Risks of Drug Diversion in Air Medical Transport

Air medical transport is one of the most demanding jobs in the healthcare industry and beyond. Air ambulance crews must stabilize critical patients in high-pressure conditions, in a confined space with limited resources.

While they face many challenges, one that often goes under the radar is drug diversion. In all emergency responses, managing controlled substances effectively and safely is a complex, but necessary part of the job. Here’s how to keep your crew and patients safe.

The Scope of Diversion in Healthcare

Unfortunately, the risk of drug diversion is real and growing across healthcare. Drug diversion can occur in any healthcare setting, but in air medical response, speed, limited oversight, and case-by-case restocking create some unique vulnerabilities.

It’s nothing any of us like to consider, but drug diversion, or the unauthorized channeling of regulated pharmaceuticals for illicit use, is a widespread issue. It’s also one that is likely to be far underreported. Some of the most commonly diverted scheduled drugs include opioids, benzodiazepines, and anesthetics.

Historically, diversion in hospitals has received the most coverage and public attention, but it’s important to note that the pre-hospital settings (such as air medical transport) are quite vulnerable. EMS agencies and flight crews must maintain controlled substances to ensure they can provide the necessary emergency care.

Unlike a hospital, an aircraft doesn’t have dedicated pharmacies and secure medication rooms. Aircraft spaces are cramped and tight. Oversight during response is also limited and minimal, making monitoring and accountability a challenge.

Helicopters and small fixed-wing aircraft lack the space for complex storage systems. Medications are often carried in a portable case, kit, or lockbox. Multiple flight crews may also handle the same kits. Shared access makes it harder to monitor the chain of custody and can facilitate the masking of diversion.

Compounding the issue in air medical response is the fact that it's a high-stress, high-speed job. Professionals must face life-or-death scenarios repeatedly—every second counts in the rush to stabilize patients. Unintentionally, documentation can get delayed or overlooked in the fray.

This speed also applies to stocking kits and units. Air medical crews must quickly restock medications between flights and be prepared for multiple hazards and scenarios. The ad-hoc approach may leave gaps in accounting for doses.

Finally, it’s important to recognize that air ambulances may launch from rural, isolated areas and bases. The physical distance takes them out of centralized oversight and adds another layer of vulnerability.

How Diversion Happens in Air Medical Transport

All of this is to say that though drug diversion may happen in air medical transport, it’s not always the result of malicious intent. Often, the issues can stem from system inefficiencies, documentation errors, stress, and even fatigue. Regardless of intent, however, the outcome remains the same: untracked, missing medication dosages that can put the organization at risk.

Many times, a provider will administer a drug during a high-stress transport, intending to fill in the log later, but in the busyness of the situation, it falls by the wayside. Medication restocking can be harried and leave inconsistencies in the chain of custody.

Waste documentation is another area of risk. Partially used vials may be discarded without the proper witness or logging. These minor discrepancies can add up quickly and lead to bad habits and patterns that threaten DEA regulatory compliance.

Of course, there's also the danger of a responder pocketing medications and supplies for personal use, too. Air medical personnel must carry a wide range of controlled substances, many of which are high-value diversion targets like fentanyl, morphine, diazepam, ketamine, and etomidate.

These drugs are necessary in emergencies, and records must be completed even in the most stressful of conditions, but that makes it easier for discrepancies to pop up, whether from innocent error or intentional diversion.

The Consequences of Diversion

Obviously, diversion is a problem, but it can have ripple effects that go far beyond a single incident or individual situation. Healthcare organizations are legally responsible for maintaining control over all narcotics and schedule drugs. If doses are missing or undocumented, your organization may face legal penalties, fines, and even loss of licensure. This can also cause irreparable damage to your reputation within the community.

Diversion also puts staff at risk. Air medical transport is an environment where trust is paramount. Everyone must rely on each other. An environment where diversion is suspected but not addressed can erode the morale of your team and contribute to burnout.

Of course, one of the biggest risks with diversion is patient safety. When drugs meant for patients are missing, care becomes compromised. Inaccurate records and dosing can lead to dangerous medical errors.

Protect Your Team from Diversion Risks

So, how do you protect your team? Especially in an environment where so many factors are undetermined and out of your control?

One of the best steps is to stop using paper-based systems to track. A paper log is notoriously unreliable, especially in a situation dominated by speed and stress. Handwritten logs are prone to error, whereas a digital tracking solution helps to strengthen accuracy and takes the burden off staff.

LogRx offers real-time mobile tracking, allowing flight crews to record transactions instantly at the point of care. There's no need to wait until the end of the shift or a return to coverage areas. Tracking can be handled quickly and easily from their hand-held device, minimizing forgotten entries and helping them account for every dose.

With scan-based verification, a simple snap of a camera lets your crew keep track of everything in their workflow. They can track each dose from pharmacy to patient, recording who dispensed, administered, or wasted each vial. This strengthens accountability at every step.

As with all medical responses, air medical transport is regulated, and personnel are required to file reports and submit to audits. For administrators, an audit can cause significant stress, especially if you aren't confident in the data. With LogRx, the Admin Portal provides a user-friendly overview to help you track and spot anomalies and inventory concerns before they become an issue.

With a mobile-first approach, LogRx is ideal for air crews on the go. Our application was designed by first responders, for first responders, making it easy to use even under high-pressure circumstances. Real-time accountability eliminates blind spots, and data is stored securely for audit-ready reporting access.

For air medical transport, a tool like LogRx reduces risk and provides an easy way to ensure that every dose reaches the patients who need it the most. To discover how LogRx can protect your team, reach out today.