The regional Medication Kit of the Peninsulas EMS Council, Inc. is a critical component of the EMS system for the treatment of sick or injured persons. The basis for restocking these medication boxes is contained in this  PEMS Regional Medication Box Plan  signed by participating acute care hospitals and out-of-hospital agencies.

The medications stocked within the Medication Kits are selected and approved for use by the Protocols, Policies & Procedures (PPP) Committee in coordination with the Pharmacy Committee.  Each of the hospitals inside the PEMS region (and several outside the region, but with our catchment area) has agreed to replace medications used in the prehospital setting on a one-for-one basis.  This exchange takes place at the hospital pharmacy or emergency department.

PEMS Medication Kits are accounted for using a real-time inventory control system operated by PEMS and the area pharmacies to ensure that security of the medications is maintained and all users in the system have sufficient Medication Kits to operate efficiently.

The Virginia Board of Pharmacy provides governing guidance for PEMS' Emergency Medical Services Medication Kits.   Guidance Document 110-41became effective on November 25, 2021.  In order to maintain compliance with the current statutory regulations, it is important that agencies within the PEMS Region and throughout the Commonwealth of Virginia read and adhere to the requirements set forth within Guidance Document 110-41.   Click here to read and to download the document.

PEMS RSI Medication Kit

The PEMS Rapid Sequence Intubation (RSI) Medication Kit is a separate kit used for difficult airway management patients.  It is only used by specifically selected and trained Paramedics with approval from their OMDs.  Only a few agencies are performing RSI at this time due to the extensive training, competence and quality assurance requirements.

Important Medication Kit Forms

• Medication Kit Schematic - This document graphically displays the normal layout of the PEMS Medication Kit.  Please note that medication availability and packaging can cause deviations from this layout.
• Medication Use/Wastage Form  - This form is for documenting the use and wastage of controlled medications contained in the PEMS Medication Kits.
•   Medication Kit Inventory - This form is used by our partner pharmacists and pharmacy technicians to ensure that each PEMS Medication Kit is properly stocked with medications having reasonable intervals before expiration.
• Medication Kit Exchange Form  - This form is used to document the exchange of PEMS Medication Kits between users and hospital personnel.
• RSI Medication Kit Inventory - This form is used by our partner pharmacists and pharmacy technicians to ensure that each PEMS RSI Medication Kit is properly stocked with medications having reasonable intervals before expiration.
• PEMS Medication Box Transfer Form - This form is used to document the transfer of PEMS Medication Kits between different agencies.
• OEMS EMS Agency Drug Diversion Report Form  - This form is used to report diversion of controlled medications.

Reporting Medication Diversions

12VAC5-31-520 requires that any diversion of (i.e., loss or theft) or tampering with any controlled substances, drug delivery devices, or other regulated medical devices from an agency facility or vehicle shall be reported to the Office of EMS in writing within 15 days of the discovery of the occurrence. 

OEMS is no longer accepting paper reports for reporting diversions.  Any report must be made via the following link:

https://vdhems.vdh.virginia.gov:444/emsapps/f?p=LCR:DRUG_DIVERSION:444/emsapps/f?p=LCR:DRUG_DIVERSION

Medication Kit Incident Report

The Peninsulas EMS Council, our Pharmacy Committee, and our PPP Committee work hard to make the Medication Kit System as secure and easy to use as possible.  However, circumstances do occasionally result in problems with Medication Kits. These problems are reported using the PEMS Medication Kit Incident Report. This report may be filed by anyone finding a problem with a PEMS Medication Kit or the system that supports it.  PEMS will follow up each incident to ensure that problems are resolved.

  Click here to submit a Medication Kit Incident Report .

Please fax the completed report to:  804-302-6073. This a secure electronic fax that meets all HIPAA/PHI security requirements.

PEMS Medication Kit Exchanges at Facilities Outside PEMS Region

PEMS has been fortunate to have entered into a PEMS Regional Ambulance Restocking Agreement with several facilities outside the PEMS region recently. These agreements were made to facilitate speedy return to service for agencies transporting to these facilities.  They are not designed to provide for the routine exchange of PEMS Medication Kits that are expired or about to expire. Please do not attempt to exchange the PEMS Region Medication Kits for expired or about to expire boxes at any hospital outside the PEMS region.  These boxes will need to be exchanged at our PEMS region hospitals including: Riverside Regional Medical Center, Sentara Careplex Hospital, Bon Secours Mary Immaculate Hospital, Riverside Walter Reed Hospital, Riverside Doctors’ Hospital, Sentara Williamsburg Regional Medical Center, Bon Secours Rappahannock General Hospital, or Riverside Tappahannock Hospital.

Training Medication Kits

PEMS has created Training Medication Kits for purchase by agencies.  Agencies be invoiced for the cost of the contents of each box and can order replacement training medication as needed for continuing training.  Once PEMS receives payment, we will order and put kits together.  This can take up to 6 weeks depending on the arrival of the training medications.

This is a limited time offer.  We are using extra boxes obtained with the RSAF grant.  Once they are all gone, the price will increase to include the cost of a box – about $350 dollars more.  If your agency would like to obtain a training medication box, please contact the PEMS Office at 804-693-6234 or Click here to email your request.

Medication Kit Shortages & Changes

Note:  Due to ongoing shortages, the FDA has authorized extensions of expiration dates for certain medications.  Pharmacists accomplish this by lining-out the original expiration date on the medication and hand writing the new date.  Providers should be aware that they may see these hand-written expiration dates on medications in the PEMS Medication Kits and that they are acceptable for use. If you find an expired medication, please look up the medication at:  https://www.fda.gov/drugs/drug-shortages/search-list-extended-use-dates-assist-drug-shortages

• Haloperidol (Haldol) 5 mg/1 mL vial - Pharmacies in the PEMS region are experiencing difficulty getting Haldol in the 5mg/1mL packaging. As the Haldol currently in the PEMS Medication Boxes expires or is used, it may be reduced from 2 to 1 vial. Affected Medication Boxes will be identified by a note placed in the exterior pocket.  (Posted 01-19-21)

• Lidocaine - Pharmacies in the PEMS region are experiencing difficulty getting Lidocaine 2% (Xylocaine) in the 100mg/5 mL preload packaging. As the Lidocaine  currently in the PEMS Medication Boxes expires or is used, the pharmacies may need to reduce the number of Lidocaine 2% from 2 to 1.  Affected Medication Boxes will be identified by a note placed in the exterior pocket.  (Posted 07-30-19)

  Amiodarone - Pharmacies in the PEMS region are experiencing difficulty getting Amiodarone in the 150mg/3mL packaging. As the Amiodarone currently in the PEMS Medication Boxes expires or is used, it may be replaced with 450mg/9mL or 900mg/18mL vials. The concentration remains 50mg/1mL.  This packaging may be located in the main compartment under the clear plastic divider. Affected Medication Boxes will be identified by a note placed in the exterior pocket.  (Posted 05-28-19)

• Benadryl/Diphenhydramine 50 mg/1 mL - Pharmacies in the PEMS region are experiencing difficulty getting Benadryl/Diphenhydramine in the 50 mg/1mL vial/syringe packaging. They will reduce the number of vials from 2 to 1.  Affected Medication Boxes will be identified by a note placed in the exterior pocket. (Posted 10-11-18)
• Sodium Bicarbonate 50 mEq/50 mL - Pharmacies in the PEMS region are experiencing difficulty getting Sodium Bicarbonate in the 50 mEq/50 mL preload packaging. hey will reduce the number of preloads from 2 to 1.  Affected Medication Boxes will be identified by a note placed in the exterior pocket. (Posted 10-11-18)
• Magnesium Sulfate 5 gm/10 mL - Pharmacies in the PEMS region are experiencing difficulty getting Magnesium Sulfate 5 gm/10mL.  As the Magnesium Sulfate currently in the PEMS Medication Boxes expires or used, there may be no Magnesium Sulfate in the boxes.  Affected Medication Boxes will be identified by a note placed in the exterior pocket.  (Posted 08-7-18)
• Atrovent (Ipratropium) 0.02% 3 mL - Pharmacies in the PEMS region are experiencing difficulty getting Atrovent (Ipratropium) 0.02% 3 mL INH.  As the Atrovent (Ipratropium) 0.02% 3 mL currently in the PEMS Medication Kits are used (beginning January 2018) there may be no replacement available. Affected Medication Kits will be identified by a note placed in the exterior pocket.  (Posted 01-16-18).
• Sodium Chloride 0.9% 100mL, 250mL - Pharmacies in the PEMS region are experiencing difficulty getting Sodium Chloride 0.9% IV Solution in small bags.  As the Sodium Chloride 0.9% 100mL currently in the PEMS Medication Kits are used (beginning November 2017) there may be no replacement available. Affected Medication Kits will be identified by a note placed in the exterior pocket.  (Posted 11-03-17).

• Morphine Sulfate 10mg/1mL- Pharmacies in the PEMS region are experiencing difficulty getting Morphine Sulfate in the 10mg/1mL preload packaging.  As the Morphine Sulfate currently in the PEMS Medication Kits expires (beginning November 2017) there may be no replacement available. Affected Medication Kits will be identified by a note placed in the exterior pocket.  (Posted 11-03-17).

• Dextrose 50% 25gm/50ml preload - Pharmacies in the PEMS region are experiencing difficulty getting Dextrose 50% 25gm/50ml preload.  As the D50 currently in the PEMS Medication Kits are used (beginning May 2017) there may be no replacement available. They will reduce the number from 2 preloaded syringes to 1, as needed to help during this shortage. Affected Medication Kits will be identified by a note placed in the exterior pocket.  (Posted 05-16-17).

• Calcium Chloride - Pharmacies in the PEMS region are experiencing difficulty getting Calcium Chloride in the 1gm/10mL preload packaging.  As the Calcium Chloride currently in the PEMS Medication Kits expires (beginning April 2017) there may be no replacement available. Affected Medication Kits will be identified by a note placed in the exterior pocket.  (Posted 03-29-17).

• Dopamine - Pharmacies in the PEMS region are experiencing difficulty getting Dopamine in the 400mg/10ml packaging. As the Dopamine currently in the PEMS Medication Boxes expires (beginning June 1, 2018), it may be replaced with 400mg/250ml IV piggyback packaging. This packaging may be located in the main compartment under the clear plastic divider or it may be placed in the clear sealed bottom compartment of the red Thomas Pack. Both packaging currently are affected.  There may be no Dopamine in the boxes.  Affected Medication Boxes will be identified by a note placed in the exterior pocket.  (Posted 05-15-18)
  
• Epinephrine 1mg/ml 1:10,000  - Regional hospitals are experiencing a shortage of prefilled epinephrine syringes.  Because of this, the pharmacies may reduce the number of prefilled syringes from 8 to 0 inside Medication Kits being restocked. A card will be placed in the outer pouch of a Medication Kit if it is affected.  Please note that there is still a 30cc 1:1000 multi-dose vial of epinephrine in the Medication Kit.  You can prepare 1:10,000 epinephrine by expending 1 cc from a prefilled 10 cc saline syringe and drawing 1 cc of 1:1000 epinephrine from the multi-dose vial. As always, have your partner verify your medication prior to administering.  (Posted 06-05-17)

• Ativan/Lorazepam  2mg/1mL- Pharmacies in the PEMS region are experiencing difficulty getting Ativan/Lorazepam in the 2mg/1mL preload packaging.  As the Ativan/Lorazepam currently in the PEMS Medication Kits expires (beginning November 2017) there may be no replacement available. Affected Medication Kits will be identified by a note placed in the exterior pocket.  (Posted 11-29-17).