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Thomas EMS Clima-Tech Studies

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	Alteration in prehospital drug concentration after thermal exposure. Dustin L. Gammon, CCEMT-P, Shujun Su, PhD, Roger Huckfeldt, MD, Janet Jordan, MD, Robert Patterson, EMT-P, Phillip J. Finley, MS, Cindy Lowe, BS, CCRP
	The Hot and Cold of Medication Storage. By Lawrence H. Brown, EMT-P
	Medication Storage in the EMS Environment: Understanding the Science and Meeting the Standards. By Lawrence H. Brown & James D. Campagna
	Out-of-hospital medication storage temperatures: a review of the literature and directions for the future. Lawrence H. Brown, EMT-P, Kurt Krumperman, MS, EMT-P Christopher J. Fullagar, MD, EMT-P
	Effect of extreme temperatures on drugs for prehospital ACLS. R. Bart Johansen, Nathan C. Schafer, MD, FACEP, Paul I. Brown, MT, ASCP
	Thermal Stability of Prehospital Medications. Valenzuela TD - Ann Emerg Med - 01-FEB-1989; 18(2): 173-6 From NIH/NLM MEDLINE
	Environmental temperature stress on drugs in prehospital emergency medical service. M. Helm, Th Castner and L. Lampl
	Thermal degradation of injectable epinephrine. Church WH, Hu SS, Henry AJ.
	Environmental Temperature Variations Cause Degradations in Epinephrine Concentration and Biological Activity. Terry A. Grant, MD, Robert G. Carroll, PhD, William H. Church, PhD, Anthony Henry, N. Heramba Prasad, MD, Abdel A. Abdel-Rahman, PhD, E. Jackson Allison Jr. MD, MPH

Drug Adulteration In Prehospital Emergency Medical Services
Robert C. Kellow, Carter L. Fergusen, JD, Wade N. Spruill, Jr.
October, 1994
"...the EMS industry has been unable to establish, control, monitor and guarantee the stability and efficacy of the drugs administered to the American public."

"...some 800,000 more Americans will receive some form of prehospital drug - the identity, strength, purity and efficacy of which cannot be established, maintained or assured. The EMS community must take immediate steps to eliminate this unacceptable public health problem."

"The Palmer study found that temperatures encountered in the prehospital setting are far more extreme than those required for safe drug storage. Further, excessive medication temperatures are sustained, disproportionate to their ambient environment ... drugs used in the prehospital setting are being chemically altered as a result of the unacclimatized storage conditions that are indigenous to the EMS setting."

"Individual storage requirements (of all pharmaceuticals) must be observed throughout the distribution of the article, i.e., beyond the time it leaves the manufacturer, up to and including its handling by the dispenser or seller of the article to the consumer."

"Unknown to most is the fact that pharmaceutical manufacturers will not warrant their products if they are stored under conditions other than those specified on the articles' container."

The question, therefore, is not whether drugs administered in the EMS environment are causing fatalities but whether they are failing to prevent fatalities."