Epinephrine,911 in New York State

Posted on: Wed, 06/28/2000 - 2:50am
Greg's picture
Joined: 01/16/1999 - 09:00

I wasn't sure of the best place to post this so I hope you don't mind it here. The following letter was drafted by a very valued and knowledgeable member of our group. He asked that we pass this on to residents of NY and This seemed like an excellent place to do it. However, It seemed to me a lot of this would be usefull to others around the country as well. Sorry if it's a little long:
To: NYNAAG Members and Friends

As most of you are aware, legislation was enacted last year that permits
ambulance providers not already authorized to carry and administer
epinephrine auto-injector devices (EPI-pens) to carry such devices to
administer epinephrine in emergency situations. In addition, the
permits children's overnight camps to possess and use EPI-Pens in

The legislation requires the proper training of persons who would be
the EPI-Pens, and requires that there be a "collaborative agreement"
the person or organization using the EPI-Pen and an "emergency medical
provider" (a properly trained physician or a hospital).

In order to assure the effective implementation of this new law in your
community, I am suggesting that you take a proactive role with respect to
emergency medical service(s) (EMS) provider in your area.

Some areas of the New York State are served by an advanced-level EMS
(Advanced Life Support--ALS) that is already trained and authorized to
EPI-Pens. If that is the case, you already have the assurance that in an
emergency situation where your child or loved one may be experiencing
anaphylactic shock, the EMS provider responding to your call will be
to administer epinephrine and respond appropriately.

Other areas of the State (generally rural or suburban areas), however,
served by Basic Life Support (BLS) emergency medical service providers,
are not currently authorized to carry and use EPI-Pens. They are the
of the new law. These providers may have to be encouraged to upgrade
training and service capacity in order to better serve the community by
carrying and appropriately using EPI-Pens.

In order to discover the level of EMS responder in your community, you
call your local city, town, or village and ask the name, and regular
number of the EMS company that responds to and emergency 911 call (almost
communities in New York employ 911 as the emergency call number). You may

also call your local police. It will be helpful also to get the name of
person responsible for operating the EMS provider company.

You should then call the EMS provider to ask whether or not they are
authorized to carry and use EPI-Pens. You should identify yourself
why it is so important to you.

If the EMS company is already carrying and authorized to use EPI-Pens,
nothing further really needs to be done, except that you may wish to
the EMS provider to the potential for an emergency anaphylactic shock
situation at your address because of your child's (or loved one's)

If the EMS company is not trained and authorized to carry and use
you should tell them about the new law and the Department of Health's
correspondence to them. (They should have received a letter from the New
State Department of Health.)

In order to meet the qualifications to carry and use EPI-Pens, BLS
medical service providers will have to establish a "collaborative
with an emergency health care provider. In order to do so, they should
contact the Regional Emergency Medical Service Council (REMSCO - EMS
companies will be aware of their local REMESCO).

BLS emergency medical service companies will also have to be properly
and must adopt the necessary protocols (see draft protocol currently
review by the State's EMS system). If your local EMS provider has any
questions that the REMSCO cannot answer regarding what needs to be done
order to qualify to carry and use EPI Pens, they should call the Bureau
EMS at the New York State Department of Health (518-404-0996).

Attached, please find a SAMPLE letter to send to your community's EMS
provider(s), urging it (them) to become qualified to carry and use
The letter will not be necessary if your EMS provider is already
The letter should be used to follow up on your initial phone call, or if
were unable to speak with anyone regarding the process to become
qualified to
use and carry EPI-pens. If your community has more than one EMS provider
may respond to a 911 emergency call, you should communicate with each EMS


Be prepared to work with your community EMS providers to assist in any
possible in order to their EMS service to you and others in the area.
will help ensure that in the event of any emergency in your community
requiring the administration of epinephrine, those responding will be
properly trained, equipped, and prepared.

The Draft:

Anaphylactic Reaction with Respiratory Distress or Shock

Anaphylaxis can be a potentially life threatening situation most often
associated with a history of exposure to an inciting agent/allergen (bee
sting or other insect venom, medications/drugs, or foods such as peanuts,

seafood, etc.) and physical reactions ranging from mild skin rashes to
catastrophic multisystem failure and/or death. The presence of
distress (upper airway obstruction, lower airway disease. severe
and or cardiovascular collaspe/hypotensive shock characterize the
findings that authorize and require treatment according to this protocol.

I. Determine that the patient's history includes a history of
allergic reactions and/or recent exposure to allergen or inciting

II. Assess the cardiac and respiratory status of the patient.

A. If the both the cardiac and respiratory status of the patient are
transport the patient, reassessing the patient's condition
during the

B. If either the cardiac or respiratory status to the patient is
proceed as
1. If the patient is having severe respiratory distress or
and has been
prescribed and epinephrine auto injector, assist the
patient in
the epinephrine. If the patient's auto injector is not
available or expired, and
the EMS agency carries an epinephrine auto-injector,
epinephrine as authorized by the agency's medical director.

2. If the patient has not been prescribe an epinephrine
auto-injector, begin
transport and contact medical control for authorization to
epinephrine if available.

3. Refer immediately to the appropriate Respiratory Arrest,
Distress, Obstructed Airway or Shock protocol.

4. Administer high concentration oxygen.

III. If cardiac arrest occurs, perform CPR according to AHA/ARC

IV. Record all patient care information, including the patient's medical
history and all
treatment provided, on a Prehospital Care Report.

DRAFT 3.0- 3/7/00

Sample Letter: (This letter should be personalized - put into your own
words, experience, and situation)

Dear EMS Provider:


take the necessary steps to become qualified to order, carry, and
epinephrine in EPI-Pens. It is extremely important to me and my family
you, as the EMS responder in my community, are able to administer
in the event that my child should experience anaphylactic shock.

As you are most likely aware, legislation was enacted last year that
EMS ambulance providers not already authorized to carry and administer
epinephrine auto-injector devices (EPI-Pens) to carry such devices to
administer epinephrine in emergency situations.

The legislation requires the proper training of persons who would be
the EPI-Pens, and requires that there be a "collaborative agreement"
the person or organization using the EPI-Pen and an "emergency medical
provider" (a properly trained physician or a hospital).

My son (daughter/other family member) is allergic to certain foods, and
therefore in danger of experiencing an anaphylactic reaction with
distress or shock that could cause hie/her death. This has already
on at least one occasion, and because we have an EPI-Pen in the house, we

were able to administer the medication and take the necessary steps to
my son / daughter to the hospital for emergency care. The precious
that can be bought with the proper administration of epinephrine are
to my son's / daughter's life. These minutes CAN help ensure a successful

transport to the hospital emergency department and treatment.

I am concerned, however, that there may be a time when, for whatever
our administration of epinephrine with the EPI-Pen is not possible or
sufficient. In such an emergency, my family turns to you as our EMS
and we need you to be prepared to step in to use the EPI-Pen.

The necessary steps to purchase, carry, and administer epinephrine with
EPI-Pen are spelled out in the law. They include the establishment of a
collaborative agreement with an emergency health care provider, training
the Emergency Medical Technicians that serve on your ambulances, and the
adoption of proper protocols. I understand that the Regional Emergency
Medical Services Council (REMSCO) can assist you in the specific tasks
necessary to meet all of the qualifications, and I am prepared to assist
you encounter any barriers.

I believe that by taking the steps necessary to become qualified to carry
preparedness and serve our community even better than it has over past

I urge you to act on my request as expeditiously as possible. I can meet
you and members of your company, and provide any additional information

Thank you for your continued efforts in providing EMS to our community,
for your attention to my request.



Posted on: Wed, 06/28/2000 - 9:12am
PattyR's picture
Joined: 04/12/2002 - 09:00

pThat is great news for NY. I would love it if NC would also agree to allow epinephrine on all ambulances. Were you actively involved in getting this legislation going? If so, could you share with us the steps of this process. I would like to start the ball rolling here but don't really know the best way to begin. Thanks!/p

Posted on: Thu, 06/29/2000 - 3:50am
Greg's picture
Joined: 01/16/1999 - 09:00

pWe were somewhat involved in getting this legislation moving. It is actually the result of timing and being at the right place at the right time. Our group is fortunate to be based around the Capital(Albany) of NY. A while back we began sending letters to our State Senators and Legislators stating our concerns about a number of issues,Labelling,Epinephrine availability..etc,etc. Around that time a local girl with PA died after eating a Chex mix containing peanut flour. She didn't carry an Epi-pen. After this, a local State Senator who has a PA relative felt he should attempt to do something. He had once tried to push for better labelling (simply having allergens written in bold letters) but his attempts went nowhere. So this time he called a meeting of public health officials to brainstorm on ideas. This is where the right place at the right time comes in. We just had a new support group member join who happened to be friends with a gentleman(the writer of the above letter) who was a VP in a public affairs company (whose president also had a PA member in the family, believe it or not). This gentleman offered to help us PRO BONO. Being a lobbyist he knew all the in and outs of State Govt and offered our group to assist with the Senators efforts. So two of us,myself and another member, joined the brainstorming session where it was decided that the EMT/Epinephrine issue was the most doable and most sure route to go. After that the public health officials took over conducting various studies and meetings. One meeting included Anne Munoz(FAN) and the inventor of the Epi-Pen(please forgive me I can't recall his name at this moment). I believe Chris Papkee attended this meeting as well. There were a lot of meetings and now they seem to all jumble together. Our group supplied the parent or PA person point of view during all of this. We also did a lot of field work for them, calling various fire dept's and EMT's among other places. While our group did a lot, none of this would have gone anywhere were we not fortunate enough have this respected State Senator strongly backing the bill. I'm not sure about other states but around here it doesn't matter as much how obviously right a bill is but more on who is backing it. If I would suggest a place to start it would be finding a strong supporter in your State Gov't. Be armed with facts. One advantage you have in getting people on your side in this is that it's one of those bills that makes the supporters look good. There is no major opposition (though there is some from the medical community), it is designed to save lives, especially children and really poses no politcal risks to those who put their names behind the bill. Once the ball was rolling things went fairly smoothly. On a side note a sister bill was passed at the same time that allowed camps to keep epinehrine on the property and allowed the camp personell to administer the epi,with proper training. Whew! Sorry for being so long winded. Probably more than you asked for but I can't help feeling proud of the work many people in our group,who did so much more than myself, did./p

Posted on: Thu, 06/29/2000 - 4:18am
CVB in CA's picture
Joined: 10/15/1999 - 09:00

pEpi,EMT's in Mono County, CA-br /
I checked this area out due to vacation plans. This is a very rural area in the Eastern Sierra of California north of Mono Lake. There are several emergency facilities, but widely dispersed- 45 min to an hour apart.br /
The rescue squad has epi, benadryl, albuterol, and oxygen and can use them. However, they cover a huge area so may be on a call at the other end of the county when you request help. The back up squad is the volunteer fire departments in the various little towns along highway 395. They do not have epi, but do cpr, etc. and help transport. I was particularly warned by the EMT at the station about the fried tortillas, etc. in the local mexican restuarant(s).br /
The Mammoth Lake ski resort area seems to be managed seperately for emergency services./p

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