Epi-Pens: Discussion

[Richard B the EMT]

I post the following, including the source (New York State Volunteer Ambulance and Rescue Association) that sent it to me, and invite discussion on the content.

The following article and reply appeared in the NY Daily News. NYC REMAC BLS Protocols # 410 Anaphylactic Reaction and #455 Pediatric Anaphylactic Reaction permit BLS ambulances to carry Epi Pens if agency Medical Director approves. Protocols are online at http://www.nycremsco.org/images/articlesse...%20v010109a.pdf A number of volunteer squads carry Epi Pens. Contact a NYSVA&RA District officer or NYC REMSCO for copies of the necessary paperwork.

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Rx for EMS allergy roulette: Mom urges city to put livesaving remedy in all trucks

BY FRANK LOMBARDI

DAILY NEWS CITY HALL BUREAU

Monday, February 2nd 2009, 9:54 AM

As the mother of three young boys with food allergies, Julie Menin knows problems can arise unexpectedly, and that swift treatment can mean the difference between life and death.

She had a brush with tragedy a year ago when one of her sons had a severe reaction to tasting a salmon dinner.

Thankfully, the allergic reaction was brought under control by a swift injection of epinephrine - a medication used to treat anaphylaxis, which is an allergic reaction that dangerously constricts the throat and airways.

But Menin, the chairwoman of Manhattan Community Board 1, warns that New Yorkers who suffer such allergic reactions have one chance in three that epinephrine will be available on a responding Emergency Medical Service ambulance.

Under a bureaucratic regulation governing city ambulances, epinephrine is carried only by Advanced Life Support (ALS) ambulances, which generally respond to the more life-threatening emergencies.

The medication isn't available on the Basic Life Support ambulances (BLS). EMS has a peak staffing of 127 ALS ambulances and 235 BLS ambulances.

"If you call 911, you only have about a 33% chance of getting one with epinephrine," Menin said. "Those odds are unacceptable."

Menin raised the problem last week during a City Council hearing on a bill to require informational posters about food allergies for use in restaurants and other food service establishments.

In her testimony, Menin also urged the Council to mandate that all city ambulances come equipped with epinephrine injectors - which she described as simple, penlike "auto injectors costing about $20 that even teenagers can be trained to use."

She described how she used an EpiPen in an incident involving one of her 3-year-old twins, Mason, who suffered an allergic reaction while the family was on vacation in Colorado and dining with friends.

"We were eating salmon and Mason took one bite," Menin recalled. "Suddenly, [he] started crying and his lips were swollen. I had him open his mouth, and his tongue was very swollen."

She said she injected Mason with the epinephrine. An ambulance later took the child to a hospital, where he was given additional treatment.

"The doctor told us we were so lucky to have had an EpiPen," Menin said.

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2/4/09

Right tools for the job

Brooklyn: Re: "Rx for EMS allergy roulette: Mom urges city to put lifesaving remedy in all trucks" (Jan. 2): With ambulance response times the fastest ever, the safety and well-being of the public always comes first for FDNY EMS. Emergency calls, including those for food allergies, are never left to chance. Trained emergency medical technicians carefully evaluate 911 calls of all types to determine what type of ambulance is required. Any food allergy call that leaves patients at risk of anaphylactic shock always receives the best medical care possible: an Advanced Life Support ambulance. A variety of drugs, including epinephrine, as well as specialized equipment and the advanced training of paramedics are required to properly respond to these cases.

John Peruggia, chief of EMS, FDNY

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Jim Downey

Coeditor, BLANKET newsletter, NYSVA&RA

Editor, PULSE newsletter, District 4, NYC Region, NYSVA&RA

To be removed from the NYSVA&RA e-mail list please send a message to jamesbdown@aol.com

[Canadian Caesar]

I wonder if she would be even MORE upset if she new the difference between BLS and ALS practicioners not to mention the equipment on the ambulance?

For example: What id the Epi didn't work? Or what is her sons airway was totally swollen by the time the ambulance got there?

10 to 1 odds says she is under the impression that the BLS ambulance will just "Stick a tube down his throat so he can breathe." or "Cut a hole in his neck to help him breathe." Just like "ALL the Ambulance Drivers on TV can do..... right?"

Who says the "dumb" public cant advocate for positive change in EMS at least once in a while? Somebody should let that lady know the real difference between ALS and BLS, she at least seems able to get her concerns in the media.

[mobey]

Of course the real "solution" is all ALS units....

But aside from that Epipen's are pretty safe, although the EMT's should have to take extra education in recognizing anaphylaxis. But then you kinda have a piece meal emt...... Just go ALS.

[fiznat]

I didn't realize epi pens weren't standard for BLS units elsewhere. Here in CT the BLS trucks have both pedi and adult epi pens, and EMTs have standing orders for their use in anaphylaxis...

[tniuqs]

So why does not the family take resposibility for their own medical condition(s) ?

There are far more individuals that suffer from siezures ... so maybe we should allow all BLS providers to carry Benzos ... honestly this thinking is flawed bottom line, its catering to one special interest group.

Why not put more ALS trucks on the road ? (what if the epi pen does not work) as this could improve medical care on numerous fronts and not just purely for the anaphlaxis patient, as the next step is D50W, then bronchodilators, chipping away at what should be ALS intervention from the get go.

My grandfather away said if your going to do a job right, get all the tools you need to do the job first and then go to work if anyone is following.

cheers

<edit> dang you mobey ! beat me to the punch again.

[fiznat]

Why not put more ALS trucks on the road ?

Not that we haven't gone down this road a zillion times before, but we don't have more ALS trucks on the road because they are expensive, insurance barely or underpays for them, and the research has not been very positive towards advanced prehospital care.

That said, I think epi pens for BLS providers is pretty reasonable. They give epi pens to patients to take home and use at will.

[mobey]

Why not put more ALS trucks on the road ?..... as the next step is D50W, then bronchodilators, chipping away at what should be ALS intervention from the get go.

My grandfather away said if your going to do a job right, get all the tools you need to do the job first and then go to work if anyone is following.

cheers

Wait a minute..... Your not talking about the article anymore are you??

[tniuqs]

and the research has not been very positive towards advanced prehospital care.

Studies Please ... ask the Brits, OZ, and Canadians if ALS is not proving its worth .... its the US studies in ALS giving Advanced Providers a black eye.

sheesh

[fiznat]

haha okay, nice gross generalization.

The OPALS study was conducted in Canada. ....That first O stands for Ontario.

[WolfmanHarris]

But aside from that Epipen's are pretty safe, although the EMT's should have to take extra education in recognizing anaphylaxis.

Seriously. The 40hr First Responders I train can recognize anaphylaxis pretty quick and thanks to Sabrina's law are expected to be able to get a patient their own epi-pen if the patient is unable to. If an EMT-Basic isn't already qualified to use this piece of equipment, then let's drop all the pretenses and call them Ambulance drivers. I know Basic education sucks, but I'd expect that giving them the epi autoinjector to use should not be a huge deal.