1. HEMS EPIPEN PROTOCOL Michael Calice MD

2. 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

3. 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.

4. Pre-Radio Indications: 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 cont’d – General- nausea, weakness, apprehension, convulsions, vomiting, diarrhea, and abdominal cramps, involuntary voiding, dyspnea due to laryngeal spasm, pruritis, urticaria,or angioedema – Medication

5. 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

6. 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.

7. 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

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

9. Post-radio Patients over 50 yo administer adult dose (0.3mg/0.3ml).

10. 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