Intramuscular Epinephrine
Administration for the NonParamedic Provider
HCEC First Responder
Organization Training
Goal
• To prepare HCEC First Responder
Organization personnel to safely
administer intramuscular epinephrine
injections within the scope of the HCEC
Fire and Rescue Medical/Trauma
Guidelines
Objectives
• Upon completion of the didactic and
practical sections of this program, the
candidate will be able to:
– Identify acceptable sites of administration on
the candidate’s anatomy
– Correctly prepare an injection of a stated
volume
– Demonstrate safe administration of an
intramuscular injection
Assessment
• Skills will be verified using inert or expired
solutions injected into an injection training
model or non-living tissue under the
supervision of an approved HCEC FRO
Trainer
• Candidates must perform the skill without
critical errors as listed on the HCEC
Psychomotor Skill Verification sheet for
Intramuscular Medication Administration
• Epinephrine is an
important pre-hospital
medication in the
treatment of asthma,
anaphylaxis, and
cardiac arrest.
Epinephrine
• Hormone and neurotransmitter
endogenous to, or normally
produced by, the body.
• Sympathomimetic
catecholamine
– Stimulates the sympathetic
branch of the autonomic nervous
system
• stimulates α1 receptors, increasing
blood pressure through
vasoconstriction
• β1 receptors, increasing heart rate,
contractile force, and myocardial
oxygen demand
• and β2 receptors, resulting in
bronchodilation.
• As an EMT-B or EMT-I you are most familiar
with assisting in the administration of
epinephrine by means of an epinephrine
auto-injector system.
• HCEC Fire and Rescue Medical/Trauma
Guidelines allow for the administration of
epinephrine by manual intramuscular
injection for anaphylaxis by FRO EMT-B’s
and EMT-Intermediates who have been
trained and credentialed by the HCEC
Clinical Division.
Packaging
• Glass ampules - breakable glass vessels
containing the liquid medication
– Cone shaped top
– Thin neck
– Circular tubular base for storing the medication
The thin neck is a vulnerable point where you
intentionally break the ampule to retrieve its
contents. The epinephrine used for
anaphylaxis is packaged in a 1 ml ampule at a
concentration of 1:1000, or 1 mg per ml.
Dosing
• The adult dose of epinephrine for
anaphylaxis is 0.3 mg. This is equal to 0.3
ml of 1:1000 solution.
• The pediatric dose of epinephrine for
anaphylaxis is 0.01 mg/kg up to a
maximum of 0.3 mg per dose.
Obtaining Medication
• To obtain medication from a glass ampule,
you will need a syringe and needle. Use
the following technique:
– Confirm the medication indications and
patient allergies.
– Confirm the ampule label (medication name,
dose, and expiration)
Obtaining Medication
• Hold the ampule
upright and tap
its top to
dislodge any
trapped solution.
Obtaining Medication
• Place gauze around the thin neck and
snap it off with your thumb.
Obtaining Medication
• Place the tip of the hypodermic needle inside
the ampule and withdraw the medication into
the syringe. Do not inject air into the ampule
as this will expel the solution from the
container.
Obtaining Medication
• Properly dispose of
the broken glass
ampule.
Intramuscular Injections
• Intramuscular injections deposit
medication into muscle. Muscle
is extremely vascular and
permits systemic delivery at a
moderate absorption rate. Drug
absorption through muscle is
also relatively predictable.
• Intramuscular epinephrine will
be delivered to the vastus
lateralis muscle, along the
lateral part of the thigh, midway
between the waist and knee, or
the deltoid muscle.
Administration
• To administer the prepared epinephrine
injection, use the following procedure:
– Draw up the correct amount of medication using
a 1 cc syringe.
Administration
• Confirm the correct dose and medication.
The medication should not be discolored
or contaminated. You should use a 1-1 ½
inch 20-25g needle for the injection.
Administration
• Prepare the injection site with an alcohol
wipe or other antiseptic. Remove the
needle cover.
Administration
• Hold the syringe upright so any air inside
rises to the base of the needle. Remove
the air by gently depressing the syringe
plunger.
Administration
• Insert the needle quickly at a 90degree angle to the injection site, deep
enough to place the tip into the muscle
beneath the skin and subcutaneous fat.
Administration
• Holding the syringe steady, gently
withdraw the plunger to ensure you are not
in a blood vessel. If you do not get blood
return, push the plunger in until it stops, to
ensure that all medication is injected.
Administration
• Dispose of the needle/syringe in an
approved sharps container.
Reassessment and Transition of
Care
• Your follow-up assessment should include
appearance, work of breathing, lung
sounds, skin signs, vital signs, and
changes in ability to speak.
• Relay to the receiving medic unit:
– Time and dose administered
– Patient response to the medication
Adapted from:
American Academy of Orthopaedic Surgeons. (2005). Allergic
reactions and envenomations. In A Pollak (Ed.), Emergency
care and transportation of the sick and injured (pp. 498-515).
Sudbury, MA: Jones and Bartlett.
Bledsoe, B.E., Porter, R.S., & Cherry, R.A. (2000). Medication
administration. Paramedic care: principles & practice (pp.
366-406). Upper Saddle River, NJ: Prentice Hall.
Hands-On Practice