Some recent proposed legislation here in the State of Wisconsin has gotten me back of the topic of ambulances carrying Epi-Pens. The bill, sponsored by Republican lawmakers, seeks to allow â€œcamps, colleges, day care facilities, restaurants and other businesses to the list of entities allowed to carry and administerâ€ epinephrine via auto-injector.
You can read the full article about the bill from the Associated Press here and in many other places on the web if you would like for more information. Basically, the bill states that if you start to have an allergic reaction to something at your local cafÃ© the fry cook is going to be empowered to jab you in the leg (hopefully) with an Epi-Pen to help your swelling come down. For better or worse, and I donâ€™t pretend that there arenâ€™t problems with this whole popular push for epinephrine administration, I support this change because I believe that overall the proliferation of public epinephrine is a net positive in spite of the potential for harm from laypersons misdiagnosing anaphylaxis and giving epinephrine to a stranger inappropriately. Epi-Pens are not toys, after all.
However, the consideration of this bill makes one of my previous positions on epinephrine auto-injectors all the more poignant.
In December of 2014 I asked the question â€œWhy do Ambulances Carry Epi-Pens?â€ in a post here on this blog. In the piece, I stated my firm belief that no ambulance in the US should be required to, or choose to carry the epinephrine auto-injectors commonly known by the trade name â€œEpi-Pen.â€ I still very much believe that carrying Epi-Pens on an ambulance is irresponsible, unnecessary, and harmful.
Of course, before you get out your pitchforks and torches, my point was that because ambulances usually are staffed by trained and competent medical providers, ambulances should carry vials of epinephrine 1:1000 along with 1cc syringes and needles and draw up the epinephrine to inject manually instead. The auto-injectors are intended for use by patients and other laypersons who need to inject epinephrine in response to the rapid onset of a severe anaphylactic reaction where seconds truly count and an emergency medical response is too-many minutes away.
My point in that article, for the Too Long: Didnâ€™t Read (TL:DR) crowd is this: Epinephrine is good when indicated for severe allergic reactions and anaphylaxis and should be carried by every ambulance and EMS response unit. However, by requiring EMS providers to use and/or carry the auto-injectors instead of drawing up and injecting epinephrine from a vial, youâ€™re actually hurting patients who then have to compete with the increased demand for the Epi-Pens by EMS agencies which creates a much higher demand in the marketplace and results in astronomically higher prices for and shortages of the medication for patients in need.
To be clear: Epinephrine = good. Access to epinephrine = also good. Requiring ambulances and EMS professionals to carry epinephrine auto-injectors due to arcane and outdated legislation or rules = bad. States or regions that require EMS providers use auto-injectors = part of the problem.
Thankfully the State of Wisconsin, who through this bill is going to again increase demand for and therefore the price of Epi-Pens, has already allowed their EMS agencies at the EMT-B level and above to use drawn-up epi. I would suggest to the State that they further incentivize EMS provider agencies to use that option instead of continuing to waste money on unnecessary auto-injectors in order to help balance patient costs and keep the pens in the hands of the patients where they are truly needed.
if youâ€™re a person who has control over this kind of stuff, or a person who wants to make sure that patients have access to epinephrine when they need it, you should consider talking to the powers that be in your state or locality to make sure your areaâ€™s ambulances, at any level of care, are using epinephrine 1:1000 from a vial that they draw up and inject rather than spending all that money on auto-injectors which are wholly unnecessary for them at their level of training.
If youâ€™d like more on my reasoning, including a breakdown of the costs and projected savings for EMS agencies based on 12/2014 pricing ($400 for an Epi-Pen vs. $4 for a vial of Epi, a syringe, and two needles) along with references, go ahead a click through to the earlier post â€œWhy Do Ambulances Carry Epi-Pens?â€ for a good explanation you can share.
Remember, Epinephrine is good. Access to Epi is also good. Epi-Pens are great for patients… but stop putting them on ambulances. Let professionals use the tools available to them for the benefit of patients in need.