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Bureau for Public Health

Office of Emergency Medical Services


Return to Medical Direction

Drug Shortage Efforts

The national drug shortage continues to impact Emergency Medical Services and their ability to obtain certain medications. WVOEMS has developed a program to allow agencies to:

  • Review alternative supply distribution options
  • Report drug supply concerns
  • Request relief when drug supplies are below required quantities

 

 


Relief Granted

Referenced Drug Time Frame 1 Scope of Relief 2 Relief Granted

1 - All relief granted by the Office of Emergency Medical Services are temporary and have a defined time-frame in which the relief is valid.
2 - Relief may be granted to an agency, a region, or to the whole state. Relief which was granted to an agency is only valid for that agency.  



Relief Denied

Referenced Drug Agency Date
Requested		 Reason
Diltiazem Hydrochloride HealthTeam Critical Care Transport, LLC 3/5/2019 See previous diltiazem substitution with verapamil relief statement.

Relief Expired

Referenced Drug Time Frame 1 Scope of Relief 2 Relief Granted
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 4/13/2016 to 7/12/2016 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
D50W, 25 gm pre-loaded syringe 4/13/2016 to 7/12/2016 Statewide policy online
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 4/13/2016 to 7/12/2016 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Atropine, 1 mg pre-loaded syringe 2/7/2013 to 9/3/2013 Statewide Due to the nationwide shortage/unavailability of ATROPINE, the following relief is being offered to all WV Licensed EMS Agencies. Protocols affected are the following : 4205 Pulseless Arrest, 4211 Symptomatic Bradycardia, 4407 Dysrhythmia - Pediatric, 9202 Nerve Agent, Agencies with ATROPINE may continue to use the medication as directed by protocol until their stock is depleted. Agencies without ATROPINE are to notify Medical Command that the medication is not available. There are no alternatives available for ATROPINE. Patient therapy requiring atropine (4205, 4211 , 4407) are to utilize PACING instead. • 4205 Pulseness Arrest - PACEMAKER 4211 Symptomatic Bradycardia - PACEMAKER 4407 Dysrhythmia - Pediatric - PACEMAKER Protocol 9202 will be reviewed further and a decision will be made at a later date. If Mark-1 kits are available; continue to follow protocol. Otherwise use 2-Pam (pralidoximine) and treat symptoms accordingly. No formal/permanent change to the State Protocols will occur at this time in anticipation of future ATROPINE availability. This relief/directive will be effective starting 2/11/2013 and will continue for 90 days until 5/10/2013. If ATROPINE is still unavailable, this directive will be reviewed and renewed. All vehicle equipment lists will temporarily change from the current requirement of 3 Atropine doses on class "C" ALS vehicles to be optional with no required quantity for the 90 day extension . A memo outlining these changes will be forwarded to all Medical Command Facilities outlining these protocol treatment options.
D50W, 25 gm pre-loaded syringe 3/4/2013 to 7/5/2013 Statewide Due to the nationwide shortage / unavailability of D50W, the following relief is offered to all licensed West Virginia EMS agencies. Protocols affected are the following: 4604 Diabetic Emergencies Agencies with D50W may continue to use the medication as directed by protocol until their stock is depleted. Agencies without D50W may use the modified protocol utilizing D5W. No formal/permanent change to State Protocols will occur at this time in anticipation of future D50W availability. This relief/directive will be effective starting 4/5/2013 and will continue for 90 days until 7/5/2013. If D50 is still unavailable, this directive will be reviewed and renewed.
Normal saline, 0.9%, 1,000 ml 2/19/2014 to 11/20/2014 Statewide Substitute Lactated Ringers for normal saline until NS becomes available again
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 4/13/2016 to 7/12/2016 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 4/13/2016 to 7/12/2016 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 4/13/2016 to 7/12/2016 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Fentanyl (Sublimaze), 200 mcg total 12/7/2017 to 3/7/2018 statewide morphine may be used in lieu of fentanyl.
D50W, 25 gm pre-loaded syringe 12/7/2017 to 3/7/2018 statewide until D50W is available stock can be reduced from 2 per vehicle to 1 per vehicle, until epinephrine is available stock can be reduced from 6 per vehicle to 4 per vehicle. see the other relief provided
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 12/7/2017 to 3/7/2018 statewide see relief
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 12/7/2017 to 3/7/2018 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 12/7/2017 to 3/7/2018 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 12/7/2017 to 3/7/2018 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 12/7/2017 to 3/7/2018 Statewide Use 1ml of Epinephrine 11000 solution added to 9ml of Normal Saline results in 10 ml of 110,000 concentration.
Normal saline, 0.9%, 1,000 ml 1/2/2018 to 4/2/2018 Statewide Lactated Ringers may be substituted for Normal Saline
Epinephrine, 1:1,000, 1 mg 1/2/2018 to 4/2/2018 Statewide Due to the shortage of epinphrine ampules, 30 ml 30 mg vial may be used to mix to a 110,000 cardiac concentration. Draw 1ml 1mg in a syringe add 9cc of normal saline to make the 110,000 cardiac concentration.
Normal saline, 0.9%, 1,000 ml 1/2/2018 to 4/2/2018 Statewide Lactated Ringers can be substituted for O.9 Normal Saline
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 3/21/2018 to 6/19/2018 See previous requests for relief. Relief has been granted. See the Relief Section.
Lidocaine (Xylocaine), 100 mg pre-loaded syringe 3/21/2018 to 6/19/2018 Statewide Substitute Lidocaine bolus and drip with appropriate Amiodarone dosage and drip. Amiodarone 300 mg and treat reversible causes consider 150 mg dose if no conversion in 3 - 5 min. See protocol 4205 cardiac arrest
Fentanyl (Sublimaze), 200 mcg total 6/11/2018 to 9/9/2018 Statewide Morphine can be substituted for Fentanyl. Caution with inferior wall MI. IF agency obtains OPTIONAL KETOROLAC this medication is not on the current equipment list and is Optional to temporarily carry and non-narcotic pain medication appears more appropriate for patient, administer ketorolac Toradol 15 mg IV or 30 mg IM per MCP order. This applies to Paramedic and ACT certification only. Any and all doses require MCP ORDER.
Morphine, 20 mg total 6/11/2018 to 9/9/2018 Statewide Fentanyl may be used as a substitute for Morphine. IF agency obtains OPTIONAL KETOROLAC this medication is not on the current equipment list and is Optional to temporarily carry and non-narcotic pain medication appears more appropriate for patient, administer ketorolac Toradol 15 mg IV or 30 mg IM per MCP order. This applies to Paramedic and ACT certification only. Any and all doses require MCP ORDER.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 7/2/2019 to 9/30/2020 statewide Due to the nationwide shortageunavailability of Epinephrine, the following relief is being offered to all WV Licensed EMS Agencies. Use 1ml of Epinephrine 1.1000 solution added to 9ml of Normal Saline results in 10 ml of 1.10000 concentration.
Epinephrine, 1:10,000, 1 mg pre-loaded syringe 4/2/2019 to 7/1/2019 Statewide See Relief posted
Diltiazem Hydrochloride 4/2/2019 to 9/30/2020 Statewide Verapamil may be substituted for diltiazem in protocol 4208. Acute setting 5 IV over 2 minutes 2nd dose of 10 mg IV PER MEDICAL COMMAND PHYSICIAN may be given 15-30 minutes later if needed. Further dosages need an order PER MEDICAL COMMAND PHYSICIAN. Elderly In general, use lower adult dosage and administer over at least 3 minutes. Contraindications severe LV dysfunction hypotension SBP 90 cardiogenic shock sick sinus syndrome without pacemaker 2nd or 3rd deg ree AV block without pacemaker A-Fibflutter conducted via accessory pathway ie, Wolff -Parkinson-White Major Side Effects hypotension, heart block, HF
D50W, 25 gm pre-loaded syringe 7/1/2019 to 6/30/2020 Statewide Adult Only 1. If blood glucose is less than 60 mgdL, administer 10 dextrose in 50 mL 5 grams boluses, one minute apart, to a maximum of 250 ml, until A the patient has a return to normal mental status, and B the patients blood glucose is at least 60 mgdL. 2. If, following 250 mL of 10 dextrose, patient has persistent altered mental status and blood glucose less than 60 mgdL, contact medical command for repeat dosing orders. If unable to start IV and blood glucose is less than 60 mgdL, administer 1 mg glucagon IM.
D50W, 25 gm pre-loaded syringe 7/1/2019 to 6/30/2020 STATEWIDE Adult Only 1. If blood glucose is less than 60 mgdL, administer 10 dextrose in 50 mL 5 grams boluses, one minute apart, to a maximum of 250 ml, until A the patient has a return to normal mental status, and B the patients blood glucose is at least 60 mgdL. 2. If, following 250 mL of 10 dextrose, patient has persistent altered mental status and blood glucose less than 60 mgdL, contact medical command for repeat dosing orders. If unable to start IV and blood glucose is less than 60 mgdL, administer 1 mg glucagon IM.

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