Use of Epinephrine for Anaphylaxis by Emergency Medical Technicians in a Wilderness Setting, ,

Study objective: To describe a case series of emergency medical technician-basic (EMT-B)-administered epinephrine for anaphylaxis in a wilderness setting. Design: Case series of patients in anaphylaxis who received epinephrine subcutaneously from EMT-Bs. Setting: National park rural/wilderness emergency medical service system covering 863,000 acres and serving approximately 2 million annual visitors. Participants: Prehospital care providers were National Park Service rangers with EMT-B training. Patients in the series were visitors to Sequoia and Kings Canyon National Parks with anaphylaxis resulting from insect stings. Intervention: Subcutaneous administration of epinephrine by EMT-Bs trained in recognition, understanding, and treatment of anaphylaxis. Results: Eight patients with anaphylaxis resulting from Hymenoptera stings, from June 1992 through September 1993, received EMT-B-administered epinephrine. All patients improved clinically after treatment with epinephrine within 25 minutes. No major side effects occurred. Conclusion: Our data suggest that EMT-B-administered epinephrine is safe when used by EMT-Bs in the rural/wilderness setting, with appropriate physician supervision. Further study in large trials will be required to demonstrate safety and efficacy. [Fortenberry JE, Laine J, Shalit M: Use of epinephrine for anaphylaxis by emergency medical technicians in a wilderness setting. Ann Emerg Med June 1995;25:785-787.]