Anaphylaxis and epinephrine auto-injector training: Who will teach the teachers?

Background: Anaphylaxis is the most urgent clinical immunologic event. Effe ctive treatment is best achieved by administration of epinephrine, Accident al exposure to the responsible allergen is the most common cause of anaphyl axis, and because it could be fatal within minutes, epinephrine in preloade d syringes and auto-injectors has been introduced. In our experience patien ts and medical personnel are not familiar with the use of this device. Objective: We sought to assess community-based professionals' knowledge of epinephrine auto-injector use and their ability to educate patients. Methods: Study participants consisted of a medical convention's delegates a nd emergency department personnel in metropolitan Toronto, as well as pharm acists of the target hospitals and retail pharmacists, Research assistants approached eligible professionals to fill out a questionnaire and demonstra te their ability to use a standard placebo auto-injector trainer. Results: A total of 122 professionals (composed of emergency physicians, fa mily practitioners, and pediatricians) consented to participate in this stu dy. The majority of participants (81%) did not have a placebo trainer to ed ucate their patients; 76% did not know the 2 available dose strengths. To p rovide instructions and reinforcement, physicians clearly must have the nec essary skills and knowledge, Jet only 25% of the study participants were ab le to demonstrate the 3 steps of injection correctly. Conclusion: Our study highlights a specific and important deficiency in med ical professionals' care of patients at risk for anaphylaxis. The results c hallenge the current methods of educating professionals, as well as patient s, when prescribing or using epinephrine auto-injectors. Clearly a new appr oach to educating and maintaining such skills is required.