Categories: General Date: May 10, 2016 Title: The Disassembling of EpiPens 'An unsafe practice'The Disassembling of EpiPens 'A unsafe practice'
It has come to our attention at Wilderness First Aid Australia that there are first aid training organisations teaching first aiders how to disassemble auto adrenalin injectors such as EpiPens to extract and redraw extra doses of adrenalin in emergency situations when an anaphylactic patient re-lapses and there is no further adrenalin available.
At Wilderness First Aid Australia we DO NOT support this practice nor will we be teaching this practice. This is an unsafe and dangerous practice with a high risk of needle stick injury and cross infection. As professional outdoor leaders and educators or anyone else for that matter your options are to carry more Auto-adrenalin injectors or carry vials of adrenaline along with appropriate needles. For the latter, personnel should source more advanced training that teaches you/organisations how to carry vials of adrenalin, along with being taught best practice, on drawing and measuring medications. This can be done by locating a Travel Doctor who will professionally interview you/organisations on your needs and if warranted teach you best practice on the skill of injections. Remember, you are professionals and with good Risk Management and thorough Risk Assessments you should ensure you have the right medications and amount for the expedition/program.
Our suggestion is DO NOT be 'caught out' with not having enough Auto-injectors (or any participant medication on that note). In the worst case scenario you should have extra vials available along with correct needles and training. There is no substitute, cutting open an Auto-injector is dangerous and is NOT best practice.
This practice is not supported by the Australasian Society of Clinical Immunology and Allergy (ASCIA) or Allergy Facts Australia. Nor is it supported by the Australian and New Zealand Resuscitation Councils. These are all professional bodies at the cutting edge of research. If the practice is not endorsed by these organisations who are we as first aid providers to teach something outside our scope.
Whether the practice of disassembling an Auto-injector to retrieve more adrenalin is illegal or NOT isn't the question, the facts are it is unsafe and NOT best practice. I am unsure what questions would be asked by the Coroner if a casualty has died due to slow reaction times of adrenalin administration. Also a question you may ask yourself?
We have watched the videos on the internet, listened to arguments for, 'if it's the only thing you have' and the against 'it's unsafe' etc. but we still come to the same conclusion. It's not supported by the experts and as professionals you should not leave yourself in this predicament. In short, the videos and demonstrations treat the EpiPen's internal vial as a storage tank for extra adrenalin (approx 1.5ml extra available). It still requires the user to draw up the medication via a second needle to measure the correct amount for administration. Without a second needle with accurate measurements there is no way of knowing the exact amount to administer as the internal Auto-injector's vial has no measurements. It is at this point why don't we create a safer environment by carrying extra vials of adrenalin which cost approx $20-$25 AUD for a packet of 5 x 1ml vials. This is equivalent to approx 15 x 0.3ml doses. Ask yourself why am I risking a needle stick injury disassembling a USED Auto-adrenalin injector when carrying vials is cheap and quicker to draw the medication?
Anaphylaxis is 'life threatening' and a condition that has to be managed seriously. Disassembling an Auto-injector is tedious, dangerous and time consuming, time your casualty hasn't got! Having available a number of quicker options in the case of Anaphylaxis should be priority.
As first aid providers our number one priority is to 'Prevent Further Harm' this is not only to our casualty BUT to ourselves.
This article is not intended to influence anyone on what should or shouldn't happen in case of an emergency. It is a brief article written ensuring the reader is well informed of certain consequences in regards to the practice of disassembling an Auto-adrenalin injector to access further doses of adrenalin.
I hope this has been helpful?
For further information on whether this is an accepted practice or for any other anaphylaxis information we highly recommend you consult:
ASCIA - www.allergy.org.au
Allergy and Anaphylaxis Australia - www.allergyfacts.org.au
Wilderness First Aid Australia