ArticlePrehospital emergency care
Degradation of benzodiazepines after 120 days of EMS deployment.
Article in Prehospital emergency care. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 26 citations in OpenAlex.
- Temperature Monitoring in Prehospital Emergency Medical Vehicles - An Observational Study.Prehospital and disaster medicine · 2025Observational
- Emergency care drugs' chemical stability after eight weeks' deployment in the prehospital setting.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Can we use normal saline stored under stress conditions? A simulated prehospital emergency medical setting.Heliyon · 2023Article
- National Variation in EMS Response and Antiepileptic Medication Administration for Children with Seizures in the Prehospital Setting.The western journal of emergency medicine · 2023Article
- Climate change and epilepsy: Time to take action.Epilepsia open · 2019Review
- Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations.The western journal of emergency medicine · 2017Article
- Observational
Corrections and comments
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Authors and funding
8 authors at 1 institution in 2 countries.
Funding
Abstract
introductionEMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures.
objectiveTo describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units.
methodsStudy boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May-August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95%CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT).
results192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95%CI) of diazepam was 97.0% (95.7-98.2%) and of midazolam was 99.0% (97.7-100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6-99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7-92.3%]). Mean MKT was 31.6°C (95%CI 27.1-36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam.
conclusionsMidazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.
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