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Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis

机译：通过紧急医疗技术人员对过敏反应的注射器施用肾上腺素

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Objective: In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the Check and Inject program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction. Treatment was guided by an EMT protocol that required a trigger and symptoms. We sought to determine if the Check and Inject program was safely implemented by EMTs treating presumed prehospital anaphylaxis or serious allergic reaction. Methods: We conducted a prospective investigation of all cases treated as part of the Check and Inject program from July 2014 through December 2016 in suburban King County, Washington, and January 2016 through December 2016 within the city of Seattle. All cases were prospectively collected using a custom quality improvement data form completed by the first responding EMTs. Two physicians completed a structured review of each EMS medical record to determine if the EMTs followed the Check and Inject protocol and determine if epinephrine was clinically-indicated based on physician review. Results: Of the 411 cases eligible for analysis, EMTs followed the protocol appropriately in 367 (89.3%) cases. In the remaining 44 (10.7%) cases, the EMS incident report form failed to document either a clear inciting allergic trigger or an appropriate symptom from the protocol list. Physician review determined that epinephrine was clinically indicated in 36 of the 44 cases. Among the remaining 8 cases (1.9%) that did not meet protocol criteria and were not clinically-indicated based on physician review, none had a documented adverse reaction to the epinephrine. Conclusion: We observed that EMTs successfully implemented the manual Check and Inject program for severe allergic reactions and anaphylaxis in a manner that typically agreed with physician review and without any overt identified safety issues.
机译：目的：近年来，美国肾上腺素自动注射器（EAIS）的成本大幅上升。国王县应急医疗服务通过教授应急医疗技术人员（EMTS）来替代EAI，通过用针和注射器从一次使用1mg / ml肾上腺素小瓶手动吸出肾上腺素，然后进行正确的成人肌肉注射或儿科剂量的肾上腺素用于过敏反应或严重过敏反应。治疗是由所需触发和症状所需的EMT协议指导。我们试图确定检查和注入计划是否通过EMTS处理预测的预孢子性过敏或严重过敏反应的EMTS安全地实施。方法：我们对2014年7月至2016年12月，华盛顿州，华盛顿州，2016年1月至2016年1月至2016年12月至2016年12月至2016年12月至2016年12月至2016年12月至2016年12月，对所有案件进行了一项预期调查。所有案例都使用第一个响应EMT完成的自定义质量改进数据表单进行预期收集。两位医生完成了对每个EMS医疗记录的结构化审查，以确定EMTS是否遵循检查和注入协议，并确定肾上腺素是否基于医生审查临床上表明。结果：411案件有资格分析，EMTS在367（89.3％）案件中适当遵循议定书。在剩下的44（10.7％）案件中，EMS入射报告表未能记录清除煽动过敏触发或来自议定书目的适当症状。医师评论确定肾上腺素在44例中的36例中临床上表明。在剩下的8例（1.9％）中不符合协议标准，并没有根据医生审查临床 - 表明，没有对肾上腺素有文件不良反应。结论：我们观察到EMTS成功地实施了严重过敏反应和过敏性的手动检查和注射程序，以通常同意医生审查和没有任何明显的安全问题。

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