OUT-OF-HOSPITAL PROVIDER USE OF EPINEPHRINE FOR ALLERGIC REACTIONS - PILOT PROGRAM

Objective: To describe experience with an out-of-hospital provider pro gram for the recognition and field management of allergic reactions by advanced life support (ALS) and basic life support (BLS) providers. M ethods: Data sheets completed between June 1, 1988, and August 31, 199 3, and records from receiving sites (physicians' offices or EDs) were reviewed for information regarding the presentation of the allergic re action, the time course and treatment provided out of hospital, and th e clinical outcome at the receiving health care facility. Results: Thi rty-seven data sheets were completed during the study period. Fourteen (38%) of the providers were BLS providers. The epinephrine was suppli ed from the emergency medical services (EMS) provider's personal kit i n 35% of the cases, from an EMS vehicle in 57% of the cases, and by th e patient in 8% of the cases. Availability of the kits allowed adminis tration of epinephrine prior to the arrival of the first EMS vehicle i n 41% of the instances and prior to physician on-line medical command in 65% of all the instances (predominantly by BLS providers). Overall, 77% of the patients experienced alleviation of their symptoms of resp iratory difficulty, swelling, or rash after epinephrine administration , while 20% were unchanged and 3% worsened. All patients receiving epi nephrine had an ED diagnosis of allergic reaction, and no adverse even t was encountered on followup of the patients treated. Conclusions: Se vere allergic reactions can be reliably identified and safely managed by out-of-hospital providers, including BLS providers. Providing perso nal anaphylactic treatment kits and increasing the pool of providers t rained to manage allergic reactions (including BLS providers) can ofte n decrease the time to treatment.