Today, Fire Commissioner Nicholas Scoppetta announced plans to begin carrying doses of epinephrine on all Fire Department of New York (FDNY) ambulances, including its 163 BLS units, to treat patients in anaphylactic shock.”ž
This initiative was spearheaded by the New York City Council and the Regional Emergency Medical Advisory Committee (REMAC) of NYC. REMAC approved this change to its regional protocols on March 24, 2009, and as of March 31, 2009, all BLS ambulances operating in NYC were mandated to carry epinephrine auto-injectors. The 71 ambulance agencies in NYC have a 60-day window for purchasing and training.
FDNY, which already carries the drug on ALS ambulances, will soon deliver EpiPens to BLS units. Chief of EMS Command, FDNY, John Peruggia, says, “We hope to have EpiPens for adult and pediatrics deployed in 30 to 45 days. The purchasing has been completed, and we’re waiting on delivery.”
Peruggia explained that the BLS crews will carry the drug in a small pouch containing three adult doses and three pediatric doses. The protocol allows for an initial dose plus a repeat dose if indicated; the third dose is a spare.
Although an FDNY ALS ambulance is typically dispatched to 9-1-1 calls for suspected anaphylactic shock, BLS crews could be asked to respond if caller information is inaccurate or in the rare case that ALS resources will be delayed.
“Currently, EMTs are allowed to administer epinephrine to patients in anaphylactic shock under medical control if the epi is available from the patient or another ambulance crew. This option has been in protocol for a while. We’re committed to delivering the best possible treatment to our patients, so we’re”žnow providing this on all ambulances although it’s not currently required by the [FDNY] protocol.”
He adds, “BLS crews may happen upon a patient while responding with ALS and find the patient first. The BLS crew will now have the ability to immediately administer epi, which could mean the difference between life and death.”
This change will likely be seen in other systems, as the prevalence of food allergies continues to rise and food allergy awareness groups continue to express concerns about EMS preparedness for these emergencies.
Peruggia emphasized that the best thing for patients with known allergies or hypersensitivities is to carry their own auto-injector and train family and friends how to use it. “The earlier the treatment, the better,” he says.