# EPI Pens for BLS



## MCSOMED54 (Aug 16, 2004)

I'm looking for states, areas or agencies that permit their EMT-B providers to carry EPI Pens for treatment of anaphalaxis. Information, protocols and conditions would be helpful. I've heard there have been some studies done.

I'm trying to propose this to our base hospital, because much of the time we are working in remote rural areas.


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## SafetyPro2 (Aug 16, 2004)

Not allowed in our protocol, but we are allowed to administer or assist with the administration of an EpiPen if it is prescribed to the patient.


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## rescuecpt (Aug 16, 2004)

We have EPI pens for BLS in Suffolk County, New York.  I believe there are no contraindications, and no contact with Medical Control needed in extreme emergent situations.  I will look up the protocol and post it later.


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## ffemt8978 (Aug 16, 2004)

This was discussed here a while ago (Does your state allow this).

From the original thread:


> *In Washington, we have a law that allows EMT's to administer Epi-Pens to somebody in certain circumstances. (Note: This is not to be confused with patient assisted Epi-Pens. Each ambulance in the state carries their own Epi-Pens, and this law allows us to use them.) I'll describe the criteria we have to meet, but I would like to know if your state has a similar law. (Note: Our criteria is actually in a flowchart format that makes it much easier to go through than these questions)
> 
> Is EPI needed?
> If NO, then do not administer EPI.
> ...



Send me an e-mail, and we'll talk about sending our protocols to you.


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## Ray1129 (Aug 16, 2004)

Maryland Protocol for Allergic Reaction:

1.  Initiate General Patient Care

2.  Presentation (Just goes over what Allergic Reactions look like (Mild, Moderate, Severe) and what to look for)

3.  Treatment
(BLS Level of Care)   a.  Assist the pt. experiencing moderate to severe symptoms or mild symptoms with a history of life-threatening allergic reaction with the pt's prescribed or EMS service's EPI auto-injector or pt's prescribe albuterol.

                                b.  Albuterol inhalor may be repeated.

(Medical Consult)       c.  Consider additional doses of Epi auto-injector or prescribed albuterol.

There's more than that, but it's all ALS schtuff.


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## ffemt8978 (Aug 16, 2004)

I found the Washington state law that allows us to do this:

The Kristine Kastner Act

Here is the full text of the law:



> *RCW 18.73.250
> Epinephrine -- Availability -- Administration.
> (1) All of the state's ambulance and aid services shall make epinephrine available to their emergency medical technicians in their emergency care supplies. The emergency medical technician may administer epinephrine to a patient of any age upon the presentation of evidence of a prescription for epinephrine or to a patient under eighteen years of age:
> 
> ...


I think it is interesting how the specifically mentioned first responders as not being allowed to do this.


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## rescuecpt (Aug 16, 2004)

> _Originally posted by ffemt8978_@Aug 16 2004, 08:47 PM
> * I think it is interesting how the specifically mentioned first responders as not being allowed to do this. *


 Me thinks they meant lay persons or CFRs?


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## ffemt8978 (Aug 17, 2004)

> _Originally posted by rescuelt+Aug 16 2004, 07:36 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (rescuelt @ Aug 16 2004, 07:36 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ffemt8978_@Aug 16 2004, 08:47 PM
> * I think it is interesting how the specifically mentioned first responders as not being allowed to do this. *


Me thinks they meant lay persons or CFRs? [/b][/quote]
 Nope, according to the definitions listed in the RCW chapter, it means ALL first responders.  You must be an EMT to administer Epi.


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## rescuecpt (Aug 17, 2004)

Isn't an EMT a first responder?  Around here first responder means any trained person who gets their first, be it an EMT, CFR, Chief, etc.


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## Ray1129 (Aug 17, 2004)

> *Isn't an EMT a first responder? Around here first responder means any trained person who gets their first, be it an EMT, CFR, Chief, etc.*



Yeah, there are two definitions of the word.  In our area you could be a first responder by being the first on scene, or you can take the first responder class.  It's basically anything and everything medical that a non-ambo trained FF would need to know.  They teach basic first aid along with a few other tricks, like backboarding and collaring.  Obviously protocols vary from state to state in what a first responder can do medical wise....but that class is mainly trauma based.

Highest to lowest:
EMPT
EMTI(CRTI)
EMTB
First Responder
CPR Trained
No Training


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## croaker260 (Aug 17, 2004)

In idaho, if you rmedical director approves, then there is a state protocol for administering EPI pens by EMT-Basics (they must have a medical director), and can stock them. Otherwise they fall under the "Assist the pt" protocols.


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## MMiz (Aug 18, 2004)

> _Originally posted by SafetyPro_@Aug 16 2004, 12:28 AM
> * Not allowed in our protocol, but we are allowed to administer or assist with the administration of an EpiPen if it is prescribed to the patient. *


 Same with us


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## cbdemt (Aug 18, 2004)

We carry them and can assist with them.  We are to call medical control b4 administering the drug, unless we feel that the delay would be immediately life threatening to our patient.  I need to double check our protocols, but I don’t think there are any contraindications for Epi.

-C


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## ffemt8978 (Aug 18, 2004)

> _Originally posted by rescuelt_@Aug 17 2004, 04:03 AM
> * Isn't an EMT a first responder?  Around here first responder means any trained person who gets their first, be it an EMT, CFR, Chief, etc. *


 Washington actually defines the difference between a First Responder and an EMT in the RCW's.


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## rescuecpt (Aug 18, 2004)

As promised, NYS EMT-B Epi protocol:

From: http://www.health.state.ny.us/nysdoh/ems/p...lsprotocols.pdf

Anaphylactic Reactions
With Respiratory Distress or Hypoperfusion

Note: Request Advanced Life Support if available.
Do not delay transport to the appropriate hospital.

I. Assure that the patient’s airway is open and that breathing and circulation are adequate.  Suction as necessary.

II. Administer high concentration oxygen.

Note: In pediatric patients, maintain a calm approach to both parent and child. Allow the child to assume and maintain a position of comfort or to be held by the parent/guardian, preferably in an upright position.

III. Determine that the patient has a diagnosed history of anaphylaxis, severe allergic reactions, and/or a recent exposure to an allergen or inciting agent.

IV. If cardiac and respiratory status is normal, transport the patient while performing frequent ongoing assessments.

V. If either cardiac or respiratory status are abnormal, proceed as follows:

A. If the patient is having severe respiratory distress or hypoperfusion and has been prescribed an epinephrine auto injector, assist the patient in administering the
epinephrine. If the patient’s auto injector is not available or is expired, and the
EMS agency carries an epinephrine auto injector, administer the epinephrine as
authorized by the agency’s medical director.

B. If the patient has not been prescribed an epinephrine auto injector, begin transport and contact Medical Control for authorization to administer epinephrine if
available.

VI. Contact Medical Control for authorization for a second administration of the epinephrine auto injector, if needed.

VII. Refer immediately to any other appropriate protocol.

VIII. If cardiac arrest occurs, perform CPR according to AHA/ARC/NSC standards and refer to the Cardiac Arrest Protocol.

IX. Transport immediately.

X. Ongoing assessment. Obtain and record the patient’s initial vital signs, repeat enroute as often as the situation indicates. Be alert for changes in the patient’s level of consciousness.

XI. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).

XII. If epinephrine has already been administered, continue to reassess respiratory effort and vital signs, transport immediately.


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## Alpha752 (Aug 21, 2004)

I dont work a squad to tell you for sure, but I was told in Basic class that in Ohio we do not carry EPI on the truck, but can administer a persons own Prescribed EPIPEN with Med-controll approval.

Russ


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