Ambulances in the Milwaukee area are running low on drugs that could save lives. It's a problem that's only getting worse.
The I-Team covered this story in 2012 with an ambulance company in Washington County. Back then the drug shortage problem was new and affected only a handful of emergency drugs. Now almost half the medicine these paramedics use is in short supply.
Paramedic Mike Krueger ran down the list of medicine for us, "pain medications that we can't get, cardiac medications that we can't get."
He owns Lifestar EMS out of West Bend. Its ambulances are stocked with 49 emergency drugs. Right now 21 are in short supply or out of stock.
One Lifestar paramedic told us, "it has been extremely more difficult to treat patients."
We first talked to Krueger six years ago about this issue. The past year has been tough.
"Every week the list changes," he said.
Right now they have no supply of epinephrine; it's a life-saving drug used to jump-start the heart.
Lifestar's ambulances are still stocked, but once that runs out there's no supply in-house. Krueger also pointed out "for a while we had mostly expired epinephrine."
Which is now allowed by the FDA. Extending expiration dates is one way the government's trying to manage the drug shortage.
The Greenfield Fire Department has not yet used expired meds. So far its been able to share drugs with other departments in Milwaukee County.
"We've given away medications, we've taken in medications," Paramedic Joel Fladwood said.
Fladwood orders emergency meds for Greenfield, which he called a constant juggling act. To make drugs last longer they've changed protocol for some, like saline. Now paramedics only start an IV if a patient needs it. Before they would run an IV on all advanced life support calls.
Right now the FDA has 100 drugs listed in short supply. Something Milwaukee County's Medical Director calls a public health concern.
"I don't see an end in sight necessarily," Dr. Riccardo Colella said.
He said the constant challenge for all EMS is adapting to drugs out of stock on almost no notice.
"We have to be able to prepare for that. Train paramedics on changes that may occur," Colella said.
With back up drugs replacing what paramedics normally use, there's always a new learning curve.
"We look at the vial and make sure that we're giving the correct dose of the drug," a Lifestar paramedic told us.
In most cases there's a Plan B for what's out of stock, but Krueger said it's not always the best for patient care.
"Sometimes those treatments aren't as good as our first line drugs the ones we would reach for first."
The FDA does require drug manufacturers to report any change in production that might lead to a shortage. That legislation was passed in 2012.
The manufacturers of IV saline are in Puerto Rico. Everything shut down after the hurricane. For shortages related to other drugs, the FDA points to manufacturing issues or production delays. Sometimes it comes down to a business decision. Companies stop making an older drug and switch over to newer, more profitable ones.