Pharmaceutical Shortage Update

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W e s t c h e s t e r R e g i o n a l E M S C o u n c i l Est. 2001 R E M A C A D V I S O R Y Pharmaceutical Shortage Update Issued: July 15, 2010 The Westchester Regional Emergency Medical Advisory Committee (REMAC) has received additional notification from the New York State Department of Health, Bureau of EMS regarding the continuing shortage of pharmaceuticals commonly found in the pre-hospital care environment. To better understand the potential and real affects on the EMS system, the Bureau has asked for feedback from all REMAC members, ALS agency medical directors, and ALS agency operations officers via Regional EMS offices. ALS services are advised to communicate with their medical directors, supplying hospital pharmacies and/or vendors to review current inventories and contingency plans. Notification of critical medication shortfalls should be made to the Regional EMS office by calling (914) 231-1616 as soon as possible so that REMAC may institute any needed protocol modifications. Enclosed are the following items relevant to the situation: Letter from the NYSDOH dated June 10, 2010 Pharmaceutical back order matrix Additional information regarding specific medication shortages may be found at the FDA website for drug shortages: http://www.fda.gov/drugs/drugsafety/drugshortages/ucm050792.htm Please refer all questions regarding this advisory to the Regional EMS office. Thank you for your attention to this matter. Issued by: Dr. Nicholas DeRobertis, MD, FACEP Chair, Westchester Regional Emergency Medical Advisory Committee Regional Medical Director, Westchester Regional EMS Council REMAC ADVISORY - Pharmaceutical Shortage Update-July2010.doc / Page 1 of 1

July 7 2010 Pharma Backorder Report BT item # 379094 379425 Description Mfctr ETA for next release Date Mfctr expects back orders to clear Possible sub ** Description C2 FENTANYL 0.05MG/ML 2ML SDV 25/BX No ETA No ETA 371124 C2 FENTANYL 0.05MG/ML, 5ML SDV 25/BOX No ETA Fall 2010 371133 371120 C2 MORPHINE 2MG, 1ML LL CPJ 10/BX July Fall 2010 370178 C4 LORAZEPAM 2MG 1MLL CPJ 10/ bx 371102 * July unknown 0102-01S C2 FENTANYL 0.05MG/ML 2ML AMPULE 10/BOX (new 222 form would be required in order to receive the sub item) C2 Fentanyl 0.05mg/ml, 5ml ampule 10/ box (new 222 form would be required in order to receive the sub item) 371121 C2 MORPHINE 4MG, 1ML CPJ 10/BX July Fall 2010 370178 Morphine 10mg, 1ml vial 25/ box Morphine 10mg, 1ml vial 25/ box (new 222 form would be required in order to receive the sub item) C4 LORAZEPAM 2MG 1ML VIAL 25/BOX *CS01 1273-05 C4 DIAZEPAM 10MG, 2ML isecure 10/bx July July 371101 DIAZEPAM 10MG, 2ML LL CPJT 10/ BOX 371775 DEXTROSE 25% 10ML ANSYR SYRINGE July August 0074490201 DEXTROSE 50% 25GM 50ML LIFESHIELD SYRINGE late July August Currently all Dextrose products (for 377515 DEXTROSE 50% 50ML ANSYR SYRINGE July September These are single source items from Hospira. D6648-02 Dextrose 50% 50ml Vial late July late July 1171-01EA DILTIAZEM (CARDIZEM) 25MG 5ML VIAL *REFRIGERATED* No ETA unknown 0510-01 370510 DILTIAZEM/CARDIZEM 25MG 5ML VL *REFRIG* mid July unknown 0510-01 0517113001 EPINEPHRINE 1:1000 30ML MDV next week mfctr discontinuing 3001-05 EPINEPHRINE 1:1000 30mL MDV Scheduled to release next week 374921 EPINEPHRINE 1:10000 LIFESHIELD SYRINGE late July August 0641142035 EPINEPHRINE 1:1000 ml ampule 4857-10 FOSPHENYTOIN 50MG/ML 10ML VIAL Mfctr stopped producing for 90 days Late Fall 2010 372034 Phenytoin 250mg, 5ml vial 6102-10 FUROSEMIDE 100MG, 10ML VIAL September unknown Currently all Furosemide products (for 6102-04 FUROSEMIDE 40MG 4ML SDV 2048 July unknown 7793-62 HEPARIN 25,000/250CC IN 5% DEXTROSE FOR INF 24/CS July unknown Updated as of July 7, 2010: ject to Change

July 7 2010 Pharma Backorder Report BT item # 0074490301 374904 Description Mfctr ETA for next release Date Mfctr expects back orders to clear Possible sub ** Description LIDOCAINE 2% 100MG 5ML ANSYR SYRINGE LIDOCAINE 2% 100MG 5ML LIFESHIELD July July 2190-00 Lidocaine 2% 100mg, 5ml Stickgard SYRINGE July Fall 2010 2190-00 Lidocaine 2% 100mg, 5ml Stickgard 371215 NALOXONE 0.4MG 1ML VIAL July unknown 373369 371219 NALOXONE 4MG, 10ML VIAL July July 373369 Naloxone 2mg, 2ml Luer Jet (product due in next week) Naloxone 2mg, 2ml Luer Jet (product due in next week) 4755-02 Ondansetron 4mg, 2ml vial July late August 305-300-107 Ondansetron 4mg, 2 ml vial (sold 5/tray) 372312 PROMETHAZINE 25MG 1ML LUER LOCKING CARPUJECT No ETA unknown 3157-83 PROMETHAZINE 25MG/ML 1ML AMP 2098 4699-33 PROPOFOL 10MG/ML 50ML VIAL No ETA unknown We have received inventory on the following products but each remain on manufacturer back order; additional inventory is not expected in the near future. 371100 C4 LORAZEPAM 2MG, 1ML VIAL 10/BOX * No ETA unknown 0102-01S C4 LORAZEPAM 2MG 1ML VIAL 25/BOX * 0409-4350-03 DILTIAZEM - CARDIZEM 100 MG ADV - NON REFRIG 10/BX July Mid October 0510-01 374402 DIPHENHYDRAMINE 50MG LUER LOCKING CARPUJECT unknown unknown 0376-25 DIPHENHYDRAMINE 50MG, 1ML VIAL 379631 FUROSEMIDE 100MG 10ML ANSYR SYRINGE unknown unknown Currently all Furosemide products (for 0186063501 FUROSEMIDE 40MG 4ML ANSYR SYRINGE July September 372339 LABETALOL 20MG, 4ML LUER LOCK CARPUJECT unknown unknown 370130 LABETALOL 100MG 20ML VIAL 375204 Quelicin 200mg, 10ml vial No ETA unknown 3009-95 ANECTINE 200 MG, 10 ML VIAL 0074490000 SODIUM BICARBONATE 8.4% 10ML LIFESHIELD July TBD 376637 SODIUM BICARBONATE 8.4% 50ML LIFESHIELD 376637 SODIUM BICARBONATE 8.4% 50ML LIFESHIELD August August 376625 SODIUM BICARBONATE 8.4% SDV 50ML **The provided alternate items may or may not be appropriate substitutes according to BTM customers' specific clinical needs and drug protocols. As always, BTM customers should confirm all potential alternative choices with the appropriate Medical Director or personnel within their organization prior to ordering from Bound Tree. The available items are not in all cases direct substitutes for the manufacturer's backordered items. Bound Tree does not prescribe or dispense pharmaceuticals and expressly disclaims all liability related to substitution choices. Although BTM has commented on supply dates provided to us by the manufacturer, our noted times of arrival are best estimates. The supply allocation and shipments from the manufacturer are fluctuating daily. BTM Customer Service Department: 800-533-0523. Updated as of July 7, 2010: ject to Change