September 26, 2025

Welcome to UH EMS-I’s Pharmacy Phriday. In the past few installments, we’ve focused on administrative and procedural topics as compared to a review of specific medications. Before completing this series, we will look at one more important issue: the “EMS Drug Box Accountability Report.”  

Multiple, blank copies are provided within each drug box for use any time the boxes are opened. Every provider needs to make sure they are filling out accountability sheets appropriately.  

In cases where the drug box was opened and a medication was used, an accountability form would be completed with the appropriate information including:  

• Patient name 

• Agency name 

• Provider name and signature 

• Date and time 

• Run number 

• Unit number 

• Drug box number 

• Medications used 

• Color and number of the tag the box is resealed with 

If there are adequate doses remaining of the medication used, then the box can be sealed using a yellow tag and secured for additional patient encounters. Remember that each time the box is opened, an additional accountability report must be completed and placed back in the box. This is one of the reasons multiple copies are placed in each box. If a medication is depleted from within the box or the provider believes there is not enough medication remaining to run a call, the box should be returned to the providing pharmacy for exchange. 

Another instance when multiple copies of an accountability report may be completed for a single drug box includes when a box is opened for training and familiarity purposes. In such cases, rather than provide patient information, a run number, etc., the provider would need to complete the form and indicate “Training” on the “Patient Name” line.  

One section of the accountability report specifically addresses the controlled substances box within each drug box. If the smaller “EMS Narcotic Box” is ever opened on a call, the “Controlled Substance Waste Report” section within the document must be completed. Documentation should include: 

• Medication name 

• Dose administered 

• Dose wasted (including vials, mixed solution in syringes, etc.) 

• Name and signature of the provider 

• Name and signature of a witness to the wasting of the medication 

• 
  

A few important points to stress about the “Controlled Substance Waste Report:”  

• Amounts wasted, even when zero, must be documented.  

• Anytime the “EMS Narcotic Box” is opened, even if no medication is used, the entire box MUST be red tagged and returned to the providing pharmacy for exchange.  

• In cases where no medications were used, the accountability form should include a brief explanation of the events and a witness name and signature as well.  

Finally, be aware that there are several methods of drug supply and exchange. Each agency should refer to their individual hospital and agency rules regarding the management of medications. If you have questions regarding any of these matters discussed, are in need of additional boxes, or have any other concerns, please contact your local EMS Coordinator.  

Until next time, stay safe!

Sincerely, 

The UH EMS-I Team 

University Hospitals