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Basic EMTs Have Hands Tied in Allergy Attacks

They can't give adrenaline in severe cases, says research

MONDAY, Dec.17, 2001 (HealthDayNews) -- Severe allergic reactions sent more than 84,000 people in the United States into anaphylactic shock last year, and almost 500 died because they don't get medical intervention quickly enough, according to research by the Food Allergy and Anaphylaxis Network (FAAN), a research and education organization.

FAAN is using its recent findings as ammunition in its fight to change laws nationwide that prevent some Emergency Medical Technicians (EMTs) from carrying and using epinephrine, the most effective antidote to anaphylactic shock. Anaphylactic shock is an allergic reaction so swift and intense that it can cut off a sufferer's breathing and kill him or her.

Depending on training, EMTs qualify as Basic, Intermediate and Paramedic, with EMT-Basics by far the most numerous, comprising roughly 72 percent of all EMTs nationwide

In all but 12 states, EMT-Basics aren't allowed to carry or give epinephrine, although the hormone, also known as adrenaline, is secreted naturally from the adrenal medulla. It is often prescribed for known allergy sufferers to carry with them and give to themselves using a simple injection device.

Chris Weiss, director of legislative and regulatory research for FAAN, says that in 38 states and the District of Columbia, a person who calls 911 because he is having a serious allergic reaction may not get effective treatment until he reaches the emergency room.

"It's a roll of the dice whether the EMT who responds to the emergency call would actually have, and be able to administer, this life-saving drug," Weiss says.

The argument against allowing minimally trained EMTs to use epinephrine is that if it's given improperly, it can be deadly, particularly if the EMT mistakes a heart attack for an allergic reaction.

But even physicians who once thought that the likelihood of giving epinephrine improperly was a serious issue are reconsidering their positions because of the growing numbers of children with asthma and serious allergies.

Dr. Roger White, an anesthesiology consultant who mainly works with emergency medical services and is the medical director of Gold Cross Ambulance Service, a subsidiary of the Mayo Foundation, was on the national committee in 1996 that revised suggested EMT training standards.

Back then, he supported a ban on EMT-Basics carrying and administering epinephrine. Since then, he has changed his mind.

"We were conservative in that area -- more so in retrospect than we should have been. My own opinion is that the curriculum needs to be revised again to allow EMT-Basics to administer epinephrine," he says.

"I think that the argument that an allergic reaction can be confused with an acute heart attack is not a strong one, and any EMT-Basic can be taught to recognize the difference," he adds.

White also supports allowing EMT-Basics to administer inhalers for asthma and give apparent heart attack victims nitroglycerin. "A lot of things have changed since the last curriculum revision; we know a lot more," White says.

Four allergies that can lead to anaphylaxis -- penicillin and other drugs, food allergies, latex and insect stings -- may affect as many as 40 million people in the United States, according an article in last January's Archives of Internal Medicine.

FAAN, with 23,000 members nationwide, is launching lobbying efforts in every state to persuade officials to implement laws or change whatever regulations are necessary to allow epinephrine to be carried on every rescue vehicle and administered by every EMT.

However, FAAN is not urging that First Responders, which can include volunteer firefighters, have this ability. "We haven't looked at that; we think more training is necessary than most of them have," Weiss says.

What To Do

If you want to know whether your state allows EMT-Basics to carry and use epinephrine, this FAAN Web site will tell you. There's also lots of good information on other issues facing allergy suffers.

Many people have their first serious allergic reaction far from medical care, after a bee stings them. The American Academy of Allergy, Asthma and Immunology offers advice for recognizing an allergic reaction following a sting as well as guidance on what to do next.

For an overview of allergy and allergy resources, try AllAllergy.net.

SOURCES: Interviews with Chris Weiss, director of legislative and regulatory research, Food Allergy and Anaphylaxis Network; Roger White, M.D., consultant in anesthesiology, and medical director, Gold Cross Ambulance service, a subsidiary of the Mayo Foundation; April 17, 2001, FAAN study (unpublished)
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