For Clinicians | 2024 First Aid Guidelines

What Changed, and What Your Patients’ Kits Still Get Wrong

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Your patient bought their first aid kit off an endcap, or from whichever online checklist looked credible. Nobody clinical was standing beside them when they did it. Pharmacists, go look at the kit on your own shelves this week. There’s a good chance it has hydrogen peroxide in it.

Patients tend to assume that buying a first aid kit means they are covered. “Well, it’s better than nothing!” They read a list, buy the box, put it under a truck seat or in a closet, and do not open it again until something goes wrong.

In 2024, the American Heart Association and the American Red Cross published the first comprehensive revision of first aid treatment recommendations since 2010¹. Yet some retail kits still ship to the previous standard and online search results still describe the outdated items.

For a quick real life example, take good ol’ baby aspirin. Many patients still have an 81- mg bottle in the cabinet, and that may be the bottle they’ll grab when a family member’s chest starts hurting. But one 81 mg tablet is below the dose the guidelines recommend in suspected cardiac chest pain. Fixing that takes fifteen seconds in the office or at the counter.

This article covers several changes in the 2024 guidelines, a few common beliefs patients’ kits continue to reinforce, and the larger preparedness gap that first aid guidelines were never designed to fill.

What changed in the 2024 first aid guidelines?

The 2024 document is the first comprehensive revision since 2010, following focused updates in 2015, 2019, and 2020.¹ The writing group identified several new or substantially revised topics: opioid overdose, bleeding control, open chest wounds, spinal motion restriction, hypothermia, frostbite, presyncope, anaphylaxis, snakebite, oxygen administration, and pulse oximetry, with pediatric guidance where it applies.¹ Earlier recommendations remain in effect unless the 2024 document specifically updates them.

Two of those changes reach into the box your patients already own.

Bleeding control: One manufactured windlass tourniquet is now a line item in the Red Cross minimum contents table for a first aid kit.² Not a tactical upgrade. The minimum. But putting one in the kit is only useful if the patient knows when and how to apply it.

Opioid overdose: When a person with a suspected opioid overdose is unresponsive and not breathing normally, the guidelines call for activation of EMS, high-quality CPR with compressions and ventilation, and naloxone.¹ Those actions may overlap. Naloxone is not in the minimum contents table.²

Nobody owns the seam

Those updates reveal a larger problem. Patients do not separate first aid, disaster preparedness, and medication planning. They expect one kit to cover all three. Four quick corrections can make the kit more useful, but they also show where its limits begin.

Two separate bodies of guidance address different parts of the same household emergency plan.

• On the injury side, the first aid guidelines and Stop the Bleed address immediate care: direct pressure, wound packing, and tourniquet use.³ No mention of prescriptions.
• On the disaster side, the federal preparedness guidance tells families to keep a written medication list with diagnosis, dosage, frequency, supply needs and allergies, plus a cooler for anything requiring refrigeration.⁴ It says little about how to effectively irrigate a wound or control severe bleeding.

Nobody at home is sorting injury guidance from disaster guidance. There’s one box on hand, and they expect it to cover whatever comes up. 

Patients ask what’s reasonable to keep at home, and neither body of guidance tells you as the provider or pharmacist what’s reasonable to authorize in advance, or where the boundary sits between preparing a patient and writing an inappropriate prescription.

Quick reference: four corrections

Four points cover much of what patients need to know when this subject comes up in the clinic or at the pharmacy counter.

Three involve time-sensitive emergencies in which the right response can save a life. The peroxide correction is less dramatic, but it can prevent avoidable tissue injury and delayed healing.

The layer the kit was never built to hold

This next part is not strictly a first aid question, which is why no first aid guideline answers it.

Some families have the pill bottles and nothing useful for a wound. Others have gauze for days and no plan for the medications they take every morning.

Household medical preparedness has at least three layers. The first is immediate first aid: the supplies and skills used for bleeding, burns, wounds, sprains, and other acute problems. The second is continuity: current chronic prescriptions, an updated medication and allergy list, and a plan for storage or refrigeration.⁴ The third is individualized contingency planning for predictable problems when timely care is unavailable. In selected cases, that may include short-course medication prescribed in advance after a licensed clinician reviews the patient and provides condition-specific instructions.

That third layer is not part of the AHA/Red Cross first aid guidelines. It is a separate clinical decision, and stored medication should be used only under the instructions provided and when qualified medical assistance cannot be reached promptly.

The missing clinical layer

Underneath all four corrections is a structural problem. A household gets one of two things: they reach a clinician, or they work with whatever is in a box assembled to someone else’s checklist. Little formal guidance addresses the space between those options, which is how an endcap product ends up deciding what a family has on hand when something goes wrong.

That clinical layer has a name: individualized medical preparation. It is work completed before an emergency for a limited set of circumstances that may not wait for business hours.A tourniquet and naloxone illustrate the broader principle that useful emergency interventions must often be obtained—and understood—before they are needed. The first aid guidelines do not extend that principle to advance prescribing, but they demonstrate why preparation matters.

This is not a replacement for primary care. Complex diagnoses, ongoing conditions, and clinical uncertainty belong in the exam room. The appropriate role of advance planning is narrower: a defined set of circumstances, a patient screened in advance, clear instructions, and a plan for what requires direct care.

If you’d rather refer

Some of you would rather not write for this at all, which is a reasonable place to land. When a patient asks and you don’t want to be the one deciding what’s appropriate to keep on hand, send them to us at Jase.com. A licensed provider reviews every request and determines if a prescription is appropriate, so the referral is a clinical handoff and not a way around a visit.

We’ll keep publishing where we draw lines, what evidence we’re using, and the criteria behind a no. If we’re going to name a clinical category, the framework should be public enough for other clinicians to scrutinize and argue with.

The bottom line

The guidelines moved in 2024, but many patients’ kits did not move with them. An emergency is the wrong time to discover that the aspirin instructions are incomplete, the tourniquet is missing or unfamiliar, or the only wound cleaner in the box is peroxide.

Tell your patients to spend fifteen minutes with the kit they already own. Check the dates, replace what’s expired, take out what doesn’t belong in a wound, and make sure they know how to use what remains. They may not need a bigger kit. They need a current one and a plan they understand.

Sources

1.  Hewett Brumberg EK, Douma MJ, Alibertis K, et al; American Heart Association and American Red Cross. 2024 American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2024;150(24):e519-e579. 
2. Minimum Contents for American Red Cross First Aid Kit, Table 2, 2024 AHA and American Red Cross Guidelines for First Aid. cpr.heart.org 
3. Stop the Bleed. American College of Surgeons Committee on Trauma. stopthebleed.org 
4. Tips for Medication. Ready.gov, Federal Emergency Management Agency.
5. Wound Home Care. American College of Surgeons. facs.org 
6. FDA Approves First Over-the-Counter Naloxone Nasal Spray. US Food and Drug Administration, March 29, 2023.

For Clinicians | Emergency Preparedness in Older Adults

The Three Parts That Are Yours

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Most of your patients over 55 are doing well. Pickleball four mornings a week, a cruise booked for October, a flight out to see the grandkids.

Then something changes the math. A first prescription for blood pressure or thyroid or a statin. A fall that took a lot longer to come back from than it would have at 40. A hospitalization nobody saw coming. Nothing catastrophic, but important enough to stay with them, and afterward a question shows up that never occurred to them at 30: what would I do if I couldn’t get to care?

At 30 nobody asks that. You take nothing, and you have never once considered slipping on your own front steps. By 60 it’s a pertinent question that is top of mind and being discussed at games on the court, on the deck of the ship, and with a whole peer group running the same arithmetic. “What if I can’t get this medication anymore? What if I get hurt again and am far from care?”

So they prepare, off the same checklist a 30-year-old would use. She isn’t going to bring that medical preparation to you as her clinician or pharmacist. Three parts of this prep are yours anyway: how long a fill she can get on the prescriptions she already takes, whether the medication reference list in her bag is sufficient, and what she decides to keep on hand for the illnesses that haven’t happened yet.

We’re a team of physicians, PAs, and pharmacists, and we field this question constantly from patients in exactly that age band. Today we’re covering what makes appropriate medical preparation different for this age group than for any other.

Your patients are already preparing, and it’s happening without us

This is not behavior we need to talk anyone into. In a 2019 national poll of adults 50 to 80, 82% said they had a week’s supply of their medications on hand, and 72% had a week of other health supplies.¹ Three-quarters had lived through at least one major emergency in their lifetime. Fewer than a third had actually assembled an emergency kit, and among the patients who depend on electrically powered medical equipment, only one in four had backup power.

So the intent is close to universal and the execution is uneven. The medication half is the part they’ve done best, which makes sense, because it’s the part they already think about every morning.

Then there’s the number that should get our attention. Only 40% had discussed their emergency plans with their own family. If six in ten haven’t raised it with the people they live with, the odds they raised it at their annual visit are worse. The planning is happening, the supplies are being bought, the medication list is being written, and no clinician or pharmacist has looked at any of it.

What makes their preparation different is that it’s mostly a medication problem

For most people under 40, preparation is a supply question. Water, food, a flashlight, a first aid kit, plus some way to hear what’s happening. Medication appears on those checklists, but it isn’t what they’re built around, and for a healthy 30-year-old that doesn’t take any chronic meds it is the right call.

It stops being the right call somewhere in the late fifties. Polypharmacy in adults 65 and older climbed from 23.6% in 1999 to 2000 up to 43.0% by 2017 through March 2020, and the average number of prescriptions per person went from 3.0 to 4.3.² In twenty years, taking five or more prescription medications went from about a quarter of this population to nearly half of it.

So her grandson’s version of this and her’s are not the same exercise. His is bandages, ibuprofen, and a flashlight. Hers is four or five prescriptions she can’t skip for a week, plus everything on his list.

And her four or five medications she does take are not equal, which is the part she may not be able to differentiate on her own. A week without a statin is a non-event. Levothyroxine has enough half-life to forgive a few missed days. A beta blocker stopped abruptly is much more time-sensitive. So are anticoagulants, antiepileptics, and insulin. It’s easy to treat all of them as one undifferentiated pile labeled ‘my medications.’ Sorting that pile into what tolerates a gap and what doesn’t only take 2 minutes and helps flag what is most important to have enough of hand on to prevent a disruption in care.

Part one: how long a fill she can get

Let’s take the easiest of the three first. When a patient asks whether she can get more of a medication she already takes, that’s a dispensing-interval question. Same drug, same dose, same indication, same prescriber. Only the interval changes, and nothing about her pharmacologic exposure does. That is, speaking for general chronic medications. This isn’t the same for controlled substances or acute cases like antibiotics.

So write it long. For a patient who’s worried, you can write a year of refills on a chronic medication up front and let her decide how much to have on hand at any one time. She can pick up a month, or three, or the whole year if her plan allows it. Some plans will cover a full year at once for travel, which is worth asking about rather than assuming.

If you do nothing else with this article, default your chronic prescriptions to 90 days. Your patients end up with a real amount on hand without anyone having to plan for it, and they stop driving to the pharmacy and standing in line twelve times a year for a medication that hasn’t changed in a decade.

Part two: the list in her bag

The AGS tip sheet says to carry a written medication list that contains all brand and generic names and doses a patient takes regularly.³ That’s the right instruction, and it’s the one she’s most likely to have done badly, because most people don’t have this written down and just cite it from memory. What comes out is “the little white one for blood pressure” and a dose she’s half sure about. And to make matters more complicated many patients pharmacy shop for the best price on medications so the Rx are spread across pharmacy chains and multiple prescribers with no central EMR hub all healthcare professionals can access.

A clearly printed, and accurately updated med list is usable by a pharmacist who has never met her. Drug, strength, and directions for each item, and the condition each one treats. Indication is important to remember and not leave off either. Add her allergies, adverse reactions to previous medications, and your office phone number while you’re at it.

This simple list costs almost nothing. Your MA can print the med list at check-out in a minute. Just make sure to add the medications prescribed by other HCPs she sees. Better than that, have her ask her pharmacy(ies) for a printed profile, because the dispensing record shows what she has actually been filling and when, which is often closer to the truth than what’s in the chart. Reconciling those two against each other is the whole exercise that is most helpful. If they disagree, you and she have learned something worth knowing whether or not a disaster ever shows up.

Part three: what she keeps on hand for what hasn’t happened yet

This is the part that earns the skepticism, and it’s also the part where the answer moves with the decade. A healthy 58-year-old on one antihypertensive is not a Beers patient⁴. A 78-year-old on four medications, with a creatinine clearance you’d want in front of you first, is a different conversation. The difference isn’t age by itself. It’s the list she’s already on.

A single new drug isn’t generally a big deal.  It’s when another is added to a polypharmacy list that there’s more for it to bump into for drug-drug interactions and drug-condition interactions. And the kidneys are slower, so the same dose hits harder. The 2023 Beers criteria are still current as of this summer if you want the reference.

And, since we are talking about appropriate medical preparation, if she’s in a situation where she can’t reach a healthcare professional she’s the one who decides whether to take it with nobody to ask. The bottle won’t tell her when not to. You will, ahead of time, while she’s feeling fine. Anything she keeps on hand is for an emergency, after she’s tried to reach a provider, and she only knows that because somebody told her. That’s the argument for having the conversation about how to prep well instead of saying no and sending her to figure it out herself with the internet chat rooms as guide.

The drug-by-drug version of what medications are appropriate for seniors in emergency kits is its own article and we’re writing it: what to look for in medical preparation after 70, and which contents actually matter at that age. 

The missing middle layer

Here’s the structural problem underneath all three parts. Care in this country is all or none. Either she reaches a clinician and gets a prescription, or she’s on her own with whatever happens to be in the house. Nothing sanctioned sits in between, which is how a reasonable 64-year-old asking a reasonable question ends up choosing between a no from her prescriber and whatever she finds on her own.

Appropriate medical preparation is the name for that middle layer. One bounded step, taken ahead of time, by a clinician, for the disruptions that actually happen to people her age: the week she can’t get to the pharmacy, the storm, the trip that puts her four hours from a clinic. Or international travel.

It isn’t a replacement for the clinician or the pharmacist she already has. It doesn’t manage her chronic conditions, it doesn’t follow her labs, and it makes no decision at the point of use. It’s what’s on the shelf for the times you aren’t reachable, used in an emergency, after she’s tried to reach someone.

If a patient in that age band asks and you’d rather not be the one to build an appropriate medication kit with her, you can send her to us at Jase.com. A licensed provider reviews every request and writes every prescription, so it’s a handoff rather than a workaround.

We’ll keep publishing where we draw the lines, including the lines that run through our own products. Right now that conversation is happening on the pickleball court with nobody clinical in it. That’s the part we’re trying to fix.

Sources

1. National Poll on Healthy Aging. Emergency Planning among Older Adults. University of Michigan Institute for Healthcare Policy and Innovation, with support from AARP and Michigan Medicine. Fielded May 2019, published September 4, 2019. n = 2,249 adults ages 50 to 80. https://www.healthyagingpoll.org/reports-more/report/emergency-planning-among-older-adults
2. Innes GK, Ogden CL, Crentsil V, Concato J, Fakhouri TH. Prescription Medication Use Among Older Adults in the US. JAMA Internal Medicine. 2024;184(9). NHANES, January 1999 through March 2020, 14,917 adults aged 65 and older. Polypharmacy, defined as 5 or more prescription medications, rose from 23.6% to 43.0%; mean medications per person rose from 3.0 to 4.3. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2820722
3. American Geriatrics Society. Tip Sheet: Emergency Preparedness for Older Adults. HealthInAging.org, September 2019. https://www.healthinaging.org/tools-and-tips/tip-sheet-emergency-preparedness-older-adults
4. By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052-2081. doi:10.1111/jgs.18372. https://pubmed.ncbi.nlm.nih.gov/37139824/

For Clinicians | Antibiotic Eye Drops for Pink Eye

What to Do When a Patient’s Pharmacy Is Closed

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

“I’m from out of town and I just took my last pill from another pharmacy. Can you give me a refill? I reaaaaally need this med”

I’ve had this happen to me dozens of times every ski season in the mountain town pharmacy I worked at for years. Friday at 4:50pm when all offices are closing up shop for the weekend. People don’t always have the pharmacy closest to them open and ready with their prescriptions. It happens for all sorts of reasons.  A hurricane or a holiday weekend. A staffing shortage that closed the pharmacy early with no sign on the door guaranteeing when they will open again. A power outage. Or the chain closed a batch of locations in one fell swoop when they went under.

Today we’re talking about closed pharmacies, and about how much of this is preventable from our side of the encounter. First, what you can put in place ahead of time so a closed pharmacy is an inconvenience instead of a crisis. Second, what you and your patient can do once the door is already locked and Monday is three days away.

How much medication do your patients actually have on hand?

Here’s how I think about this as a pharmacist. Picture a patient on a 30-day prescription. Their plan lets them refill once they’ve used about 75 percent of it, so somewhere around day 22. Most people go pick it up right then, because that’s when the pharmacy texts them that it’s ready. So they walk out with 30 new pills while a week of the old bottle is still sitting at home. Seven or eight pills, if it’s a once-a-day medication.

That’s the whole cushion. Seven pills. Nobody chose that number. It falls out of a 30-day fill and a refill window, and that’s the only reason it’s seven. If you’re prescribing rather than dispensing, this is the part you never see, because the refill math happens weeks after the patient leaves your office.

Now here’s what bugs me. Nobody agrees on the number. The Red Cross says keep a 7-day supply of medications.¹ The CDC’s own emergency kit checklist says at least two weeks.² FEMA’s Build a Kit page lists prescription medications and never names a number at all.³ Seven days is the one that propagated out to every state and county checklist, and seven days is what the patient already had by accident. The one study I know of that looked at what a household actually needs put the number at 14 to 30 days, and said the way to get there is longer fills.⁴ The CDC is closest to right and nobody is following it.

What to put in place ahead of time

These are workflow changes, not clinical ones. 

• Default to a 90-day fill on stable chronic medications. Same drug, same dose, same annual quantity. What changes is how often that patient has to stand in a line for it.
• Synchronize the refill dates. A patient on five chronic medications with five different fill dates is making five trips a month and getting five separate chances to run out on the wrong weekend. Write them all in one visit, aligned to a single date. The AAFP has recommended this for years as practice management, and it’s the same action with a different reason attached.5 Your MA can call the pharmacy to align the first cycle so it doesn’t eat your afternoon.
• A year is on the table, and most people don’t know it. For chronic medications that aren’t controlled substances, a prescriber can authorize up to a year of a patient’s own validated prescription to fill at a single time. Plenty of prescribers assume that isn’t allowed. Insurance likely will only cover 90 days regardless of what you wrote. It’s something for the patient to ask about, not something to promise them.
• Put the list on paper. Every medication in the house, with drug, dose, prescriber, and pharmacy. A pharmacist who has never met your patient can work from that list. Without it we’re guessing, and we don’t fill on a guess. Simple solution is to just print their med list from your EMR and give it to the patient instead of having the MA re-write everything by hand.

Can another pharmacy fill your patient’s prescription?

Usually yes, and more easily than most patients expect. Inside a chain, any store can pull up that patient’s prescriptions and fill them. Controlled substances get more complicated, but even then the new store can see the prescription and who wrote it, which is enough to start the conversation.

Outside the chain, it comes down to whether the patient brings the bottle. When someone handed me their bottle from another pharmacy, I could verify the prescription off the label, get them an emergency supply, and call their office Monday for a formal script. Without the bottle, at 8:55 on a Sunday night, there was nothing I could do for them because I couldn’t just take their word for it that they were taking that specific Rx.

So the counseling is four things:

• Bring the bottle to the pharmacy where you are. The label is what makes verification possible.
• Call ahead instead of walking in. Five minutes before close is the worst possible time to ask.
• Give lead time. “I have three pills left” on Thursday morning opens doors that “I’m out” on Friday at 5:59pm does not.
• Expect to pay cash. Insurance usually won’t process a fill this way, and a patient shouldn’t expect coverage. Great time for a discount card.

Two extra things to know. The first is the 72-hour emergency supply. A pharmacist’s authority to dispense without prescriber authorization varies enormously by state, and a meaningful number of states give pharmacists none at all. Several states that do have public-health-emergency provisions require a governor’s declaration to activate them, so the advice is weakest in the situation patients actually find themselves in: an ordinary Friday, nothing declared, nothing activated. Look up your own state before you tell a patient to count on it.6 It’s really more for epic natural disaster situations.

The second is Schedule II. There is no refill mechanism under federal law, so a patient who runs out on the road needs a new written prescription, not an authorization. A prescriber can verbally authorize an emergency quantity limited to the emergency period, with the written prescription delivered to the pharmacy within days. This is federal, so a state’s emergency dispensing rules don’t create a workaround. For patients on stimulants or opioids, that’s a conversation to have before the trip, not during it.7

Ahead of time there is one thing you can do. Federal rules let you issue multiple Schedule II prescriptions totaling up to a 90-day supply, each one marked with the earliest date a pharmacy may fill it, where your state permits it and where you judge there’s no undue diversion risk.⁷ It isn’t a refill and the regulation is careful to say it isn’t an expectation, but it’s the closest thing these patients have to the 90-day fill everyone else gets.

Everything above is a workaround

Now that we’ve covered the basics, look at what this article has covered. A longer fill, because the default one is too short. A bottle carried to a stranger’s counter, because there’s no other way to verify. A 72-hour supply that depends on which state line your patient happens to be standing behind. Every one of these gets around the same absence. There’s no sanctioned step between reaching a clinician and being on your own with whatever is in the cabinet. Care is all or none. Either your patient gets to someone who can write or verify, or they’re counting seven pills on a Friday night.

That missing step is what we build at Jase, and the category has a name: appropriate medical preparation. For a short list of well-understood conditions, the clinical work happens on the front end. A licensed provider reviews the request and writes the prescription before anything ships, so the patient isn’t hunting for a prescriber at 8:55 on a Sunday night. It’s for emergency use only, after first seeking the assistance of a qualified healthcare provider.

This is in no way a replacement for primary care. Chronic disease management, complex diagnoses, and the ongoing relationship belong with you. What a JaseCase holds is the acute layer a disruption creates, the infection or injury that shows up during the week nobody can reach a pharmacy. The chronic half of the problem is the one you solve, in your office, with the four things in the list above.

If you’d rather refer

Some of you will want to work out the day-supply and standby-prescribing questions yourselves, and you should. Some of you have a full panel and no room for a new category of conversation inside a 15-minute visit or a line at the counter. Either is a reasonable place to land. If it’s the second, send them to us at Jase.com, where one of our licensed providers reviews the request and writes anything prescription that gets filled.

The criteria are the part we owe you. Which conditions qualify, what we decline to prescribe ahead of time and why, and how we handle the cases that don’t fit cleanly. We publish that here as we settle it, so you can argue with it or borrow it.

TL;DR

Patient calls, their pharmacy is closed:

• Same chain nearby? Any store can pull their profile and fill it.
• Different pharmacy? Bottle in hand, call ahead, expect cash.
• Schedule II? No refill exists. New written prescription, or a verbal emergency quantity with the written script following in a few days.
• No bottle and nobody reachable? A state emergency supply, if your state has one.

Every workaround in this article exists because there’s no sanctioned step between reaching a clinician and going without. We’re building that step and publishing the criteria as we set them. Until it exists, the shortest path runs through the script you write: ninety days instead of thirty, synced to one date, printed on a list your patient can hand to a stranger.

Sources

1. American Red Cross. Survival Kit Supplies. “Medications (7-day supply) and medical items.” https://www.redcross.org/get-help/how-to-prepare-for-emergencies/survival-kit-supplies.html 
2. CDC. Emergency Kit Checklist: Pregnant Women, Infants, and Children. Updated April 30, 2026. “Prescription medications (at least 2 weeks supply).” https://www.cdc.gov/children-and-school-preparedness/resources/emergency-kit-checklist-pregnant-women-infants-and-children.html 
3. FEMA. Build A Kit, Ready.gov. Updated July 1, 2026. Lists prescription medications among additional emergency supplies with no day-supply figure given. https://www.ready.gov/kit 
4. Carameli KA, Eisenman DP, Blevins J, d’Angona B, Glik DC. Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers. Disaster Medicine and Public Health Preparedness. 2013;7(3):257-265. Los Angeles County sample. “Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days.” Health professionals in the study supported 60- to 100-day dispensing units to reach the recommended 14- to 30-day reserves. https://pubmed.ncbi.nlm.nih.gov/23103395/ 
5. Sinsky TA, Sinsky CA. A Streamlined Approach to Prescription Management. Family Practice Management. 2012;19(6):11-15. The physician renews all of a patient’s chronic medications, excluding narcotics and benzodiazepines, at the annual comprehensive care visit; estimated saving of one to two hours of physician and staff time daily. https://www.aafp.org/pubs/fpm/issues/2012/1100/p11.html 
6. Healthcare Ready. A Review of State Emergency Prescription Protocols. September 18, 2022. 16 of 51 jurisdictions have no laws or regulations pertaining to emergency prescriptions; 23 allow a general emergency refill; 12 have public-health-emergency-specific provisions, of which 10 activate on a governor’s declaration. More than half of states allow only a 72-hour emergency supply or none at all. https://healthcareready.org/a-review-of-state-emergency-prescription-protocols/ 
7. 21 CFR 1306.12(a): “The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.” 21 CFR 1306.12(b): a practitioner may issue multiple Schedule II prescriptions totaling up to a 90-day supply with earliest-fill dates marked, where permissible under state law. 21 CFR 1306.11(d): an emergency oral Schedule II prescription is limited to the quantity needed for the emergency period, and the prescriber must cause a written prescription to be delivered to the dispensing pharmacist within 7 days. https://www.ecfr.gov/current/title-21/part-1306

For Clinicians | The September Asthma Epidemic

Why the Controller Refill Matters More Than the Rescue Inhaler

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Right now your patients are buying pencils, brand new white sneakers that’ll stay white for only a few days, a graphing calculator they’ll use twice, and a backpack with so much storage space. They’re paying registration fees and signing a stack of forms about photo permissions and field trips. Very few of them are making a back-to-school doctor’s appointment, and almost none of them are thinking about the inhaler that has been sitting in a drawer since late May.

Asthma doesn’t make the back-to-school list. For most of these kids, the next time they cross our radar is the third week of September, when a refill request hits the pharmacy, a parent calls the office at 7am, or the exacerbation lands in the ED.

This season is the most predictable respiratory event of the school year, and the medication that blunts it has to be restarted before the first bell. Not after the first bad night strikes.

So this is the time to dust off the inhalers. Today we’re talking about the September asthma epidemic: why hospitalizations spike two to three weeks after school starts, why the controller is the inhaler that matters here and the rescue inhaler isn’t, and what has to be signed before the surge instead of during it.

Why does childhood asthma get worse in September?

Because three separate things arrive in the same two weeks. A rhinovirus moves through a building full of kids who haven’t shared air since May. Ragweed peaks in September and mold counts climb as leaves come down. And controller inhaler use is sitting at its annual low.1,2

The size of it is bigger than you’re probably mentally calculating it is as well. In Canadian surveillance, 20% to 25% of all childhood asthma exacerbations requiring hospitalization occurred in September.¹ In school-age children the peak lands on average 17.7 days after Labor Day. Preschoolers peak at 19.4 days, and adults at 24.¹ The surge starts in the classroom and affects everyone else in the family in a domino effect after that.

You’re reading this thinking it’s just fall, and asthma is worse in fall. That was the assumption for years. Yet, it’s the school calendar that actually broke it. Scotland and Sweden send kids back in the third week of August, and that is when their peaks land. England and Canada go back the first week of September, and theirs land then.¹ Large peaks show up two to three weeks after school return in all four countries, with Scotland’s and Sweden’s smaller in amplitude.¹ Move the return date, move the peak. The epidemic has been documented in the US, the UK, Mexico, Israel, Finland, Trinidad, and Canada.1

Viral infection, mostly rhinovirus, is associated with roughly 80% of asthma exacerbations in this age group.¹ Which matters, because the medication that lowers exacerbation risk in that setting is the most important one. Prescription data show fewer asthma medication fills over the summer months, especially for children, and inhaled corticosteroid adherence is poor at baseline and likely worse in summer.¹

Controller or rescue inhaler: which one prevents the September spike?

The controller. The rescue inhaler treats an attack that has already started. The controller is what makes that attack less likely when a rhinovirus comes through the classroom. Nearly every back-to-school checklist tells parents to make sure there’s a rescue inhaler at school. That advice is correct. Yet, it’s still the wrong thing to lead with, because a rescue inhaler is what you reach for after prevention has already failed.

Current GINA guidance is pretty blunt: a short-acting beta agonist should not be used alone at any step.³ For adults and adolescents the preferred track is as-needed ICS-formoterol, which cuts severe exacerbations by roughly 60% compared with a SABA-only reliever.³ For children 6 to 11 with mild persistent asthma it’s daily low-dose ICS with as-needed SABA, and at the mildest step, ICS whenever the SABA is taken.³ So a child whose only asthma medication is albuterol is undertreated by current guidance. A child who has a controller prescription and stopped filling it in May is in the same position.

A lapsed controller medication doesn’t announce itself, either. The kid feels fine in July, which is partly what a working controller is for, and can feel superfluous so it gets dropped. There’s no symptom to report, no visit to schedule, and nothing in the chart to look at. Asthma that has been well controlled all summer can look and feel identical to asthma nobody has treated since May.

One place that this is visible is through a pharmacist’s eyes checking out their Rx fill history. A last 30-day ICS fill in April with three refills untouched is a big flag that asthma for this child is likely uncontrolled. The pharmacy for most of these families is the only place a clinician touches them before September. An albuterol refill request in August is worth two minutes of fill-history review, and a technician can pull it before the counseling conversation ever reaches you.

What has to be signed before the first bell

Almost no parents are scheduling back-to-school visits for their kids with you. So all the work is done with parent phone calls or pharmacy requests.

Three documents to know about to be able to refer patients to:

1. The self-carry authorization. All 50 states have laws letting a student carry and self-administer their own inhaler at school.⁴ The laws vary, and many districts still require written parent and prescriber permission on file, often renewed each year. Last year’s form doesn’t always carry over so double check that. 
2. The asthma action plan. Clinician-completed, listing medications, triggers, and the step-by-step response. Schools want a current one.
3. The medication the school keeps. Where district policy requires a supply in the health office, that’s a second labeled inhaler and a second prescription.

A national analysis of these state policies found enough gray area in how they’re written that schools misinterpret them, and children end up without immediate access to an inhaler they are legally entitled to carry.⁵ 

One more thing that stalls August refills: albuterol shortage headlines. The current shortage is nebulizer solution, not the metered-dose inhaler most of these kids carry. But it is a good reminder that drug shortages happen frequently and it is a very good idea to have the medication you need already on the shelf, instead of hoping you can get it in an emergency.

Preparation is the whole point

School inverts the way parents can help kids during a health event. A kid in a classroom, or a student three states away at college, handles the first ten minutes alone with whatever is in the backpack or the dorm room. That’s what appropriate medical preparation means in practice: the clinical decisions made ahead of time, so nobody is improvising during the emergency.

For September asthma the thing that has to be in hand in August is the controller medication, and that comes from your office and your pharmacy. Jase carries albuterol and epinephrine auto-injectors as JaseCase add-ons, which covers the emergency layer rather than the daily one. That complements what you’re already doing. We’re here for the times you aren’t reachable.

The bottom line

The September asthma peak is already on the calendar for 2026 in your area. It’ll hit two to three weeks after the first school bell rings. The medication that changes the outcome is the controller nobody has filled (or thought of) since spring. That gets fixed in August by you, over the phone or at the counter. A fill-history check and a signed form now are cheaper than an ED visit in six weeks.

Sources

1. Sears MR, Johnston NW. Understanding the September asthma epidemic. J Allergy Clin Immunol. 2007;120(3):526-529. The 20% to 25% September share is Canadian surveillance data.
2. Asthma and Allergy Foundation of America. The September asthma epidemic. community.aafa.org/blog/september-asthma-epidemic
3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025 update. ginasthma.org
4. Allergy & Asthma Network. State laws on student self-carry and self-administration. advocacy.allergyasthmanetwork.org/state-laws
5. National Analysis of State Health Policies on Students’ Right to Self-Carry and Self-Administer Asthma Inhalers at School. Journal of School Health. 2018.