Carrying controlled drugs in a pre-hospital setting is a recipe for accidental vial breakages.

In January 2014 the weaknesses of the traditional leather and closed cell foam belt pouch were discussed: Care for your controlled drugs – a 3D printer solution.

The innovative 3D printed vial insert greatly improved vial breakages. Review of the insert’s function identified two failings: Firstly occasional vial breakage occurred; Secondly the Morphine ampules abruptly began to get stuck within the insert. The first problem seemed to arise due to downward blows onto the expose vial tops. The second problem was tracked to a change in the manufacturers label thickness only affecting the Morphine ampules that led to the vials jamming in the precisely moulded insert. 

These difficulties prompted a search for solutions. The further evolution of the drug pouch followed the realisation that an insert could become the whole carriage system and protection from downward forces would be required to stop breakage. 

Evolutionary Steps

Original leather pouch with the 3D printer insert  

Wooden prototype protecting vials in up to 2m falls onto concrete

HDPE vial holder showing magnetic catches, stainless fastenings and moulded belt loops

Controlled drug carry system in use

Some of the successes of the system include: A durable non-porous material capable of wash down and disinfection; magnetic catches; silicon rubber seated vial wells for shock absorption. 

Current feedback from the austere clinical environment is that the system is working well.

Controlled drugs have long been carried by clinicians in a leather pouch on the belt. Closed-cell foam inserts surrounded the vials to provide impact and deformation protection to the glass vials. The original pouch was designed to carry Opiates and with the addition of Ketamine these new vials were placed either above or below the foam insert. There was no room to incorporate further vial spaces in the closed cell-foam as wide cushioning margins were needed to provide impact protection. Due to the harsh prehospital environment vial breakage was common and appeared to be related to both loose vials and the ability of the closed-cell foam to flex. Rebuilding the pouch to a larger size had the concerns of greater size, weight and cost and could not solve flex related breakages. 

The solution came from pilot Armin Egli who overheard the failings of the controlled drug pouch. His answer was to design and make a rigid plastic insert by 3D printer. This insert fits the vials precisely preventing rattling. The vial insert depths are tailored to the vial sizes to allow ease of vial removal while maintaining maximum protection. As the inserts are rigid the vials can be closely stacked allowing the original pouch to fit all the current vials carried with a spare slot.

There have been no known vial breakages with the new insert and only positive feedback has been heard. This was a reminder that any member of the team may have the solution to a problem and often the most innovative answer comes from an interface between skill sets. The alternative explanation is that a man who can single handedly make a helicopter simulator can make whatever he likes.

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