EMTs and Epinephrine
One of FAAN’s ongoing initiatives is to help assure that all ambulances are equipped with epinephrine, and that levels of Emergency Medical Technicians (EMTs, or 911 personnel) are fully authorized to administer the medication during an anaphylactic emergency. Although we’ve made considerable progress since the late 1990s, there is still much work to be done.
States generally have three types of EMTs: Basics, Intermediates, and Paramedics. Basics are usually the most numerous.
There are also, in general, two types of ambulances: Basic Life Support (BLS) and Advanced Life Support (ALS).
Depending on where you live in the country, however, EMT-Basics may not have access to epinephrine and/or may not be able to administer the medication in the field. Instead, Basics may only be allowed to "assist" with a person's own prescribed epinephrine device.
Such a policy overlooks the possibility that a patient, or a patient’s family, may not be in possession of prescribed epinephrine at the time of a reaction. In such a situation, EMT-Basics responding to an anaphylactic emergency would be forced to transport the individual to the nearest hospital or to call for Paramedic (or Intermediate) backup. Either scenario delays treatment and could result in tragedy.
THE NATIONAL MAP (.bmp ~878 KB). Each state has been placed into one of three categories according to its EMT/epinephrine policy. This classification, though based on correspondence between FAAN and state EMS agencies, should not be considered absolutely precise, because decisions pertaining to EMTs often vary within each state. FAAN has always advised that individuals contact their state EMS agency and their local ambulance provider in order to clarify the coverage in their particular locality.
If you live in a needs improvement or locality-dependent state, FAAN recommends that you contact your local ambulance provider, and ask whether: 1) all ambulances are equipped with epinephrine, and in what form (auto-injector, vial, syringe), and 2) whether all types of EMTs (specifically, EMT-Basics) are authorized to use epinephrine in the field.
If you live in a good coverage state, we still recommend you contact your local ambulance service, and ask the questions above. It never hurts to confirm your local coverage!
Report what you find out to FAAN by sending an email to advocacy@foodallergy.org
* In the case of Delaware and Hawaii, EMT-Basics are not allowed to access and administer epinephrine; however, due to the small size of the states, Advanced Life Support (ALS) ambulances staffed by Paramedics cover virtually the entire area. In the case of Vermont, EMT-Basics could, under extenuating circumstances, administer epinephrine with appropriate Medical Control.
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