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Predrawn prehospital medications are microbiologically safe for up to 48 hours
  1. Torgrim Soeyland1,
  2. Alan Garner2,
  3. Sam Vidler3,
  4. Cristian Humberto Gutierrez4,
  5. Arnold Foster5,
  6. Jane Kitcher5
  1. 1Hunter Retrieval Service, John Hunter Hospital, New Lambton, New South Wales, Australia
  2. 2Operations, CareFlight Ltd New South Wales, Wentworthville, New South Wales, Australia
  3. 3Hunter Retrieval Service, Hunter New England Local Health District, New Lambton, New South Wales, Australia
  4. 4John Hunter Hospital Emergency Department, Hunter New England Local Health District, New Lambton, New South Wales, Australia
  5. 5New South Wales Health Pathology, Hunter New England Local Health District, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Torgrim Soeyland, Hunter Retrieval Service, John Hunter Hospital, New Lambton, NSW 2305, Australia; Torgrim.Soeyland{at}health.nsw.gov.au

Abstract

Background Prehospital medical teams are commonly required to administer a range of medications for urgent stabilisation and treatment. The safe preparation of medications during resuscitation requires attention, time and resources, and can be a source of medication error. In our two road and HEMS (Helicopter Emergency Medical Service) prehospital services, medication errors are mitigated by predrawing commonly used medications to set concentrations daily (Hunter Retrieval Service, HRS) or second-daily (CareFlight Sydney, CFS). However, there are no published data confirming that such practice is microbiologically safe.

Methods A convenience sample of 299 predrawn medication syringes with syringe dwell times up to 48 hours were collected at the end of their operational deployment. Predrawn medication syringes collected for culture were ketamine, midazolam, fentanyl, thiopentone, rocuronium, suxamethonium, metaraminol and normal saline. The samples were incubated and cultured at a tertiary hospital pathology laboratory using best-practice methodology for non-tissue samples. The samples were collected from June 2017 to February 2018.

Results The mean dwell times ranged from 30.7 hours (fentanyl at HRS) to 48.5 hours (rocuronium at CFS). None of the 299 cultured samples yielded significant micro-organisms. One sample of suxamethonium with a syringe dwell time of 34 hours grew Bacillus cereus but was likely a contaminant introduced during sample collection.

Conclusion Predrawing of the eight studied medications for urgent prehospital procedures appears to be a microbiologically safe practice with syringe dwell times up to 48 hours.

  • acute care
  • prehospital care, advanced practitioner
  • resuscitation

https://doi.org/10.1136/emermed-2018-207864

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    Footnotes

    • Contributors TS designed the study. TS, AG, SV and CHG were involved in sample collection, and literature and document reviews. AF and JK were involved in laboratory processing and document review. All listed authors partook in several stages of the preparation of the submitted document.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Hunter New England Local Health District Human Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement An extensive spreadsheet listing all sampled medications with their syringe dwell time, and so on, are available on request.