Georgia emergency physicians say a shortage of drugs to treat critically ill and injured people poses a ‘‘real danger to our patients today, without relief in sight.’’

The Georgia EMS Medical Directors Advisory Council, in a letter Tuesday to the state commissioner of Public Health, said EMS physicians are adjusting protocols because of the shortages, including restricting the use of scarce drugs ‘‘to only the most severely ill and injured.’’

The physicians said there has been reported use of expired medication when up-to-date medication was not available. “The risk of using properly stored expired medication is preferable to helplessly witnessing the death of an adult or a child,’’ said the letter written by Dr. Robert Cox, chairman of the council, to Dr. Brenda Fitzgerald, commissioner of Public Health. A copy of the letter was obtained by Georgia Health News.

The EMS physicians asked that consideration be given to using properly stored expired medications and allowing access to lifesaving drugs in the Strategic National Stockpile.

A spokesman for Public Health said Tuesday that the agency is aware of the shortages and is taking steps to deal with them.

The Georgia situation is part of a nationwide gap in availability of EMS medications.
An article published this month in the Journal of Emergency Medical Services said the shortages first surfaced nationally in 2010, starting with epinephrine, which treats cardiac arrest, and dextrose, which replenishes bodily fluids and nutrients and is used to treat insulin shock.

EMS officials have also experienced shortages of benzodiazepines, which treat seizures and anxiety, and narcotic pain relievers.

“These are real shortages, affecting real people and putting our citizens in harm’s way,’’ said the authors of the article, which gives EMS officials guidance on dealing with the shortage. “These medications are essential to the ambulance drug box.’’

The EMS drug gap reflects wider shortages of medications that hospitals, physicians and patients have grappled with over the past several years.

Drug shortages have nearly tripled from 2005 to 2010 and reached record levels last year, as pharmaceutical manufacturers halted operations or had production problems, the Washington Post reported last week.

More than 210 drugs are in short supply or unavailable, Bona Benjamin of the American Society of Health-System Pharmacists told the Post. These include drugs to relieve pain, battle cancer or infections, anesthetize patients, and treat heart disease and psychiatric conditions. ADHD drugs have also been difficult to find.

The Food and Drug Administration has helped firms resume production more quickly and approved emergency imports of supplies, the Post said.

A Georgia Department of Public Health spokesman said Tuesday that Commissioner Fitzgerald had not yet seen the letter.

The spokesman, Ryan Deal, said, “We became aware in Georgia of the magnitude of the [drug scarcity] problem two to three weeks ago.’’

The medications needed are generally not being manufactured in the right dose or form to be easily used by an ambulance crew, he said.

Deal said Commissioner Fitzgerald and the agency are asking for ‘‘a national response,’’ through the Association of State and Territorial Health Officials, to communicate to the drug manufacturers exactly what EMS operations need.

Rural/Metro Corp., an Arizona-based company that has 911 ambulance operations in Fulton and DeKalb counties, said Tuesday that the EMS drug shortages in metro Atlanta have existed for about a year.

Trey Phillips, the company’s Georgia EMS director and general manager, cited current shortages of the pain relievers morphine and fentanyl, plus benzodiazepines.

Phillips said Rural/Metro has created a network of pharmacies to respond to the shortages. “We’ve been able to substitute drugs that do the same job,’’ he said, “and get the same drug in a different concentration.’’

EMS services that are hospital-based are probably faring better than those in smaller communities, Phillips said.

No Rural/Metro patient has had a negative outcome because of the shortages, he said.

Deal said Public Health also is not aware of any patient impact in Georgia  from the shortages.