Nationwide shortages have forced local emergency medical workers to make drug substitutions and to scramble for medications that once were easily available.

Directors of the Berkeley, Charleston and Dorchester county Emergency Medical Service systems said last week they have struggled for at least six months with shortages of a handful of medications that include painkillers and anti-seizure drugs.

Hospitals also have faced shortages, but EMS officials said the problem has a more acute effect on the care they provide. Hospitals have pharmacies, making substitutions easier, Berkeley County EMS Director Bob Mixter said. But ambulances have limited space for a short list of drugs approved by state health regulators. Regulators must approve substitutions, and in some cases medics must receive additional training with the new drugs.

That’s what happened when some benzodiazepines, types of anti-seizure drugs, became unavailable. State regulators approved use of an older drug, phenobarbital, that had fallen out of favor because it is not as efficient as the one in short supply. “It’s a dinosaur, but it does work,” Mixter said of the drug, which is administered intravenously. “It takes longer to take effect and has more side effects and more risk of a reaction.”

Additionally, it costs more than the one in short supply, putting the department thousands of dollars over budget for that medication, Lundy said.

Dorchester County EMS Director Doug Warren said his department has been without medications, including some painkillers, for more than a year. And Charleston County EMS Director Don Lundy said the current shortages are the worst he has experienced over nearly four decades in the field.

“I haven’t seen anything as serious as this one,” Lundy said. He noted that “no patients have been in danger” as a result of the shortages locally.

Like other departments, Charleston County has reduced ambulance inventory of certain drugs, carrying four doses of a drug instead of six, for example. Lundy declined to name the specific medications but said his department has relied on hospital pharmacies to supply medications it cannot get from its regular vendor.

Lundy, who is president-elect of the National Association of Emergency Medical Technicians, said EMS departments get little notice before shortages occur. Federal legislation being proposed would require manufacturers to issue advance warning before shortages, Lundy said.

The U.S. Food and Drug Administration has reported shortages of dozens of drugs nationwide. The reasons behind the shortages include quality problems, manufacturing delays and discontinuations, the FDA says on its website. Manufacturers are not required to report either the reason for or expected duration of shortages, according to the FDA.

Reach Renee Dudley at 937-5550 or on Twitter @renee_dudley.