I’ve been doing a little thinking, a dangerous past time I know.  I’ve been thinking about safes.  In EMS, why do we have safes on our ambulances and fire engines?  Backup...  Actually, not all apparatus in EMS have safes on them.  A review of Code of Federal Regulations 1301 (available via the DEA website) specifically sections 1301.71 Security requirements generally and 1301.75 Physical security controls for practitioners, show me that the DEA requires Controlled substances listed in Schedules II, III, IV, and V shall be stored in a securely locked, substantially constructed cabinet.  Mind you, there is nothing in CFR 1301 about ambulances or firefighting apparatus.  So this seems to be the closest thing I found to a regulation that covers narcotic storage in the rolling stock of the EMS industry.

Back to not all apparatus in EMS have safes on them, and according to CFR 1301.75, that may be ok as long as the narcotics are stored in a securely locked, substantially constructed cabinet.  That lockable door above the jump seat in the back of the ambulance seems to meet that requirement.

Now to the question, why do we have safes on our ambulances and fire engines?  Even if the safe is a locked cabinet, why are they locked?  The easy answer is that they are locked to prevent the contents from being stolen.  Fair enough.  After a few years of thinking about Narcotic Diversion, I don’t believe that simple answer is the intent.  

The intent of why narcotics are to be securely locked in a substantial cabinet is to prevent diversion.  Diversion isn't only outright theft, but it is also substitution.

When we make discouraging tampering or substitution our primary focus, we of course also discourage outright theft.

Does a locked cabinet or simple safe discourage tampering or substitution?  Not really, especially not to a committed addict.  I’m afraid the dumb locks found on many apparatus simply don’t cut it anymore.  When an addict has the means, motive and opportunity to commit the act of tampering, don’t be surprised when they take it.  Having the drugs in a locked cabinet does little to take away the opportunity, as for means, all the tools needed to tamper with drugs can be found in the ambulance, kitchen or home.  

To properly address opportunity, we need to move towards what I like to call, "event logging safes."  The safes we use need to record the following information at a minimum:

Who accessed the safe,

What time did they open it,

What time did they close it,

That tells us, how long was it open.  

Failed attempts to access the safe (Time stamped)

When each member of an agency has their unique method/combination for opening a safe (special issue key, unique keypad combination, RFID proximity sensor, card key, biometric finger scan, retina scan, etc.) then it becomes very easy to audit the system to verify that your people are 1) doing their daily checks, 2) they are not getting their hands in the cookie jar at inappropriate times.  Systems can be designed to give you instant or regular notification when access to the safe has been made, whether you need to know right now or at designated times such as the end of the month doesn’t matter.  What matters is that there is a sense in your people, that if someone tampered-with the drugs, they would get caught.  

Event logging safes will increase your peoples confidence that the narcotics they carry will work as advertised, will increase your confidence in your people and that should equate to better trust between you and your people.  “Trust, but verify” is not exclusive to the superpowers.  

The dumb locations (pun intended) we store narcotics, even if they are securely locked and substantially constructed, do little other than throw up a short hurdle to the committed addict.  When we utilize smart safes, smart event logging safes we take away the ability of the committed addict to hide and we force them to leave evidence behind.  While not the silver bullet, that my friends and colleagues is one the best ways to stop narcotic tampering.  

Just be sure that drugs are stored with the same level of securely at the office and on supervisor rigs as well.

-Alton 03/05/11