Q: Can a group of field researchers, certified in basic first aid, be allowed to have an epipen in a first aid kit at the location. There are no individuals with known allergies or prescription for epipen, but they will be in a remote location (2-6 hrs from emergency medical services.
If you are trained to identify anaphylaxis and properly use the device, I would argue, yes. I have been reviewing the experience of organizations that sponsor our courses. Even at the first aid level more then a few have used epinephrine accurately and successfully. Although less frequently, they have administered epinephrine in circumstances where a person with a history did not have the injector and in people who have not had a reaction previously.
I would argue that epinephrine use is first aid for properly trained individuals working in remote environments. The major problem is state law. I don’t know the rules, if there are any, in CA.
If you decide to use epinephrine, make sure that you do your due diligence and have a workable and useful risk management process. Make sure everyone is trained. You might consider including a yearly review. Have a good way to store the med, monitor its expiration date and properly dispose of expired and used injectors. Also, engage whomever writes your prescriptions to review every instance where it is used.
Ideally, everyone on an expedition should have the medication prescribed for themselves, whether they actually carry the medication or, in the case of the epipen, have it carried by someone in the group. To the extent possible, the individual should self administer any medication. This provides some protection to the group medical personnel who may lack the licensing or medical control back up to administer prescription medications. In the case of an epipen the question is easy: “Do you want to give yourself this shot, or do you want to stop breathing and die?”, which of course doesn’t relieve anxiety.
In the AHA First Aid course they advise to “help” the person administer the epi by asking if they need help and having that person place their hand on yours as you administer the auto injector. However, I believe their example is when the person is having difficulty reaching and administering an epi pen that has been prescribed to them already and is in their possesion. Technically, if you have an Epi-Pen that was prescribed to you, then the prescription is being used against the law (ie given to someone to whom it is not prescribed) when you give it or offer it to someone else. Also, even if you have prescribing authority, you may not be licensed in the state where the event occurs and not being a pharmacist you are likely not to have dispensing authority. Furthermore, there is the issue of you prescribing a medication without having done a proper history or exam or having a medical record for the patient. I suppose you could “accidentally” leave your personal auto injector out and the person developing anaphylaxis could “steal” it from you for self use but that is supposing that there is enough time for all this to play out (ie the “wink-wink” scenario) when the person is in full blown anaphylaxis.
I think the solution is to change some aspects of state laws to accomodate wilderness or rural emergencies when EMS is not readily (within minutes) available
I agree. Carefully worded legislation would go a long way toward offering clarity to this issue. Safe and sensible policy is possible.