(M0930-06-34) Stability of Medications Used by Qatar’s Ambulance Service in Rapid Response Vehicles: Protocol Development

Purpose: Paramedics need a range of medications that are stored in bags for easy transportation to the patient’s side and are exposed to temperature variations, especially in a hot country like Qatar¹. The thermal stability of some medications was examined in previous studies^2,3.

Methods: A safe and practical solution had to be found and should be approved by the Production committee to investigate the thermal stability of a range of 13 medications over different periods of time (Table 1).

Results: Six medication bags have been specially prepared with the drug samples presented in Table 1. While one data logger was fixed to the metal net divider at the back of the rapid response vehicle, each bag contained a radio-frequency identification (RFID) tag for tracing, two data loggers to measure the temperature and humidity every 10 minutes over a 3 to 12-month period, and an initial 15 drug samples (Table 1). The bags have been labeled “For research purpose” and placed at the back of rapid response vehicles (Figure 1). At collection times, 3 samples of each medication will be removed for analysis and replaced by new samples. Similarly, data loggers will be collected and replaced with new ones. As per Qatar Ambulance Service’s standard operating procedures, paramedics are required to always keep their medication bag with them when they leave their vehicle for a break or to treat a patient, but for practical and safety reasons it will not be the case with the research samples. Although this means that the research bags will have less exposure to the outdoor environment, they will still be subjected to temperature variation in case the vehicle is parked without air conditioning1. The collected samples will be kept at 4°C until analyzed by high-performance liquid chromatography.

Conclusion: Based on the findings of this study, the results may have a significant impact on how some of the drugs are handled in the pre-hospital setting, especially, possible modification of the recommended expiration date specified by manufacturers to ensure patient safety.

References: [1] Rachid O, Makhlouf A, Kerkeni H, Alinier G. Monitoring temperature and humidity in ambulance service rapid-response vehicles and paramedics medication bags: A pilot study, Journal of Emergency Medicine, Trauma & Acute Care 2022:59
[2] Rachid O, Obasi J, Mohamed Ibrahim M, Diab M, Al-Moslih A, Makhlouf A, et al. A systematic review of stability of medicines used in emergency medical service settings. J Emerg Med Trauma Acute Care. 2020(3):8.
[3] Armenian P, Campagne D, Stroh G, Ives Tallman C, Zeng WZD, Lin T, et al. Hot and Cold Drugs: National Park Service Medication Stability at the Extremes of Temperature. Prehosp Emerg Care. 2017;21(3):378 – 85.

Acknowledgements: The researchers acknowledge HMCAS for funding the study by providing the required medication samples. This work was made possible by the Qatar National Research Fund [UREP25-069- 3-021] and Qatar University Student Grants [QUST-1-CPH-2020-11, QUST-2-CPH-2019-23, QUST-1-CPH- 2019-7, QUST-2-CPH-2018-6]. The analysis of medication samples will be accomplished in the Central Laboratories Unit at Qatar University. The contents herein are solely the responsibility of the authors.


Table 1. The list of medications with a schedule of sample collections.


Figure 1. Research bag containing drug samples and data loggers.