Question about epi-pen use

[KitFox]

So I'm posting this for a friend who was to lazy to register...but anyway:

My friend is an EMT and goes to college in Maryland. Their unit only operates at the first responder level, however, so I don't think they're allowed to administer epi-pens. But they have a student there who suffers from some sort of severe food allergy, and their medical director & especially the student's parents are kinda pushing for the entire squad to be trained in administering epi-pens just in case. I don't think their unit really wants to just because of the legal issues involved with that, being only first responders and all (although they have many EMTs on their squad). But it turns out now that the school wants to also train all their RAs (resident advisors) to be able to administer an epi-pen for this one student. It just struck him as kinda odd that trained EMS providers (at the first responder level anyway) wouldn't be able to (legally) administer epi-pens if the student goes into anaphylaxis, yet they're willing to train just regular students who will have absolutely no other medical training to be able to use an epi-pen.

Does anyone have any insight into this issue? Can anyone clarify whether first responders are allowed to administer medications aside from glucose and oxygen? Is the whole idea of training non-healthcare professionals even legal?

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[BaylorHopeful]

I don't know about Maryland, but in working a Volunteer event with a First Responder (I'm an EMT-B, hopefully soon to be I), I understood that here in Massachusetts the Epi-Pen and Oxygen were the only things they could administer, and both had to have other "higher trained Healthcare Professionals on the way."

To me this makes more sense than glucose and oxygen, partially because if you pass out from a DIA emergency, the medics can infuse some glucose for you here. Once you're down for the count because your airway seized up from anaphylaxis...you're, well.....kinda screwed .

Again, I can't speak for Maryland, as I'm only certified right now in Massachusetts.

As for the RA's, your EMT friend should be able to administer the Epi-Pen, since he is an EMT and should have received that training in his EMT class. I recognize there's some whole squad certification legal crap to it, but there are also the Good Samaritan laws that should help protect your EMT friend under some situations.....

 

[OSUdoc08]

In Texas,

EMT-B's can:

-assist with patients taking their own inhaler or nitro tabs
-give aspirin for chest pain
-administer albuterol nebulizer (in selected services, mostly rural)
-administer oxygen
-assist patients with using their own epi-pen
-administer epi-pen (in selected services, mostly rural)
-use glucometer
-give oral glucose
-give activated charcoal

-they are working on being able to allow EMT-B's to administer sub-Q epi, in rural services, but it has not been cleared yet

-----------------------------------------------
The rural service I work for stopped carrying epi-pens, because they are expensive, and the expire frequently.

 

[beanbean]

Teachers and day care providers are often taught how to administer an Epi-pen if they have a child in their class who has a known anaphylactic rxn to peanuts, bee stings, etc.

It is certainly not a difficult skill and is life-saving. The signs of anaphylaxis are quite obvious and easy to teach to non-medical personnel.

In my region in CT EMTs can

Administer:
O2
activated charcoal with direction from med control or poison control
oral glucose
patient's own nitro
Aspirin for chest pain patients
EpiPen and EpiPen Junior for analphylaxis
patient's own inhaler

 

[flighterdoc]

So I'm posting this for a friend who was to lazy to register...but anyway:

My friend is an EMT and goes to college in Maryland. Their unit only operates at the first responder level, however, so I don't think they're allowed to administer epi-pens. But they have a student there who suffers from some sort of severe food allergy, and their medical director & especially the student's parents are kinda pushing for the entire squad to be trained in administering epi-pens just in case. I don't think their unit really wants to just because of the legal issues involved with that, being only first responders and all (although they have many EMTs on their squad). But it turns out now that the school wants to also train all their RAs (resident advisors) to be able to administer an epi-pen for this one student. It just struck him as kinda odd that trained EMS providers (at the first responder level anyway) wouldn't be able to (legally) administer epi-pens if the student goes into anaphylaxis, yet they're willing to train just regular students who will have absolutely no other medical training to be able to use an epi-pen.

Does anyone have any insight into this issue? Can anyone clarify whether first responders are allowed to administer medications aside from glucose and oxygen? Is the whole idea of training non-healthcare professionals even legal?

In California, EMT-B's are allowed to "assist" people in using epi pens, inhalers, and other drug administration devices. If I came across someone in severe anaphylactic shock, I'd assist them by taking the caps off the epi-pen, putting it in their hand, and "assisting" them to jab it into their thigh.

And, since I have an epi pen (bee sting alergy), I hope that someone would do the same for me.

 

[hakksar]

Some evidence based medicine findings that demonstrate that both first responders and the lay public (RA's) should be trained in Epi-Pen administration:

J Allergy Clin Immunol. 2004 May;113(5):837-44.

In particular the following paragraph is shameful and illustrates the need to improve training to as many people as possible who might be in a situation to need to use it:

"Epinephrine is widely dispensed in the community; however, in retrospective studies of individuals dying from anaphylaxis, it has been consistently reported to be underused, and failure to inject it at all, delayed use, inappropriate dose, or inappropriate route of administration have been identified as contributing factors to death. In 1 autopsy series, although epinephrine was given in 62% of fatal anaphylactic reactions triggered by a variety of agents, it was given before respiratory arrest in only 14% of these reactions. In a study of 32 individuals dying from peanut or tree nut allergy, 12 did not receive epinephrine at all, 10 received it too late, 4 died despite receiving it in a timely manner, and for 6, no information was available. In studies of individuals surviving anaphylaxis episodes, it has been reported that only 30% to 40% of subjects who required epinephrine actually received it."

Anyhow, food for thought.

 

[KitFox]

"Assisting" is all the first responders are allowed to do with that squad also. I guess it's just such an unclear definition so it confuses everyone because it can be interpreted in so many ways. I guess all we can do is pray that since it is college, this incoming student will be smart enough to not eat peanuts...

 

[flighterdoc]

"Assisting" is all the first responders are allowed to do with that squad also. I guess it's just such an unclear definition so it confuses everyone because it can be interpreted in so many ways. I guess all we can do is pray that since it is college, this incoming student will be smart enough to not eat peanuts...

or just make certain the squad knows how to "assist".