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The United States Pharmacopeia (USP) National Formulary prescribes the packaging, storage, and distribution of medications. Most of the medications commonly used by emergency medical services (EMS) are intended for storage at "controlled room temperature." The USP definition of controlled room temperature is multifaceted and complex, and cannot be easily described as a simple range of acceptable temperatures, or even as an average temperature. The out-of-hospital environment is notoriously uncontrolled, and one of the uncontrolled aspects of that environment is temperature. This report reviews and summarizes the past 15 years of published research relating to out-of-hospital medication temperature exposures. Although the evidence is clear that EMS medication storage is not consistent with the USP definition of controlled room temperature, the impact of EMS medication storage on medication stability and potency remains unclear. Further research is needed to determine the true extent of the EMS medication storage problem, and to develop and validate appropriate solutions.