EPI training for EMT-B

[FinlieFanatic]

Our department decided to stop purchasing the EPI-pens and are now training our EMT-Bs to give EPI IM injections. During the training the officer in charge has the EMTs injecting each other, which I think is a good idea. He is using sterile water to draw up and inject in the proper IM site, but I think it should be Normal Saline, not sterile water. Everybody getting the injection so far has stated the needle did not hurt but the injection did and hurt for some time. I can not find much information to back me up on my feeling of using NS over sterile water, what do you think? or has anyone found anything I can use.

 

[bstone]

Epi, not EPI.

 

[TransportJockey]

NM EMT-B's train for IM/SQ Narcan and Epi. Did my initial training and used sterile water to inject into each other. For IM/SQ it's fine. If it was IV, that would be another matter. As for pain... well, you're expanding a muscle group that is not used to expanding in that way. It will be sore for a bit. Shouldnt be near what a TDAP hurts, but it'll still hurt.

 

[Veneficus]

It is probably good you are not training for some type of surgery.

Really though, some states prohibit practicing on people where injections are not indicated because of the risks involved. I agree with that thinking fully.

While it may seem like a good idea to always practice how you perform, in the off chance you get a plebitis or the like, is your agency paying for the medical care? Are you getting paid for the time off of work if you are required to miss it? How about rehab or partial/total disability if you strike a nerve because of normal anatomical variation? What is the compensation in the event that you have permanat parathesia or sensation loss?

I know that the risks are really small, but who wants to be the 1:100,000 or so?

It doesn't matter if you are using sterile water or NS, the question is why are you using anything at all?

From the economic standpoint if you are replacing autoinjectors because they cost more than a vial, are you encountering an anaphylactic reaction often enough to justify the cost at all?

 

[PotashRLS]

We are considering going back to Epi injections because of the cost of Epi pens. We tend to throw too many away in the cold weather months because of expiration. We do try to rotate them based on expiration but it doesn't always mean they get used up.

As far as injecting fellow department members, we have never done that IM or SQ. Our IV instructors had us starting IVs on members for practice and technique but primarily on simulator arms.

 

[usalsfyre]

Not sure why a sim arm, or for that matter a roast, pork loin or chicken breast wouldn't work.

 

[ffemt8978]

Our department decided to stop purchasing the EPI-pens and are now training our EMT-Bs to give EPI IM injections. During the training the officer in charge has the EMTs injecting each other, which I think is a good idea. He is using sterile water to draw up and inject in the proper IM site, but I think it should be Normal Saline, not sterile water. Everybody getting the injection so far has stated the needle did not hurt but the injection did and hurt for some time. I can not find much information to back me up on my feeling of using NS over sterile water, what do you think? or has anyone found anything I can use.

So your "department decided to stop purchasing" Epi-pens and has designated a training officer to teach EMT-B's how to perform IM injections? What does the state and your Medical Director say about this practice, since this is beyond the scope of the EMT-B scope of practice in most states?

The 5 Rights are barely covered in the basic class, and become even more important when drawing up doses from a vial. I'd be interested to see what the protocol is for this, because I can the potential for huge problems in the future.

 

[NomadicMedic]

Most of the services here have stopped buying EpiPens and now carry vials and 1ml syringes.

It's a huge pain. I had to teach the EMTs on my shift at my fire department how to draw up Epi and administer it IM.

Smells like a huge liability issue.

 

[Mobey]

The pain associated with the injections was likely not from the solution as it is isotonic. the pain will be from the amount of fluid injected.

If you are using 1 or even 3 ml syringes, there is no reason to inject anymore than 0.3ml. Once you get up around 1.0ml, the muscle is going to be sore.

 

[MrBrown]

A vial of adrenaline and a 1ml syringe with a filter needle costs about $2 whereas an EpiPen costs what about $150?

Makes sense to Brown.

 

[8jimi8]

I propose no more BLS providers.


Minimum education can be solved that way. No more people parlaying on the way to medical school, or PA school... (or CRNA school... lol)

EMT-P or nothing. Then we can get rid of EMT and just be Paramedic.

Everyone deserves an ALS assessment and then we don't have people who don't understand that there are consequences to medical interventions.