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A Nurse Works to Make Epinephrine the New AED in Public Venues

The hard work of getting legislation passed to allow public entities to stock and administer epinephrine has been accomplished. But much remains to be done in order to convince the owners of restaurants, sports stadiums, daycare centers and churches to stock EpiPens and to be properly trained. Read about a Canadian nurse who took matters into her own hands to provide storage cabinets and obtain EpiPen donations from pharmaceutical companies along with free training materials.

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A Nurse Works to Make Epinephrine the New AED in Public Venues

By Janet Goldman
May 22nd, 2017

What happens if you’re at a restaurant when suddenly your best friend has a severe allergic reaction?! Furthermore, what happens if your friend forgot his/her epinephrine auto-injector? What happens if they didn’t know they had any allergies to begin with?! Last September, Governor Andrew Cuomo signed New York State’s Emergency Allergy Treatment Act (EATA). This legislation allows public entities to stock and administer epinephrine. Public entities include a wide variety of venues such as restaurants, sports leagues, daycare centers and community centers. The possible benefits are priceless!

A growing number of people are finding themselves at risk for life-threatening allergies. Consider a few food allergy statistics. According to Food Allergy Research & Education (FARE), “Each year in the U.S. 200,000 people require emergency medical care for allergic reactions to food. About 40 percent of children with food allergies have experienced a severe allergic reaction such as anaphylaxis.”

Although EATA became New York state law at the end of 2016, our communities’ public entities don’t appear to be utilizing this authorization. Any combination of several factors could be delaying the transformation to a safer allergy environment: The price of epinephrine auto-injectors (EAI) devices, prescription arrangements, training procedures and liability concerns.

A more positive situation exists just north of the border. Beginning in 2014, the town of Sussex, New Brunswick, in Canada, began a pilot project, stocking epinephrine in public entities. More specifically, Kelly Dunfield,, a Canadian nurse practitioner, helped 28 public locations with this process. These locations included: sports arenas, community centers, a golf course, restaurants, even a wilderness lodge. With her son, Robert, a medical student, and local allergists, she developed storage cabinets for the epinephrine auto-injectors. To finance the cabinets, she arranged funding from a community foundation. For the injectors, she coordinated an 18-month supply of Auvi-Qs from Sanofi, Canada. Additionally, Sanofi provided free training materials.

By September of 2015, this pilot project already saved one life. Wasps stung a man who was riding his ATV. At the nearby wilderness lodge, a first aid responder administered two doses of the stock epinephrine and saved this man’s life. Allergic Living magazine published an article, September 1, 2015, about these Canadian public entities, “Where Stock Epinephrine is the New AED.” Since then many groups have asked Kelly for assistance. Kelly said: “The initial pilot of 28 sites has now grown to over 20 communities and 150 plus sites with a variety of venues from churches, daycares, recreational facilities, funeral homes, restaurants and many others.” Besides sharing the expanded number of participating facilities, Kelly reported the number of saved lives has grown to four.

Due to the growing popularity of the concept, Kelly has started a small business, Be Ready Healthcare. When asked how she selects venues, she responded, “We are truly happy to respond and work with any venues. Having EAIs publicly available is working and we need to get beyond pilots so this will be recognizable, accessible and central in any areas where there is food, insects and medications, including places of exercise.”

For training, Kelly suggested arranging volunteer time from trained healthcare professionals. For purchasing the EAIs, Kelly explained the sponsorship concept. “In one location, a local pharmacy entered into a ten-year agreement to provide the EAIs and in return, their logo was placed on the front of our cabinet. We are also working to deploy our cabinets with a large international corporation to deploy cabinets at all their sites and their logo will be prominently displayed.”

When requested, Kelly’s business provides a one-hour training session which includes a presentation, hands on practice and materials. However, she said some sites use their own training resources. Kelly said “Education is essential and ongoing. We believe it is important to educate as many people as possible to allay the fear of administering the EAI. It is important to ensure that whoever is delivering the education has the proper knowledge and experience with anaphylaxis and using EAIs.” In New York, the training must be provided by a “nationally recognized organization experienced in training laypersons in emergency health treatment or an entity or individual approved by the department.

In Canada, EAIs are available without a prescription. However, in New York, an authorized healthcare provider needs to prescribe the epinephrine for the individual or the public entity. Furthermore, the entity must arrange the required training for the staff who might administer the epinephrine. While the basic framework of EATA has been established, the NYS health department is continuing to develop comprehensive regulations.

Regarding liability protection after administration of the EAIs at public entities in Canada, Kelly replied “Anaphylaxis is a life-threatening emergency and they are expected to respond appropriately as guided by the Good Samaritan Act enacted in many jurisdictions.” Similarly, in New York, EATA provides immunity from liability for trained employees who prescribe and administer epinephrine.

Emergency supplies of non-specific epinephrine saves lives. Findings from the EpiPen4Schools survey, revealed at the American Academy of Allergy, Asthma and Immunology (AAAAI) annual meeting in Houston, show that 852 individuals nationwide in public schools (mostly students but also staff) experienced anaphylaxis, with some individuals suffering multiple reactions during the school year. Seventy-five percent of them were treated with an epinephrine auto-injector and – in 49 percent of the cases – it was a school-supplied “stock” epinephrine auto-injector that was used. The survey was sponsored by Mylan Specialty. If public entities participate in EATA in New York, the lives of many individuals at risk for anaphylaxis will be saved.

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