# Should dispatchers tell callers how to give allergic reaction medication?



## MMiz (Apr 14, 2009)

*Should dispatchers tell callers how to give allergic reaction medication?*
_Austin EMS officials push for national standard on giving instructions over the phone._

On the day she dialed 911 in November, the caller knew from a previous near-fatal experience that her 80-year-old husband was probably having a severe allergic reaction and needed an urgent dose of a potentially life-saving drug.

She told the dispatcher, a trained paramedic, that she had a shot of epinephrine at hand but wasn't sure how to give it.

Under Austin-Travis County Emergency Medical Services rules, the dispatcher wasn't supposed to tell her. 

*Read more!*


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## LucidResq (Apr 14, 2009)

Ok, tangent... but what the heck is up with this picture? Why is she wearing a face mask? And what's with her nails?! 







It's like the reporter needed a picture for this story so he grabbed his 16-year-old daughter, had her wear a face mask and hold an epi-pen. 

"Honey... try to look... you know... medical-ish"


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## Mountain Res-Q (Apr 14, 2009)

MMiz said:


> *Should dispatchers tell callers how to give allergic reaction medication?*
> _Austin EMS officials push for national standard on giving instructions over the phone._
> 
> On the day she dialed 911 in November, the caller knew from a previous near-fatal experience that her 80-year-old husband was probably having a severe allergic reaction and needed an urgent dose of a potentially life-saving drug.
> ...



On a case by case basis, their might be arguments for and against this.  The problem is, IMHO, I don't trust dispatchers.  My dispatchers are idiots.  While I will not classify them all as such, does anyone here really believe that all the dispachers that they deal with are smart enough?  On the other hand, most dispatchers have a roladex at hand with "cheat sheets" to dirrect callers how to do CPR, control bleeding, etc...  I'm confused as to why it is against protocol for her to do so.  A true severe alergic reaction with respiratory issues ranks pretty high on my emergency list, so as a Paramedic, why didn't she violate what is obviously a stupid protocol, just as the medics who treated that dog in Canada did?


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## Sasha (Apr 14, 2009)

^_^





LucidResq said:


> Ok, tangent... but what the heck is up with this picture? Why is she wearing a face mask? And what's with her nails?!
> 
> 
> 
> ...



Her nails are so tacky looking!

As for the face mask.. maybe someone with TB was having an allergic reaction! ^_^


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## rescuepoppy (Apr 15, 2009)

Speaking from a dispatchers point of view. As long as the EMDPRS is in place to allow us to advise on the use of prescribed Epi-Pens I think it should be allowed. The key would have to be emphasizing to the caller that the meds are being used on the patient they are prescribed for. Added to our protocol cards already in place this could be another tool and one that could make a difference in the outcome of a call.


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## marineman (Apr 15, 2009)

If the caller can't figure out how to use it on their own then I say no. Nothing against dispatchers on this but I've heard the horror stories from providers getting an epi pen through their thumb while trying to save a patient, I don't think it would be a good idea to have joe blow go try it, then I end up with 2 patients and definitely don't like that idea.


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## reaper (Apr 15, 2009)

Nothing like getting on scene to a severe reaction, with the wife going 90mph through the house. Then you realize that she injected her thumb while trying to help husband!!

Most it will not harm them, but some it can. So you end up with two pt's, because you do need to evaluate the wife now!


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## CAOX3 (Apr 15, 2009)

marineman said:


> If the caller can't figure out how to use it on their own then I say no. Nothing against dispatchers on this but I've heard the horror stories from providers getting an epi pen through their thumb while trying to save a patient, I don't think it would be a good idea to have joe blow go try it, then I end up with 2 patients and definitely don't like that idea.



If the alternative is death.  Then I would say yes.

Children are prescribed epi-pens and taught how to use them.


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## LucidResq (Apr 15, 2009)

marineman said:


> If the caller can't figure out how to use it on their own then I say no. Nothing against dispatchers on this but I've heard the horror stories from providers getting an epi pen through their thumb while trying to save a patient, I don't think it would be a good idea to have joe blow go try it, then I end up with 2 patients and definitely don't like that idea.



I've seen a paramedic demonstrating what he thought was an epi-pen trainer, after being asked by an EMT-B student "if that's a trainer why does it have an expiration date?", stab himself in the thumb. 

If someone can't figure out something as simple as an epi-pen on their own, I fear what would happen if they are panicked and being instructed by someone else by phone.


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## STATION4 (Apr 16, 2009)

Hey Moutain Res-Q your hand a tied when you are a dispatcher.The dispatcher was following protocol.Hey we might read of cards thats what our protocols tell us.And where i'm from most of our dispatchers are EMT so our hands are tied also.Where ever you get dispatcher are stupid why dont u try doing it and u might get what a  dispachers go through.

what other commits do u have now??


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## EMTinNEPA (Apr 16, 2009)

135383 said:


> Hey Moutain Res-Q your hand a tied when you are a dispatcher.The dispatcher was following protocol.Hey we might read of cards thats what our protocols tell us.And where i'm from most of our dispatchers are EMT so our hands are tied also.Where ever you get dispatcher are stupid why dont u try doing it and u might get what a  dispachers go through.
> 
> what other commits do u have now??



Tunkhannock, eh?  Do you dispatch for Wyoming County or Luzerne County?

Edit: Disregard, I just read your post in the Intro thread.

p.s. I work for Medic 12 and 15 out of Luzerne County... you and I may have worked together before.


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## STATION4 (Apr 16, 2009)

Hey EMTinNEPA yes i do work for Wyoming County 911 Center.Good to hear from someone from around this neck of the woods 10-4...


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## EMTinNEPA (Apr 16, 2009)

There are actually more of us than you may think.  Artman works down in Snyder County and I think I talked to a guy from Schuylkill County before.

But back on topic...

If the dispatcher is also a paramedic, than they should be able to explain how to use an epi-pen.  Even if the dispatcher is an EMT, they should be able to explain how to use an epi-pen.  If the patient has a prescription for the epi-pen, even better.  It doesn't take a rocket scientist to use an epi-pen properly.  But then again, a panicky wife might not exactly be a rocket scientist.  I'd use caution, but try to get her to use it.


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## bmennig (Apr 16, 2009)

I see your logic EMTinNEPA, absolutely. I agree 100% that we should be able to, however in the dispatch world "if it's not in our fantasic EMD protocol, you can't tell them to do it". The EMD we use (in Wyoming County) is quite extensive, however, very hard to navigate through. I just looked at it and all we can tell the caller is that "if they have medication perscribed by the doctor for this type of situation, use it now as directed" It tells nothing of how to inject it what so ever. While I can definately tell somebody how to use it, we can't vary from the protocol. 

FYI: we use the National Academy of Emergency Medical Dispatch protocol... It's a real treat to use


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## EMTinNEPA (Apr 16, 2009)

The idea behind epinephrine auto-injectors is to deliver epinephrine as quickly as possible to counter-act a severe allergic reaction.  My ALS service is the only one around here that actually carries epi-pens, because they came to the conclusion that actually establishing IV access, then drawing up epinephrine in a syringe and administering it was too time-consuming.  If the husband is having legit and severe anaphylaxis, no point in NOT using the epi-pen.  It will probably save his life.

A good paramedic/EMT/dispatcher knows when to deviate from protocol and avoid cookbook medicine.


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## Mountain Res-Q (Apr 17, 2009)

135383 said:


> Hey Moutain Res-Q your hand a tied when you are a dispatcher.The dispatcher was following protocol.Hey we might read of cards thats what our protocols tell us.And where i'm from most of our dispatchers are EMT so our hands are tied also.Where ever you get dispatcher are stupid why dont u try doing it and u might get what a  dispachers go through.
> 
> what other commits do u have now??



I have no doubts that there are many GREAT Dispatchers out there, including yourself, I hope.  But with all due respect, you don't know the Dispatchers where I am from.  I've got the stories.  I fully understand that Dispatchers don;t have an easy job.  It can be as hard as being in the field.  But 90% of teh Dispatchers I have "worked with" don't seem to understans that our job ain't easy either.  Unfortunately, most of my Dispatchers have no real emrgecny service training.  I have problems with Dispatchers from my experiences with my mentally challenged ones (seriously-I don't trust most of them and neither do any of the people I work with becasue of many near misses and screw ups that endanger lives, mostly ours).  I have no problem with this particular Dispatcher, just this particular set of circumstances that placed her in a no-win situation.  But if you are one of the good Dipachers then all I can say is that I can get you a job if you want to move to the Sierra Nevadas.


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## bmennig (Apr 17, 2009)

how good do they pay?


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## Mountain Res-Q (Apr 17, 2009)

bmennig said:


> how good do they pay?



Based on looks alone:  Well enough to afford candy and cake every day, but not enough for a make over.  

Seriously, my biggest problem was that all EMT's and Medics were required to do 12 hours of "Dispatch Time" once a year to see how bad the Dispatchers have it.  Meanwhile, they didn't have to join us out in the field to see what our side had to deal with.  Didn't seem fair.  Our jobs are all difficult in their own way, so we should create mutual understanding so that we act as a team.  My job is hard, your job is hard, I make your job easier, you make my job easier, and we are all friends.  Maybe that is how it is in your neck of the woods... but not in mine, sadly.


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## STATION4 (Apr 17, 2009)

we are trying to get it so that we go out in the field and the police and fire and ems comes in to sit and see what goes on in the 911 center...it will be good for all of us here in Pennsylvania Wyoming County.


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## Mountain Res-Q (Apr 17, 2009)

135383 said:


> we are trying to get it so that we go out in the field and the police and fire and ems comes in to sit and see what goes on in the 911 center...it will be good for all of us here in Pennsylvania Wyoming County.



ABSOLUTELY!!!  There is nothing I hate more than the "Them against Us" mentality in emergecny/public service.  I everyone is this field learns to respect each others abilities and functions and sympathise with issues that they must deal with to help others then the better we will all do our jobs.  IMHO.  I just wish that I had slightly more skilled dispatchers in my world.


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## STATION4 (Apr 17, 2009)

YES i agree 100%


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## EmsPrincess* (Apr 17, 2009)

I don't think dispatchers should explain how to administer allergic reaction medication, but in this example the wife should have been well informed before hand.


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## redcrossemt (Apr 18, 2009)

A few thoughts:

*Don't dispatch against or without protocols* without medical direction or supervisory approval. Dispatch protocols are just like medical protocols. Sometimes being a cookbook medic is bad - but in cases where we want to provide "extra" care, we need online medical direction and approval. Dispatching without protocols opens you up to huge liabilities if things don't go right. Your center will probably leave it all on you too - saying that they provided you with protocols, you didn't follow them, and it's not their fault.

Second, the latest EMD protocols (at least the widely used NAEMD MPDS cards and software) allow for advice on the administration on aspirin in cases of chest pain. The dispatchers go through a series of questions about disqualifiers - including altered LOC, age under 16 years, allergic or any bad reaction to aspirin before, or if the patient has any recent history of bleeding. The NAED put out a statement that there would likely be a few patients who qualify for aspirin therapy, are instructed to take aspirin by the dispatcher, and experience adverse effects. However, they stated that because of the high risk of death in AMI syndomes, early administration of aspirin greatly outweighs the risks. It seems to me that Epi-Pens are no different. If dispatchers can ascertain that it is in fact anaphylaxis (severe symptoms with known ingestion of allergen, hives, itching, facial edema, etc.) and there are no contraindications (are there any in the use of epinephrine for anaphylaxis?), *we should be able to assist with online Epi-Pen administration instructions*. It seems that while there are some risks of administration, a well-written protocol could save lives, and the benefits would greatly outweigh the risks. However, I don't recommend implementing this protocol without local direction by a dispatch medical director, or until the NAEMD publishes an Epi-Pen directive for the MPDS system.

Thirdly, without medical direction, but after verifying that it's the patient's Epi-Pen, *I don't think there's much risk in advise the caller to follow the instructions of the physician and/or directions on the Epi-Pen*. I'm pretty sure they still have 1-2-3 step written instructions. I think it was: 1. Pull off gray cap. 2. Jab black tip into thigh and hold 10 seconds. 3. Call 911. If I remember correctly, the latest generation of pens also includes pictures of how to operate them.

Just some thoughts. I think the EMS community as a whole is generally unaware of how emergency medical dispatch and pre-arrival instructions work. If you have a chance to spend time in a dispatch center, or take an EMD class, jump at it. At the same time, I want to point out that we require our dispatchers to be both EMT-B licensed (road experienced medic preferred), and AEMD certified so they understand what it's like to be on the other side of the radio. Thanks for posting, MMiz.


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## mycrofft (Apr 20, 2009)

*You are relying on a telephoned diagnosis by a layperson?*

Supposing this story really is as it was told (how often is THAT), what if this dyspnea or whatever was not linked to anaphylaxis? 
Oops so sorry you killed your husband.

PS, 
I've heard the epi pen in the thumb one before and nearly did once myself, but when I cross questioned a couple victims they got vague when 
I pinned them down.  Pump epi into a digit and you can lose it.
I personally saw a nurse put an epi Bristoject into her lower lip during a code three across a rr track but she didn't inject.


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## redcrossemt (Apr 20, 2009)

mycrofft said:


> Supposing this story really is as it was told (how often is THAT), what if this dyspnea or whatever was not linked to anaphylaxis?
> Oops so sorry you killed your husband.



This could be part of the disqualifiers... 

You get to the dispatch card based on specific information. If it's dyspnea related to chest pain, you go to the chest pain protocol. If it's just dyspnea, you go to the difficulty breathing protocol. If it's dyspnea that's occuring with hives right after the patient ate seafood, and they have a known allergy to seafood, and are carrying an Epi-Pen; you could use the allergic reaction protocol. If you really want to be safe, you can exclude those over a certain age (45 y/o) for risk of cardiac complications.


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