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transport times than any other country
due to political situation.
The availability and quantities of anti-
dotes in Palestinian hospitals were not
in accordance with recommendation
and guidelines. Despite that, it is not
considered a drawback for certain hos-
pital not to have all antidotes because
of the nature of the medical service
they provide. Furthermore, the guide-
lines by which we compared the stock-
ing of antidotes where those imple-
mented in USA and UK. The nature of
poisoning cases in Palestine might be
different than those in the USA and UK.
Our study is the first in Palestine to
compare provincial antidote stocking
to an established consensus guideline.
The results obtained were similar to
those of other US studies, which sug-
gest that antidote stocking is often in-
adequate.[3,6,8,9] In a recent Canadi-
an study from Ontario, only 1 out 179
surveyed hospitals stocked adequate
amounts of all 10 antidotes evaluated
[10], while in a similar study from Que-
bec found that the number of ade-
quately stocked antidotes per hospital
ranged from 0 to 9 of 13.[11]
The major reasons of inadequate anti-
dote stocking are probably a lack of
awareness of the deficiencies and a
belief that maintaining such stocks
would be excessively costly [23, 24].
Prior to 2000, there were no concise,
evidence-based guidelines for stocking
of emergency antidotes [15]. In the ab-
sence of such guidelines, physicians
and pharmacists may not know which
antidotes need to be stocked. They
may conclude, for example, that a
rarely used antidote is not worth stock-
ing, or they may be unaware of the
need for timely administration of cer-
tain antidotes and assume they can
obtain these from other facilities in the
area at the time they are necessary
[8]. In addition, centers that do not
perform regular stocking reviews may
be unaware of their actual antidote
our survey did not solicit explanations
for antidote shortfalls; therefore at
Palestinian hospitals.
We also found wide variation in avail-
ability among the different antidotes
(Table 1, 2). As has been previously re-
ported, antidotes used to treat condi-
tions other than poisonings were more
frequently stocked such as dopamine,
dobutamine, calcium gluconate, di-
azepam and sodium bicarbonate.
The unavailability of some antidotes
through normal commercial channels
may also contribute to insufficient anti-
dote stocking in Palestine and also
some antidotes have never been mar-
keted in Palestine. Some hospitals pre-
fer to manage poisoned patients by re-
ferral to other medical facilities.
Insufficient stocking of antidotes is not
a unique problem to Palestine. It has
been identified as a worldwide issue
and its consequences may be
serious.[3,5,7,8,25,26].
Recommendation and Solutions:
Based on the results presented, we
recommend the following in order to
improve the antidote stocking in
Palestine: 1)New legislations should be
adopted by the Palestinian ministry of
health (PMOH) regarding the stocking
of antidotes at private and
governmental hospitals. The new
legislation should take into
consideration the international and
WHO recommendations; 2)
Coordination between PCDIC and
hospitals should be established
regarding the type and quantity of
antidotes in each hospital for the
PCDIC in order to direct the poisoned
patients to the hospital where the
appropriate antidote is available.
stocks. Although stocking shortages
may occur for any of the reasons cited,
OJHAS Vol 5 Issue 4(4) - Sawalha AF, Sweileh WM, Zyoud SH, Al-Jabi SW. Antidote Stocking at Hospitals in North Palestine