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

Abstract

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.