Emergency care drugs’ chemical stability after eight weeks’ deployment in
the prehospital setting
Dublin Core
Title
Emergency care drugs’ chemical stability after eight weeks’ deployment in
the prehospital setting
the prehospital setting
Subject
Drugs
Out-of-hospital
Environmental exposure
Prehospital drug storage
Out-of-hospital
Environmental exposure
Prehospital drug storage
Description
Temperature conditions vary in emergency service vehicles, which may pose a risk to the integrity of the drugs
on board, possibly rendering them ineffective and increasing morbidity and mortality in patients.
Aim: This study assessed the stability of four emergency care drugs (adrenaline, etomidate, ketamine, and
rocuronium) after eight weeks of deployment in the prehospital context.
Methods: The study adopted a longitudinal quantitative design to evaluate the chemical stability of emergency
care drugs. The study was conducted at four emergency medical service bases in Ballito, Durban and Pietermaritzburg, South Africa. The primary outcome was the relative reduction in drug concentration from the
labelled concentration after four and eight weeks. High-performance liquid chromatography-mass spectrometry
(HPLC-MS) analysed samples to determine the concentration of active ingredients in the drug samples.
Results: HPLC analysis was done on 176 samples. The ambient temperature ranged from 18.7 to 44 ◦C in the first
four weeks, averaging 26.8 ◦C ± 3.0. At 4 and 8 weeks, Adrenaline decreased 24.93 % and 22.73 %, respectively.
Etomidate’s control had 3.06 mg/ml, not the 2 mg/ml on the bottle. After 4 and 8 weeks, the samples had 3.10
and 3.15 mg/ml active components, respectively. Ketamine degraded over 30 % after four weeks but not beyond
that. The Ketamine package states 10 mg/ml. However, we found 17.46 mg/ml. Rocuronium was 6.45 mg/ml in
the control, although the manufacturer specified 10 mg/ml. At four weeks, the concentration was 6.70 mg/ml; at
eight weeks, 6.56.
Conclusion: This study suggests that adrenaline and ketamine degrade by more than 20 % within four weeks of
deployment in the prehospital field, whereas etomidate and rocuronium remain stable after eight weeks
on board, possibly rendering them ineffective and increasing morbidity and mortality in patients.
Aim: This study assessed the stability of four emergency care drugs (adrenaline, etomidate, ketamine, and
rocuronium) after eight weeks of deployment in the prehospital context.
Methods: The study adopted a longitudinal quantitative design to evaluate the chemical stability of emergency
care drugs. The study was conducted at four emergency medical service bases in Ballito, Durban and Pietermaritzburg, South Africa. The primary outcome was the relative reduction in drug concentration from the
labelled concentration after four and eight weeks. High-performance liquid chromatography-mass spectrometry
(HPLC-MS) analysed samples to determine the concentration of active ingredients in the drug samples.
Results: HPLC analysis was done on 176 samples. The ambient temperature ranged from 18.7 to 44 ◦C in the first
four weeks, averaging 26.8 ◦C ± 3.0. At 4 and 8 weeks, Adrenaline decreased 24.93 % and 22.73 %, respectively.
Etomidate’s control had 3.06 mg/ml, not the 2 mg/ml on the bottle. After 4 and 8 weeks, the samples had 3.10
and 3.15 mg/ml active components, respectively. Ketamine degraded over 30 % after four weeks but not beyond
that. The Ketamine package states 10 mg/ml. However, we found 17.46 mg/ml. Rocuronium was 6.45 mg/ml in
the control, although the manufacturer specified 10 mg/ml. At four weeks, the concentration was 6.70 mg/ml; at
eight weeks, 6.56.
Conclusion: This study suggests that adrenaline and ketamine degrade by more than 20 % within four weeks of
deployment in the prehospital field, whereas etomidate and rocuronium remain stable after eight weeks
Creator
Simpiwe Sobuwa a,*
, Thishana Singh b
, Kerusha Kalicharan b
, Thishana Singh b
, Kerusha Kalicharan b
Source
https://pdf.sciencedirectassets.com/280685/1-s2.0-S2211419X23X00056/1-s2.0-S2211419X23000630/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEJ%2F%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIQD0%2Fglkjo9jO5s77xNslfuyWYWSj%2Bofu42WYpcCvTtsdgIgDPqhJPcez5Rgvc%2BpKw5kE10fT29oQQ9WSgebdN9xebgquwUIiP%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARAFGgwwNTkwMDM1NDY4NjUiDHJASr1DII2F%2B6OKiyqPBZUIz1ns62Ka9d9fOyGlmaZN3BZcrsVKwir%2Fv9j0MSIjYPHQU7fO2lGcMaZuEpnqy2m31u6eLJ8rRj6mHmk9drafMwXxd%2FJyz%2F5I3cFmQLDA2vhjVfWfjgd8OAkO0kbuViEPfd8ONoFq3I0oS2mrIJNIlzX3zlsLdIK5lrV%2F0iOZQBVyJpRDtpL4X%2FBjlbPOBeBcBYADYZv1UpTgqoBSVxrNkOrlKaJzoYSyHt%2BlWbUS8SUUTjEtAc330403PznoBeq787NUy5vCIkffF8%2FDQIT4TqLYgZ5akVLdloaLcRprLDzH%2FsNtlAZWgiv8RKa%2FV%2Bp6OIWQ2hfMDSpz56NS2ZL9t06IcNzlE6gTlYim1ItIiBEwPif0v4jfxPrWNxiejRHCqfNCkikiRi15rANpplbjydUJ6VHwPonVfu%2FOTkNqypV1DDw6JOjx4pfAhEgaD9cT9GE5n%2F0CTk7tueqXZBoFccnAbbv2Lw7EGiLFho5TD3ijEieNX%2FQvW1z7qtF8PlJ7laGB2mxFP%2BOjJMwHq7inlp24nlOJh3TAXKkRmMlWpsecB2Tn%2BWmLiDoDEH1lTCu6%2BsNI7yo5zjpO9AqLkAVkq9%2FpNJA3z48gYSOjgMx0E8EPs%2FrPBnQdpyVrFJwVCrUeZaNNw6kCPOqWQAwMaW52Az2TziMLGPy0fVkTI1tX8BIJ1RMr6ff6ziv2k7xdv%2BXMIuBR%2FlIJOOT2Je40jm1MjBejTM7zSZ8CXvjatcINNHMi627D7MO2yIFQzC6t58sd4w1s1dOiVCgNu4dbhO%2FcqsvXHU4jTTIY7PYmn0ieN8nyXUr0ScKAAsy9mnuKF3pKUSanmZNArQ%2FOTis5W9LcblGfJ%2BTKIOJqc0b64b0w38nJwgY6sQHwN%2FFF6pJ1B89VwpL9yqQp9GMDaZZG5qMRtN6ZTI%2FvtVS3tpzIZw2z4RGY80Xv8h9PvjVBQAwNA3Mha6BWWrnoJuAbdfDusl4n6gTDj6Skc0MtxftNYv222JlvGoUJ1l4g9ZmjwkWF%2BOt80K9x%2B5UVIWJ2gHUYmY%2FrhAs8EcE1OFLHc28f83nlNntOLZBiTxim4cdPj%2Ff4gt0cGvMA25ZKDl%2FM7nDp4o1rPPMpKVdWkp0%3D&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20250618T080125Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYTSUGM2Y2%2F20250618%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=30232d323b5777688f7d2d9dd35702cdbf28b2cf630fbcdcc6250df00f4c509f&hash=1785781ff87cc8854b6a119b6c493c8f37553e280e4b0b2d6d76c96db7407e57&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S2211419X23000630&tid=spdf-34191aec-c995-4dba-baab-2143426606dc&sid=14b8a1eb7498d34787591540b87a02ee8336gxrqb&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=13025d5355595356515106&rr=95194231e8e14f50&cc=id
Publisher
a Faculty of Health & Wellness Sciences, Department of Emergency Medical Sciences, Cape Peninsula University of Technology, Cape Town, South Africa b School of Chemistry and Physics, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
Date
28 november 2023
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Citation
Simpiwe Sobuwa a,*
, Thishana Singh b
, Kerusha Kalicharan b , “Emergency care drugs’ chemical stability after eight weeks’ deployment in
the prehospital setting,” Repository Horizon University Indonesia, accessed July 11, 2025, https://repository.horizon.ac.id/items/show/9549.
the prehospital setting,” Repository Horizon University Indonesia, accessed July 11, 2025, https://repository.horizon.ac.id/items/show/9549.