Should dispatchers tell callers how to give allergic reaction medication?
- Thread starter MMiz
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EmsPrincess*
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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.
redcrossemt
Forum Asst. Chief
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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.
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.
mycrofft
Still crazy but elsewhere
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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.
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.
redcrossemt
Forum Asst. Chief
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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.