Epinephrine AutoInjector Training This training content meets the

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Epinephrine Auto-Injector Training

Epinephrine Auto-Injector Training

 • This training content meets the requirements of the California Emergency Medical Services

• This training content meets the requirements of the California Emergency Medical Services Authority (EMSA) and complies with AB 1386 • Upon satisfactory completion of a written exam and skills test you will be eligible for an epinephrine certification card (good for two years)

Allergens “Insect sting allergy can occur at any age, often following a number of

Allergens “Insect sting allergy can occur at any age, often following a number of uneventful stings. . . Systemic allergic reactions are reported by up to 3% of adults, and almost 1% of children have a medical history of severe sting reactions. (21, 22) The frequency of large local reactions is uncertain, but is estimated at 10% in adults. At least 50 fatal sting reactions occur each year in the United States. (6) Half of all fatal reactions occur with no history of previous sting reactions. ” (Insect Sting Anaphylaxis: Golden, 2007)

Steps Involved in Immediate Hypersensitivity. Illustration by: Scott Charlesworth, Purdue University Extension

Steps Involved in Immediate Hypersensitivity. Illustration by: Scott Charlesworth, Purdue University Extension

Allergic Reactions Signs/symptoms can range from mild to severe, may be immediate or delayed

Allergic Reactions Signs/symptoms can range from mild to severe, may be immediate or delayed Mild to Moderate Reactions: • Local swelling near a sting • Runny nose, sneezing, swollen eyes, hay fever • Flushed and itchy skin • Mild or no breathing difficulty Anaphylaxis: • Severe, generalized reaction • Hives and welts on skin • Swollen face, lips, and tongue • Respiratory distress • Shock Treatment: • Remove pt from allergen contact • Administer oral antihistamines • Hydrate • Monitor for increased breathing difficulty Treatment: • Remove pt from allergen contact • For large areas of swelling, respiratory compromise, or shock administer epinephrine • When the patient can swallow, administer oral antihistamines • Monitor for a second reaction as you evacuate/activate EMS system

Indications • Epinephrine is used to treat life-threatening allergic reactions caused by insect bites

Indications • Epinephrine is used to treat life-threatening allergic reactions caused by insect bites or stings, foods, medications, latex, and other causes. • It works by relaxing the muscles in the airways and tightening the blood vessels.

Drug Actions • • • Epinephrine = Adrenaline It stimulates both the alpha- and

Drug Actions • • • Epinephrine = Adrenaline It stimulates both the alpha- and beta-adrenergic systems Causes systemic vasoconstriction Stimulates the heart Dilates bronchi and cerebral vessels For the treatment of anaphylaxis. NOTE: Epinephrine absorption is rapid and complete if administered IM in the anterolateral aspect of the thigh (PDR. net).

Contraindications • In a field setting, there are NO absolute contraindications to administering epinephrine

Contraindications • In a field setting, there are NO absolute contraindications to administering epinephrine for anaphylaxis, if properly dosed • Adverse outcomes from field administration of epinephrine: “There are reports of arrhythmias, stroke, and myocardial infarctions in people who received epinephrine for anaphylaxis. 19 Most of these adverse events occurred in the elderly, in individuals with preexisting heart disease, in patients who did not actually have anaphylaxis, or in overdose situations. Indeed, a Colorado youth experienced ventricular dysrhythmias and myocardial ischemia from an overdose of epinephrine after 2 emergency medical technicians drew 9 times the recommended dose into a syringe. 20 In this respect, auto-injectors or prepackaged medication kits should decrease the possibility of overdose”. Wilderness Medical Society Practice Guidelines for the Use of Epinephrine in Outdoor Education and Wilderness Settings: 2014 Update. Published in Wilderness and Environmental Medicine Journal, Volume 25, Issue 4, Supplement, Pages S 15–S 18.

Adverse Effects • • Too much epinephrine can cause dangerously high blood pressure, stroke,

Adverse Effects • • Too much epinephrine can cause dangerously high blood pressure, stroke, or death Rarely, patients may develop infections at the injection site within a few days of an injection. Some of these infections can be serious. Call your healthcare provider right away if you have any of the following at an injection site: – Redness that does not go away – Swelling – Tenderness – The area feels warm to the touch • • • Faster, irregular or “pounding” heartbeat Sweating Headache Weakness Shakiness Paleness Feelings of over excitement, nervousness, or anxiety Dizziness Nausea or vomiting Breathing problems

Emergency Use of Epinephrine Auto-Injectors • AB 1386 and the California EMSA epinephrine certification

Emergency Use of Epinephrine Auto-Injectors • AB 1386 and the California EMSA epinephrine certification card allows you a role as a Lay Rescuer: i. e. someone who has met the training standards and other requirements of this section but who is not otherwise licensed or certified to use an epinephrine auto-injector on another person, if… • The epinephrine auto-injector is used on an individual, with the express or implied consent of that person • To treat a person who is suffering or reasonably believed to be suffering from anaphylaxis • You must follow your Emergency Action Plan, get patient to emergency medical care, and report the incident

Administration by Auto-Injector • Epinephrine auto-injector should only be injected into the middle of

Administration by Auto-Injector • Epinephrine auto-injector should only be injected into the middle of the outer thigh (upper leg) • If you accidently inject into any other part of your body, go to the nearest emergency room right away. Tell the healthcare provider where on your body you received the accidental injection.

Acquisition of Epinephrine Auto-Injectors • Epinephrine Auto-Injectors require a prescription from a health care

Acquisition of Epinephrine Auto-Injectors • Epinephrine Auto-Injectors require a prescription from a health care provider • For prescriptions fulfilled for a trained “Lay Rescuer” or “Prehospital emergency medical care person” (per AB 1386): (b) The pharmacy shall label each epinephrine auto-injector dispensed with all of the following: (1) The name of the person or entity to whom the prescription was issued. (2) The designations “Section 1797. 197 a Responder” and “First Aid Purposes Only. ” (3) The dosage, use, and expiration date.

Dosing • Follow the product instructions. • Each auto-injector delivers a single dose of

Dosing • Follow the product instructions. • Each auto-injector delivers a single dose of epinephrine. • More than two sequential doses of epinephrine should only be administered under direct medical supervision.

Commonly Available Models of Epinephrine Auto-Injectors Epi-Pen by Mylan Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Epi-Pen by Mylan Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Epinephrine Injection, USP Authorized generic for Epi-Pen Safety

Commonly Available Models of Epinephrine Auto-Injectors Epinephrine Injection, USP Authorized generic for Epi-Pen Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Auvi-Q includes voice instructions. Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Auvi-Q includes voice instructions. Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Adrena. Click by Amedra Pharmaceuticals Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Adrena. Click by Amedra Pharmaceuticals Safety Information

Commonly Available Models of Epinephrine Auto-Injectors Impax Epinephrine Auto-Injector available at CVS Pharmacy Safety

Commonly Available Models of Epinephrine Auto-Injectors Impax Epinephrine Auto-Injector available at CVS Pharmacy Safety Information Authorized generic of Adrenaclick

Maintenance & Quality Assessment of Epinephrine Auto-Injectors • Read the label • The epinephrine

Maintenance & Quality Assessment of Epinephrine Auto-Injectors • Read the label • The epinephrine auto-injector must be stored and maintained as directed by the manufacturer’s instructions provided with that product • Visually inspect products for particulate matter and discoloration prior to administration whenever solution and container permit. Do not use solutions that are pinkish to brownish in color, cloudy, or contain a precipitate or particulate matter. • Protect from direct light; Refrigeration is not required • Keep accessible with your first aid supplies • If multiple staff are trained in your group, always know who is carrying your first aid supplies and check quality/expiration date prior to departing on a trip

Proper Storage, Handling, & Disposal of Used/Expired Injectors • Epinephrine auto-injectors are a potential

Proper Storage, Handling, & Disposal of Used/Expired Injectors • Epinephrine auto-injectors are a potential SHARPS hazard and contain unused drug • Never dispose in the normal trash • If the auto-injector has been used and the needle does not retract automatically, carefully recap using a one handed technique to avoid a needle stick • All used and expired epinephrine auto-injectors must be disposed as hazardous waste: – Ask your pharmacy, they may accept expired auto-injectors back for disposal – Or for campus operations, contact your EH&S department for pick up/disposal If a needle stick ever occurs, seek medical care immediately

Good Samaritan Law In California, it is the intent of the “Good Samaritan Law”

Good Samaritan Law In California, it is the intent of the “Good Samaritan Law” to encourage individuals to volunteer to assist others in need during an emergency. HEALTH AND SAFETY CODE DIVISION 2. 5. EMERGENCY MEDICAL SERVICES 1799. 102. (a) No person who in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission. The scene of an emergency shall not include emergency departments and other places where medical care is usually offered. Important points: Provide treatment within the scope of your training level and don’t abandon your patient

Consent Law In the medical field, there are two types of consent: 1. Expressed

Consent Law In the medical field, there are two types of consent: 1. Expressed consent is communicated either verbally or nonverbally. Simply put, the victim gives you permission to provide assistance. In this case, the victim must be able to understand the situation and communicate clearly in order to provide expressed consent. 2. Implied consent happens when the rescuer is unable to communicate with the victim. This most often happens because the victim is unconscious, but may also be a result of intoxication, language barriers, mental disorder, or age. With implied consent, there is an assumption that the victim would ask for help if he or she could. If a victim is not impaired, a rescuer must receive expressed consent before physically touching a victim. This is important for all first aid providers, but it is essential for medical professionals and first responders.

Emergency Care Plans

Emergency Care Plans

Activation of the EMS System by Calling 9 -1 -1 • The emergency medical

Activation of the EMS System by Calling 9 -1 -1 • The emergency medical services system must be activated as soon as possible when an epinephrine auto-injector is used. • Provide EMS the patient’s condition and your specific location • Stay on the phone to answer questions and provide clear directions • Develop an emergency action plan in advance that is readily accessible • In field settings lacking reliable phone service, improve response time by carrying: – Field radios – Satellite phone or communicator like an in. Reach, Spot or PLB

Recordkeeping Requirement as Specified in Section 100045(b) Certified persons shall maintain, and make available

Recordkeeping Requirement as Specified in Section 100045(b) Certified persons shall maintain, and make available to EMSA upon request a record for five years reflecting: (1) Dates of receipt, use and destruction of each autoinjector dispensed, and (2) The name of any person to whom epinephrine was administered by using an auto-injector, and (3) The circumstances and manner of disposal of any auto-injectors. Important points: Keep your prescriptions and receipts, write notes during and/or immediately after an incident, and follow your emergency action plan

Course Exam Written Quiz: • 10 questions • Passing rate is 70% • Put

Course Exam Written Quiz: • 10 questions • Passing rate is 70% • Put your name at the top Skills Test: • Mock scenarios with partners or small groups • Demonstrate patient evaluation • Administer with a TRAINER auto-injector • Provide verbal report of next actions

Course Completion Document

Course Completion Document

Next Steps • Submit to California EMSA: – Course completion certificate – CPR/AED card

Next Steps • Submit to California EMSA: – Course completion certificate – CPR/AED card – $15 fee • Complete a written Emergency Action Plan • Present your State Epi Auto-Injector Certification Card to Health Care Provider/Medical Director • Fulfill prescription at a pharmacy California Emergency Medical Services Authority (EMSA) 10901 Gold Center Drive, Suite 400 Rancho Cordova, CA 95670 Phone: (916) 322 -4336 Forms and further info: http: //www. emsa. ca. gov/Epinephrine_Auto_Injector

References • American Academy of Allergy, Asthma, and Immunology: Emergency Action Plan (example) •

References • American Academy of Allergy, Asthma, and Immunology: Emergency Action Plan (example) • • American College of Allergy, Asthma and Immunology: Anaphylaxis • California Health & Safety Code, DIVISION 2. 5. EMERGENCY MEDICAL SERVICES § 1799. 102. Liability Limitation. “Good Samaritan Law” • California Assembly Bill 1386. Emergency Medical Care: Epinephrine Auto-Injectors (Aproved September 16, 2016) Epi-pen®. Important Safety Information. • Insect Sting Anaphylaxis, Immunol Allergy Clin North Am. 2007 May; 27(2): 261–vii. , David Golden, MD • NOLS Wilderness Medicine, 6 th Edition, Tod Schimelpfenig (2016). • Wilderness Medical Society Practice Guidelines for the Use of Epinephrine in Outdoor Education and Wilderness Settings: 2014 Update. Published in Wilderness and Environmental Medicine Journal, Volume 25, Issue 4, Supplement, Pages S 15–S 18.

Contact Information Sara Souza, MPH, CIH, REHS Health & Safety Advisor University of California

Contact Information Sara Souza, MPH, CIH, REHS Health & Safety Advisor University of California Field Research Safety 510. 725. 2517 | sarasouza@berkeley. edu UC Field Research Safety UC Global Operations