EPIPen, ideas on why it's in the kit?

[will]

Ok, not to start a likely controversial subject again. however I got to thinking after having looked at the kit the other day, and recent discussions here.

A place where I work on occasion has a BLS kit that was put together by another person who works there such as me, that is an RN.

The kit is in a tactical medical pack, and is "supposed" to be the same equipment or kit as the dispatched fire trucks would have. The kit has several smaller bags broken into "broke bone", "gun shot wound", "wound care/epi pen" Theres some basic tools, an Ambu-bag, etc.

What got me was the fact there is in fact an Epi Pen in the bag which says there is.

I KNOW EPI is an Rx only to be administered by an MD, etc, etc...

I know that people who may have severe allergic reactions are prescribed Epi-Pens in case of severe reaction, and relevant family members are trained in when and how to use them.

However I also know that the only person that works there likely to know how to use the EPI is the RN who put the kit together, who is there possibly 10% of the time, perhaps a bit closer to 25% of the time. The next 2 people in medical training would be me, and one other who are your typical Basic Aid/Lay Rescue trained... neither of which are trained, nor qualified to administer the EPI.

So, is it logical to say the RN put the EPI in there, in case he's around, he can administer it? Seems silly given he's there considerably less than any other person (including me, and I'm not there very often), he put it there for EMS? Redundant since they should have their own, and then some... He put it there for the person having the reaction who knows when and how to use it, but then shouldn't they already have their own?

Can anyone see any reasoning on why he would have supplied the kit with this medication? There is always a possibility an EMT/RN/or MD is at a class and could administer, but I would say odds are one in every 4-10 classes has someone trained in it's use.


Does it seem logical to anyone that an EPI pen is a good choice in the kit, or just a bit over the top? EMS response to the location is around 15-30minutes, with likely the first responder arriving in their POV, does the response time and likely hood of the first responder showing up without supplies warrant this? or just a bit overkill?

Opinions, anyone? I'm thinking it's in ways a useless item since no one at the facility on a regular basis could administer this in any sense (not to mention may not even know what it's for)

 

[Onceamedic]

Its in the kit cause it can save a life. Anaphylactic shock is scary.. and kills quick. Now the caveats.... it can save a life IF it has not expired, IF it has not been exposed to excess sunlight and/or heat (what color is it?) , IF it is administered correctly, IF the patient is in fact having a life threatening reaction, IF.. IF... IF

My personal opinion - it will probably never be needed, but then, I dont understand personal jump kits anyway. Any aid I render before the arrival of the cavalry is first aid and I can do it with my hands/and or stuff that's easily around.

 

[ResTech]

If no one is qualified to administer it then it really should'nt be in there. Not sure what state ur in but in PA we have specific guidelines and protocol for "primary use epi"... that is... epi-pens we carry on-board a BLS unit and administer to all patients with anaphylaxis regardless if they have their own or not.

Epi is a potent drug.... don't touch it unless qualified and research your states guidelines.

 

[will]

Yeah, not sure about Oregon's guidlines on EPI... might try looking it up, unless someone knows.

As far as the reason for the kit, it's at a firearms training facility, so it's not necissarily a bad kit to have on hand... especially from a liability standpoint... if something ever happened they couldn't accuse us of not being prepared when we are equipped similarly to the first responding EMS units (who would likely be called to testify to that fact) Hopefully it never sees use, however it's there if ever needed, people fall, and get hurt, stuff happens.

I might as the RN who put it there if he knows the local protocal/laws regarding EPI's use... maybe he feels it's worth having regardless if anyone can use it or not... I would assume an RN in Oregon is qualified to use it, but who knows.

 

[BossyCow]

In our state (WA) there was legislation passed requiring all ambulances to carry Epi-pens because a couple of high falutin' attorneys who lived next door to a state legislator, lost their daughter to anaphylactic shock. The original law stated that all EMT-s had to carry both adult and ped. These things outdate and they aren't cheap. The cost of that legislation state wide was huge, for an instance that affects around 3% of the population. They did re-write it to be only ambulances which saved some. Personally, I've thrown out more outdated Epi-pens than I have used.

Granted, if you need one, you need one and they are certainly nice to have. But their effects are short term, you may need three or four for the trip to the hospital if you are in a rural area. In the backcountry, we don't even bother. There's no point. We have one in the first aid kit for base camp but we don't carry Epi-pens on our packs

In our state, we are allowed to 'assist people with their medications'. We have to make sure it is their's (not some meds they borrowed from their uncle Victor when he had the same thing). We have to make sure it's still viable (not that bottle of nitro they've had since the heart attack in '87.) We also have to make sure that the dosage is correct. That they are taking what they are supposed to be taking (not 4 of the oxycodone because they are really small and not that strong)

But, you need to know what the contra-indications are to giving any medication before you use it. I know, if I had an Epi-pen right in front of me, and someone appeared to be in distress, and I don't have the proper training, it's going to be very difficult to not use it. I say remove the temptation to use a med that you aren't trained about. If your RN wants it, let him or her carry it in his/her personal kit.

And besides, it's a prescription med, who's name is the prescription in?

 

[Ridryder911]

Okay, how hard is it to use an Epi pen? ..duh! I always wonder why states mandate "special training" to open the end and jab into thigh! C'mon, we teach common layman how to use the thing.

More important, I would say 99.% of the time, I have never have seen a need to ever use one. Much, rather have Benadryl in the system. Most of the cases are reactions, not anaphylaxis, which there is a huge difference.

I probably can count how many times, I have administered epi in the field for anaphylaxis. It just doesn't occur that often. Most know if they had a real reaction and carry epi pens with them.

For those 1% of the time, I would say it is important to have an Epi-pen available. I know my state allows basics to administer it.

R/r 911

 

[BossyCow]

But Rid, this is an Epi-pen (adult or peds? Who knows?) placed into a pack that is accessed by untrained and uncertified personel. I think its highly irresponsible to place a prescription med into a first aid kit without any precautions. Like you say, most who need it carry it.

Yes they are easy to use. But that doesn't mean that you allow a layperson access to meds.

 

[VentMedic]

We recently had a good discussion on this where it concerned Bee-Keepers and having the Epi-pen available.

http://www.emtlife.com/showthread.php?t=4706&highlight=epi-pen

 

[akflightmedic]

But Rid, this is an Epi-pen (adult or peds? Who knows?) placed into a pack that is accessed by untrained and uncertified personel. I think its highly irresponsible to place a prescription med into a first aid kit without any precautions. Like you say, most who need it carry it.

Yes they are easy to use. But that doesn't mean that you allow a layperson access to meds.

So put a disclaiimer tag on it that says to be used ONLY by EMTs, RNs or MDs. How many people are really going to play with something unfamiliar?

Here on our camp, we have AEDs dispersed throughout. Inside those AEDs are little baggies with ASA and NTG spray...INSIDE the AED case where any layperson can get to it!!! OMG!!! They are labeled "To be used by med personel only".

In all seriousness, I think you are making a moutain out of a molehill. As Rid stated, it is hardly ever used prehospitally, and I see no harm in having it there.

As little time as you and the RN are there, I would say the same for the Billy Joe Bob rescue man idiot is there either..(you know, the guy you are concerned with using this device while being untrained.)

The cosmic odds of Billy Joe Bob being there at same time a true emergency develops, where IF he even remembers to get the kit as well as considering using anything inside it are dismal.

On another tangent, is there ASA,Motrin,Tylenol, Immodium, Tums, or Rolaids inside your 1st Aid Kits?
This is highly irresponsible as well. I mean dispensing medications without orders, or being a doctor is highly irresponsible.

That is unless people know where to get them and are allowed to help themselves and self medicate. Then it isnt an issue, but as an EMT you better not be handing this stuff out when people make complaints to you.

 

[medman123]

Call med control before you do anything that you have to question. It not a big deal to know when to use it, and useing is simple also. Trust me one day you will be happy thats it there.

 

[ffemt8978]

Call med control before you do anything that you have to question. It not a big deal to know when to use it, and useing is simple also. Trust me one day you will be happy thats it there.

Correct me if I'm wrong, but Med Control only applies to EMS and not the lay rescuer, which is the case Will would be in without an agency affiliation.

 

[medicdan]

Correct me if I am wrong, but in general, doesn't the first aid service at the firing range need Medical Supervision (an overseeing MD) in order to get a script for the pen? Doesn't there need to be a protocol or a standing order for it? Who wrote the script for the pen you have?

As others have stated, the pens expire quickly (in one year, as I recall), and once administered, the patient needs to get to a hospital quickly either for more epi or for treatment of the side effects.

I work at a summer music venue doing first aid and during concerts, we always have one RN and two EMTs/Ski Patrol people on. We kept epi pens for a while, but we used them so infrequently, and we needed a new one every summer, it just didn't make sense financially. We always have a basic ambulance on the grounds, and they carry at least one, so we dont worry.
Because we administer O2, bandaids, carry an AED and used to have an epi pen, we had to register with the state for what I think is the equivalent of an ambulance license, which came with requirements of its own. Do you need to do something similar?

Good Luck!

 

[will]

Correct me if I am wrong, but in general, doesn't the first aid service at the firing range need Medical Supervision (an overseeing MD) in order to get a script for the pen? Doesn't there need to be a protocol or a standing order for it? Who wrote the script for the pen you have?

I don't think that's the case since it was never really originally obtained by the range... in fact I may be incorrect in the RN leaving it, I always thought he left it there (which he shouldn't have a script as far as I know he has no allergies, he's a diabetic requiring insulin but not allergic) it may have been some regular student who thought we needed to have one on hand, or perhaps left us a spare so if he needed it and forgot it, we'd have one... Perhaps then when the RN put the new kit together he found the one someone had left and put it in the new kit (he didn't complete build the new kit from scratch, some of it was from an old kit they had prior.

Interesting theories and thoughts... perhaps if I remember I can ask him this week, since I'll see him... see if he did in fact put it there, or if had found it already in some of our stuff, and if he did put it there what he was thinking.

Anyone know, can an RN usually administer EPI without an MD supervising? I'm guessing a Nurse Practitioner could, but then they are almost MD's anyways.

 

[Flight-LP]

Will,
It doesn't matter how or why the EPI pen is there, you cannot use it, period! To answer your question, no the nurse cannot either without MD order. Honestly, I think you need to stop and put down all of the EMS toys and take a little look at reality..............

1. You are not a certified medical provider. Dive certs don't amount to crap for emergent medical care outside of the dive realm. That means you CANNOT LEGALLY PROVIDE ANY TREATMENTS ABOVE WHAT ANY LAY PERSON CAN OFFER. That includes oxygen administration. It is a drug that you are attempting to administer without a prescription or physician order. Giving it at your family place of business (or wherever you wish give it) is not allowed. Receiving training on something is not an approval to play............Hell, I have been trained and educated on performing emergent appendectomies, but do you see me cutting open people's RLQ? No. Because I am not authorized to do so by my medical director............See how that works?

2. You need to learn a little your states civil statutes and health codes. You are asking the right questions and we are responding with the right answers. But it seems that your rebuttal gets twisted around every time. Again, what you are proposing is not legal in most states. You need to be affilitated with an EMS organization or become one through your state EMS office. Regardless, you MUST have a physician on board, or you WILL eventually sued and probably prosecuted should you screw up while treating someone.

Sorry to be harsh, but man, your just not getting what we are trying to tell you. We're in the biz, many of us for decades. Take a moment to listen, you may be surprised at what you can learn.......

 

[will]

I'm done, thanks for playing... never once did I mention me using the EPI, I said to my knowledge no one except possibly the RN could use it, or would even know how to use it, if they could.

I was only trying to see if someone could help me understand why it may have been put in the kit in the first place, to which everyone is as stumped as I am in why it's there.

But for some reason people seem to think just because I ask a question I want approval or something, when I said from the start of this thread that NO ONE WAS TRAINED NOR ALLOWED (Legally, etc) TO USE THE DEVICE so why might it be there... This whole thread was about why would it be there since the only people around are Lay Persons who can't use such an item...

Nothing further...

 

[BossyCow]

So put a disclaiimer tag on it that says to be used ONLY by EMTs, RNs or MDs. How many people are really going to play with something unfamiliar?

Sorry, but I've seen what happens when idiots who think they are saving a life do something stupid. In this post, we have a guy who has not yet taken his EMT who is all excited about all the new toys.

I had a similar situation on a call where some helpful harry dosed a bee stung kid with no hx of allergies with an adult epi-pen because he panicked. Very different from a kit with limited access by those who have a system of training in place. Like Rid said, most people who have severe allergic reactions carry their own epi-pens and it's a very small percentage of people who have that severe of a reaction anyway. It's irresponsible to have a prescription med, unprescribed, unmonitored, unchecked for expiration date etc, just hanging about just in case.

 

[rgnoon]

It looks like he got scared off. It's too bad...it was a point that definitely needed to be made. Well put flight-lp.

 

[medman123]

Correct me if I'm wrong, but Med Control only applies to EMS and not the lay rescuer, which is the case Will would be in without an agency affiliation.

He does not work for a Company?

 

[ffemt8978]

He does not work for a Company?

Nope, he stated in another post that he was thinking about taking the EMT class for his own education.

 

[ffemt8978]

I'm done, thanks for playing... never once did I mention me using the EPI, I said to my knowledge no one except possibly the RN could use it, or would even know how to use it, if they could.

I was only trying to see if someone could help me understand why it may have been put in the kit in the first place, to which everyone is as stumped as I am in why it's there.

But for some reason people seem to think just because I ask a question I want approval or something, when I said from the start of this thread that NO ONE WAS TRAINED NOR ALLOWED (Legally, etc) TO USE THE DEVICE so why might it be there... This whole thread was about why would it be there since the only people around are Lay Persons who can't use such an item...

Nothing further...

But you did ask about you carrying and administering oxygen in another thread. Do you see where this could lead to the impression that you may end up wanting to use the Epi?

As to why the Epi pen is there, the only way to know for sure is to find the person that put it there and ask them. Otherwise, remove it from the kit to remove the temptation of using it.