Before transfer into boxes, drugs should always be thermally preconditioned (2) Increase the filling degree of the boxes with thermally preconditioned water bottles or re-usable thermal packs will increase the heat capacity. Do not deep-freeze the bottles or packs below 0 °C to avoid drug freezing due to contact. (3) Open the lid of the boxes only to uncase drugs that are immediately needed. (4) The bigger the box and the higher the filling degree, the longer the retention time of the transport box. (5) Wherever possible, place the drug box at a cool site inside the vehicle. (6) The monitoring of the inside temperature of the transport boxes is recommended. By the proper use of such transport boxes the recommended temperatures can be maintained over one working day.

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Environmental temperature stress on drugs in prehospital emergency medical service

Abstract: These results show that even in a moderate climatic zone, drugs used in prehospital EMS are significantly influenced by temperature stress; furthermore, these results recommend the usage of temperature-controlled drug boxes.

Cited by 23 publications

References 14 publications

Personal medicines storage in New Zealand

Personal medicines storage in New Zealand

Medication storage in Emergency Medical Services: Temperature ranges from a South African sample

How to transport veterinary drugs in insulated boxes to avoid thermal damage by heating or freezing

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