Anaphylaxis is a medical emergency that emergency medical service (EMS) providers of all levels should be prepared to recognize and treat. Parenteral epinephrine is the first line treatment for this condition. Epinephrine autoinjector devices are preferred by many EMS systems because they require less psychomotor training and pharmacology education than drawing up medication from a vial or ampule. The increasing cost of epinephrine autoinjectors presents a challenge for some EMS systems.
The National Association of EMS Physicians believes that:
It is important for all levels of EMS providers to identify patients with anaphylaxis and to recognize the need for prompt initiation of treatment with epinephrine.
The preferred route for administration of epinephrine in the treatment of anaphylaxis is intramuscular.
Epinephrine dosing for anaphylaxis should be consistent with current clinical guidelines.
There is some evidence that intramuscular injection of epinephrine drawn up from a vial or ampule by appropriately trained EMS providers is safe, facilitates timely treatment of patients, and reduces costs.
EMS system medical directors are the decision-making authority regarding whether and how best to provide epinephrine for anaphylaxis. When creating policies and protocols for anaphylaxis treatment, EMS system medical directors should consider local circumstances, including (but not limited to) the incidence of anaphylaxis, system clinical resources, education and training capacity, and opportunity costs.
Epinephrine autoinjectors, ampules, and vials should all be readily available and affordably priced for EMS agencies that elect to use them.
Medical oversight for the administration of epinephrine in anaphylaxis should be based on written protocols or standing orders that permit the administration of epinephrine without requiring prior contact with direct medical oversight.
EMS systems that provide epinephrine for anaphylaxis must do so with medical oversight, must ensure that every provider receives appropriate initial and ongoing training, and must use continuous quality improvement practices to promote the safety and effectiveness of anaphylaxis care.
Further research is necessary to understand the impact out-of-hospital treatments have for patients with anaphylactic reactions and to determine best clinical practices.