So the presence of urticaria, tissue swelling and respiratory distress, +/- gastrointestinal symptoms compared to AMI signs and symptoms is difficult for even a physician to tell the difference between? There are exceptions to the rule, but surely those cases are few and far between. Do the benefits outweigh the risks? I believe they do. If educators can't provide enough education to BLS on recognition of S+S of anaphylaxis and when to implement a prepared, pre measured dose of adrenaline, then maybe that's the issue that should be looked at. Or is the issue really protection of ALS skills and apprehension that dissemination of those skills will mean loss of recognition/pay?