Food Allergy, Anaphylaxis & the 911 Lottery
Judi Miller RN, EMT-I
Today’s Presenter
Judi Miller RN, EMT-I
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OBJECTIVES
Explore the issues of epinephrine availability and administration
by EMS providers, including:
- legislation
- guidance documents
- individual state initiatives
Results from a recent survey of almost 1,000 pre-hospital
caregivers
Tips to help you navigate the 911 lottery
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Picture this…
 Your child is experiencing symptoms of a severe
allergic reaction. You go to grab his epinephrine
auto-injector from your purse and it’s not there. After
a brief moment of panic, your locate your cell phone
instead and call 911. The dispatchers reassure you
an ambulance is on its way.
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Everything’s going to be OK. Right?
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…it depends!
 Who responds to the call
 Where you live
 Local protocols
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Who responds to the call
EMTs may be divided into several groups based on
their level of certification and permitted skills:
 EMT Basic (EMT-B)
 EMT Advanced (EMT-A) / EMT Intermediate (EMT-I)
 EMT Paramedic (EMT-P)
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Who responds to the call
 Although 911 calls for anaphylactic shock typically
receive an ALS ambulance, BLS crews could be
asked to respond to those cases if a distressed
caller gives incomplete or inaccurate information to
an emergency dispatcher.
 A BLS ambulance arrives first on scene when an ALS
ambulance is further from the scene of the
emergency.
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Who Responds & Provider Knowledge
 A 2012 survey of US paramedics revealed gaps in knowledge and practice
Jacobsen RC, Toy S, Bonham AJ, et al. Anaphylaxis Knowledge Among Paramedics: Results
of a national survey. Prehospital Emergency Care 2012;16:527-534
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Where You Live
 Wide differences in population density, topography,
funding and other conditions have resulted in
different types of EMS systems
 Significant variation between EMS provided from
state-to-state...county-to-county…and even agencyto-agency
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Different EMS systems
Fire based EMS systems
Non-profit agencies (Rescue squads)
Private EMS industry
Public service EMS (independent government agency)
Hospital based EMS providers
Combination systems
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Different EMS systems
U.S. Department of Transportation National Highway Traffic Safety Administration
2008 survey of 7 Mid-Atlantic States
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Where You Live
 All 50 states allow paramedics to administer
epinephrine
 48 states allow EMS personnel to help administer
the patient's own epinephrine auto-injector
 31 states require that all levels of EMS personnel
carry epinephrine auto-injectors or vials
 17 states require that EMT-B personnel carry epi
 19 states do not require any level of EMS personnel
to carry any epinephrine for anaphylaxis
Wallace DV, Vitanza JM, Marshall G. The use of epinephrine for the treatment of anaphylaxis
in the prehospital setting. ACAAI 2009
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Where you Live
WA
NY
TX
NH
MA
RI
CT
NC
TN
KY
MD
IL
MI
WI
MN
OR
http://latexallergyresources.org/epinephrine-policy
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Where You Live
 Since 2010 a bill has mandated that all ambulances
in New York State, carry epinephrine regardless of
the level of provider.
“Epinephrine auto-injectors must be on all in-service
transporting ambulances. This requirement is for
adult and pediatric patients. It may be met by stocking
both adult and pediatric epinephrine auto-injectors or
through the use of ALS modalities that are already inplace.”
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Different systems – different protocols
 EMS providers practice under the license of an EMS
Medical Director and deliver care according to local
protocols
 Local protocols override State guidance
 Providing care that exceeds the scope of the
practice outlined in protocols can result in
certification being revoked
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Different systems – different protocols
ARLINGTON: ALS only. Severe reaction only
FAIRFAX CITY: ALS only. Moderate &
Severe reactions
FAIRFAX COUNTY: ALS only. Severe
reaction only
LORD FAIRFAX : BLS & ALS
LOUDON : ALS only. Moderate & Severe
MANASSAS CITY: BLS & ALS
PRINCE WILLIAM: ALS only. Mild, Moderate
and Severe
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From an EMS Perspective…
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751 Definitions…
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Epinephrine & BLS Providers
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Naïve Patients
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Epinephrine use by patients
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Triggers
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EMS PHYSICIANS POSITION STATEMENT
 Epinephrine is the cornerstone of treatment for the
potentially life-threatening condition of anaphylaxis
 There are many reasons why EMS agencies that
utilize both BLS and ALS providers should be allowed
to carry and administer epinephrine
 The NAEMSP believes that EMRs should be allowed
to both carry and administer EAIs to patients with
anaphylaxis
Jacobsen RC, Millin MG. The use of epinephrine for out-of-hospital treatment of
anaphylaxis. JEMS 2011;127(3):587-93.e1–22
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Navigating the lottery
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Educate Yourself
 Call or visit your local ambulance provider and learn
about the EMT- epinephrine policies in your area
 What type of EMT will respond to a severe allergy /
anaphylaxis call?
 Are all ambulances equipped with epinephrine?
 What type of EMTs can administer epinephrine, and
in what form?
 What is the average response time?
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Be Prepared
 Have an Anaphylaxis Action Plan
 Avoid allergy triggers
 Learn how to recognize signs and symptoms
 Always carry your epinephrine
 Know when to give it
 Check expiry dates regularly
 Give epinephrine before calling 911
 When calling 911 request an ALS ambulance
 Contact your state legislature
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Questions
Thank You
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Our Next Webinar
Managing Food Allergies in the Early Care Setting
Wednesday, July 9, 1:00 – 2:00 PM ET
Member registration opens Friday, June 6
Open registration begins Monday, June 16
Laurel Francoeur, Esq.
AAFA Patient Advocate
KFA Education Project Manager
Gina Mennett Lee, M.Ed.
Food Allergy Consultant, Mennett Lee, LLC
Founder, Food Allergy Education Network
Director, National Allergy & Anaphylaxis
Council
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