Epi-Pens: Discussion

[Richard B the EMT]

As a BLS EMT, I have been trained over many refreshers (every 3 years) on how to use an Epi-Pen. Now (and forever, it seems), we are waiting for the NY State DoH to authorize a pilot program, that the EMTs in New York can start using them when needed.

As of this time, that I am aware of, the only autoinjectors we in the FDNY EMS Command carry, is the stuff in the WMD packs.

[JPINFV]

haha okay, nice gross generalization.

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

Correct me if I'm wrong, but didn't OPALS mostly look at trauma? There's published studies that show a decrease in mortality in patients transported by POV than ambulance.

[Eydawn]

Doc, what is Sabrina's Law? And I know that it's now required for summer camps in Tennessee (Last I checked) to have every staff member trained on the use of an Epi-pen and a stock of said Epi-pens in the infirmary. And every kid who's never been stung gets flagged and pointed out to staff at one camp I know of, just in case. I think it's a good idea.

After all... can you kill someone by giving them an Epi-pen? It's possible, but not terribly likely...

Wendy

CO EMT-B

[tniuqs]

haha okay, nice gross generalization.

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

Yes it does ... and what did OPAL prove ?

ps Yes I read Dr. Westlys JEMS comments, he was baiting for a debate, but then I debated with him over a bottle of Whiskey ... LMAO quite amusing.

OK some brilliant conclusions in OPALs :

That the sooner you get to an out of hospital arrest (BLS and ALS) then more of then patients survive (ps and old CPR standards) Bloody Rocket Science .... and it only cost 12 million to evaluate that .. sheesh man. Now on the same issue this has given the Fire Departments impudus to purchase AEDs ... huh?

And If you look and actually READ the ALS outcomes in Trauma .. you will find a differenet demographic group was evaluated in ALS vs BLS. (ps geriatrics composed more in the ALS group) hmmm again.

If I can recall a .8 % difference in to door discharge ... I will look at the study again this just off the top of my head.

Can You say FLAWED, I can on the groups studied alone !

But look to the success rate of Intubations WITHOUT paralytics about 80% first attempt ... and large bore IVs established .. nice job Ont ACPs !

Look past the very now very dated info and jaded conclusions but do look to the recognition of superiour treatment for SOB and Cardiac and outcomes and OPAL researchers conclusions there! Honestly, it amazes me just how many pple read the conclusions and political/media spin ... INSTEAD of reading the entire study and draw to their own conclusions. Please remember that this study looked at to door discharge ... no factoring in the ENTIRE hospital treatment. Besides the major centers and most highly populated areas were "ommited" from the study because they were exclusive ALS provision of care.

Late Edit I belive the study was concluded in 1998 and thats 10 years ago and many protocol changes since then .. one marked difference was volume of fluid and targets for MAP, just saying field treatment of trauma has also changed in 10 years.

ps Absolutely no mention of "chest decompression capabilities even m entioned on the OPAL study either, I guess that over 3000 patients entered in the study ... no one had a tension pneumo ? I digress.

cheers

Now tell me why basic providers should be doing advanced treatment without ALL the tools to deal with the anaphlaxis issue .... like again ?

<END RANT>

[tniuqs]

Doc, what is Sabrina's Law? And I know that it's now required for summer camps in Tennessee (Last I checked) to have every staff member trained on the use of an Epi-pen and a stock of said Epi-pens in the infirmary. And every kid who's never been stung gets flagged and pointed out to staff at one camp I know of, just in case. I think it's a good idea.

Sure its a good idea for the Parents (in this case) to provide an epi pen for their children, but this is off topic ... umm not that I don't stray more often than not. :oops:

After all... can you kill someone by giving them an Epi-pen? It's possible, but not terribly likely...

Disagree, mostly because the vast majority of Anaphlaxis ARE self limiting oh yes really,really and the number of kids told by their GPs (in Challenge Studies by a Dr. Zuberbulher et all) that possibly more than 80 % of kids are a "precautionary Dx only" quite interesting is it not ?

Ok is epi a drug of abuse ? ... and again yes ... I have seen this on many occasions just to get a "rush" and some will try to get a buzz anyway they can, just to mess with the providers.

Now can you kill someone with .5 of epi ... again oh yes you can, just take the next obese cardiopath (that just so happens to "react" to bee stings and is already taching along at 140 bpm ... give him epi instead of benadryl ... because he is still moving air and 15 minutes after the insult ?

Ok then, good luck with that.

cheers

The entire point of my musings is this "epi situation" in itself is good grounds to justify the upgrade to ALS services . PERIOD. :roll:

[JPINFV]

I have nothing really to add to this discussion except that when I read the title just now I had a dyslexic moment that forced to say, "Whoa, wait, what's this thread about?"

[tniuqs]

My Bad ? :oops:

mobey started this .... :twisted:

[CBEMT]

You people realize that if FDNY went 100% ALS, you'd probably end up with paramedics going for entire shifts or even longer without ever seeing a real ALS patient? Do you have ANY idea what kinds of things people in New York City call 911 for?

[mrmeaner]

Do you have ANY idea what kinds of things people in New York City call 911 for?

The same crap that people get seen by nurses and docs in the ER for?

[Richard B the EMT]

The same crap that people get seen by nurses and docs in the ER for?

Indeed, I do. I used to work in the EMS EMD, for 11 years before the merger into the FDNY, CBEMT.

And, as if I have to tell it, just how do these people get to the ERs for the nurses and doctors to review their crap? Why, by an ambulance, of course, MrMeaner.

I have seen the attempt to weed out the calls that should have gone by taxi, bus, or even walking, to a low priority treatment clinic, from those who truly would benefit from immediate care by EMS, both at the scene, and on the way to the ED, but the call volume on both sides of that question have increased at the same rate.

I honestly don't know how to get away from the ambulance to each request system in current use.

I repeat myself here, and probably will do again down the road, that the 9-1-1 systems are, in part, a victim of their own success. "Got a problem? Call 9-1-1, and help is on it's way."

Further repeating myself: A commercial showed a 1930s large scale party, quite noisy, with the voice over saying "save 9-1-1 for true emergencies". This is followed by the biplanes circling the Empire State Building, as King Kong is holding onto Fay Wray at the top, and again, the voice over says, "save 9-1-1 for true emergencies"

I guess it didn't work.