and you thought it was bad when BLS was pushing meds...

[Dustdevil]

However, for the very reasons everyone here supported Epi in the classroom, there should also be preload epi pens on every BLS ambulance in the nation. We can agree on that, right? Can't we...?

Absolutely not. Not in my nation. As an emergency, last ditch effort in a paediatric population, I can almost go for it. As was already mentioned, the worst you are going to do is tach the kid out a bit. But in an adult population, there is way, way, way too much room for catastrophic error by an ambulance driver with one hour of "training" on allergic reactions. It's hard enough for a paramedic or even a physician to tell the difference between a heart attack and anaphylaxis without the benefit of diagnostic tools. And if you go giving epi to an AMI because the signs matched up with your cookbook, you're likely to kill somebody.

No way.

[Stoker]

Absolutely not. Not in my nation. As an emergency, last ditch effort in a paediatric population, I can almost go for it. As was already mentioned, the worst you are going to do is tach the kid out a bit. But in an adult population, there is way, way, way too much room for catastrophic error by an ambulance driver with one hour of "training" on allergic reactions. It's hard enough for a paramedic or even a physician to tell the difference between a heart attack and anaphylaxis without the benefit of diagnostic tools. And if you go giving epi to an AMI because the signs matched up with your cookbook, you're likely to kill somebody.

No way.

So the presence of urticaria, tissue swelling and respiratory distress, +/- gastrointestinal symptoms compared to AMI signs and symptoms is difficult for even a physician to tell the difference between? There are exceptions to the rule, but surely those cases are few and far between. Do the benefits outweigh the risks? I believe they do. If educators can't provide enough education to BLS on recognition of S+S of anaphylaxis and when to implement a prepared, pre measured dose of adrenaline, then maybe that's the issue that should be looked at. Or is the issue really protection of ALS skills and apprehension that dissemination of those skills will mean loss of recognition/pay?

[HellsBells]

First off I really don't want this to turn into another endless BLS debate. I really was just making a point to be the devils advocate and I found it interesting, the ease in which people agreed on teachers giving epi vs the ongoing, raging debate over BLS and drug admin.

Of course there are more issues that arise with the older population and heart defects, but we can say what if, what if, what if all day long if you want Dust. What if there is a substitute teacher who doesn't know a certain childs full medical history, thinks he needs epi and it exacerbates a previous congenital heart defect, perhaps a previously undiagnosed Wolff-Parkinson-White Syndrome.

[HellsBells]

First off I really don't want this to turn into another endless BLS debate. I really was just making a point to be the devils advocate and I found it interesting, the ease in which people agreed on teachers giving epi vs the ongoing, raging debate over BLS and drug admin.

Of course there are more issues that arise with the older population and heart defects, but we can say what if, what if, what if all day long if you want Dust. What if there is a substitute teacher who doesn't know a certain childs full medical history, thinks he needs epi and it exacerbates a previous congenital heart defect, perhaps a previously undiagnosed Wolff-Parkinson-White Syndrome.

[ccmedoc]

Most students have health cards in the principal's office..all necessary cards pulled before drug administration. The teacher of the student most probably would not even do the deed. Schools like this have pre-appointed faculty to go to in times of crisis.

Its not a BLS/ALS issue..it's a safety issue for the students. any pride should be left at the door for this argument.

[Just Plain Ruff]

let's put this in personal terms

your child, playing on the playground. Gets stung by a bee. Been stung two or three times previously with no problems. Now he's having short of breath, hives, urticaria, sweating and decreased LOC.

Your school thought about getting a epi pen and then due to liability or whatever dynamics came up decided against it.

ALS is 20 minutes away or even 8 minutes away.

You do have an AED but no epi-pen.

Your child goes into resp arrest and then codes all while the teachers and the nurse even watch in horror as two teachers do cpr on your child but in the end your child died due to the decision made by the administration of the school system were either too scared of liability or they assumed EMS would be there in time.

What would you do in that situation?

I had the unfortunate circumstance to be involved in trying to save that said child. No epi pen due to a districts inability to decide to have this life saving intervention. You cannot say it doesn't or has not happened.

[ccmedoc]

Yep...It happens....more than you think!!

[Just Plain Ruff]

I know it happens. So what as providers can we do to help the districts with this issue? I think these pens are just as beneficial as AED's in the schools plus they are cheaper.

[VentMedic]

Each state has its own set of statistics on the deaths of children originating on school property. There are only about 3 states in the U.S. that are still hold outs on forming adequate policy to allow anyone but a nurse in the school system to carry medications and administer medications. That even includes an asthmatic child that can not carry their inhaler to the ball field.

Good information for anaphylaxis:

http://www.safe4kids.ca/content/schools/anaphylaxis_eng.pdf

Great organization for information and good links:

Allergy & Asthma Network Mothers of Asthmatics

http://www.aanma.org/

http://www.aanma.org/breatherville.htm

Rights of the child to carry or receive medication.

http://www.aanma.org/cityhall/ch_childrights.htm

[ccmedoc]

We try to have yearly health fairs. Try to get the kids and parents involved in the prevention of these things. The administration is on board, as it was pitched to the school board many years ago. I think that if the providers got together; the hospital, prehospital, and community health, the funds could be made available for this type of intervention/prevention package. Its not that hard to talk the administration into when the possible repercussions of not having these meds available are. Education, training, and education..for the parents, teachers, administrators, and the students (where applicable). The same thing we have been preaching in this, our profession..

Besides, AED is becoming common, if not required in most public settings. Addition of epi-pens or epi-pen jr, should not be an issue..they are not that expensive once authorized..