HEMS EPIPEN PROTOCOL

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HEMS EPIPEN PROTOCOL

• Michael Calice MD

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Epipen Auto Injectors

• BLS and LALS providers by Dec 22, 2004.
• MCA approved MFR providers, based upon need/ not
  required for ALS.
• Treat life-threatening anaphylaxis
• PA 233 of 2003 all BLS and LALS will carry 2
  epinephrine auto injectors
• Adult------------- over age 11
• Jr.----------------- age 2 to 11

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Agency Responsibility

• A. Obtain a signed legend and pharmaceutical
  auth form from medical director for each purchase
  of medication.
• B. Ensure medication is securely stored in a
  locked compartment of the EMS vehicle.
• C. Design a tracking system to ensure that
  expired medication is not being used.
• D. Provide initial and ongoing training in the
  use of epinephrine auto injectors.

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Pre-RadioIndications Specific objective
findings in the setting of a LIFE THREATENING
allergic/anaphylactic reaction, which may include

• Assessment for allergic reaction
• Resp DIB, wheezing, stridor, retractions.
• Swelling- facial, tongue, upper airway
• VS- hypotension, tachycardia, thready or
  unobtainable pulse
• Skin-itching, hives, swelling, flushing, rash

• Assessment contd
• General- nausea, weakness, apprehension,
  convulsions, vomiting, diarrhea, and abdominal
  cramps, involuntary voiding, dyspnea due to
  laryngeal spasm, pruritis, urticaria,or
  angioedema
• Medication

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Contraindications

• Use caution in patients with heart disease,
  high blood pressure, and stroke
• a. EMT and Specialist contact medical control
• b. MFR do not administer

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Pre-radio Management

• Establish and maintain airway.
• Provide oxygenation
• Support ventilation as needed
• Upright position if not hypotensive
• Consider early intubation before laryngeal
  swelling becomes severe.
• Determine substance or source of exposure, remove
  patient from source if known.

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EMT/Specialist

• Administration of epipen
• Determine which Epipen to administer
• Adult Dose (0.3mg/0.3ml)
• Age over 11 and less than 50
• Patient over 32 kg
• Pediatric Dose (0.15mg/0.3ml)
• Age 2 to 11
• Under 32 kg
• Consult med control for anyone outside these
  parameters or h/o CAD, Stroke, high BP

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Administration

• Follow packet insert for administration
  procedures specific for brand of epipenephrine
  auto injector.
• Monitor for reactions
• Closely monitor the patients condition.
• Record all patient condition information and
  medication administration on run record.

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Post-radio

• Patients over 50 yo administer adult dose
• (0.3mg/0.3ml).

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QUALITY REVIEW

• EVERY USE OF THE EPINEPHRINE AUTO INJECTOR SHALL
  BE SUBMITTED TO THE HEMS FOR REVIEW BY THE
  PHYSICIAN QUALITY REVIEW COMMITTEE, WITHIN 72
  HOURS
• (PSRO PROFESSIONAL STANDARDS
  REVIEW ORGANIZATION)
• REVIEW REQUIRED BY MDCH