Epinephrine,911 in New York State


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 legislation permits children's overnight camps to possess and use EPI-Pens in emergency situations.

The legislation requires the proper training of persons who would be using the EPI-Pens, and requires that there be a "collaborative agreement" between 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 the emergency medical service(s) (EMS) provider in your area.

Some areas of the New York State are served by an advanced-level EMS provider (Advanced Life Support--ALS) that is already trained and authorized to use 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 equipped to administer epinephrine and respond appropriately.

Other areas of the State (generally rural or suburban areas), however, are served by Basic Life Support (BLS) emergency medical service providers, which are not currently authorized to carry and use EPI-Pens. They are the subject of the new law. These providers may have to be encouraged to upgrade their 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 should call your local city, town, or village and ask the name, and regular phone number of the EMS company that responds to and emergency 911 call (almost all 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 the 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 explain 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 alert the EMS provider to the potential for an emergency anaphylactic shock situation at your address because of your child's (or loved one's) allergies.

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

In order to meet the qualifications to carry and use EPI-Pens, BLS emergency medical service providers will have to establish a "collaborative agreement" 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 trained and must adopt the necessary protocols (see draft protocol currently under review by the State's EMS system). If your local EMS provider has any further questions that the REMSCO cannot answer regarding what needs to be done in order to qualify to carry and use EPI Pens, they should call the Bureau of 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 EPI-Pens. The letter will not be necessary if your EMS provider is already qualified. The letter should be used to follow up on your initial phone call, or if you 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 they 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 way possible in order to their EMS service to you and others in the area. This 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 respiratory distress (upper airway obstruction, lower airway disease. severe bonchospasm) and or cardiovascular collaspe/hypotensive shock characterize the clinical findings that authorize and require treatment according to this protocol.

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

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

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

B. If either the cardiac or respiratory status to the patient is abnormal proceed as follows: 1. If the patient is having severe respiratory distress or shock and has been prescribed and epinephrine auto injector, assist the patient in administering the epinephrine. If the patient's auto injector is not available or expired, and the EMS agency carries an epinephrine auto-injector, administer the 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 administer epinephrine if available.

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

4. Administer high concentration oxygen.

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

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

As you are most likely aware, legislation was enacted last year that permits 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 using the EPI-Pens, and requires that there be a "collaborative agreement" between 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 is therefore in danger of experiencing an anaphylactic reaction with respiratory distress or shock that could cause hie/her death. This has already happened 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 bring my son / daughter to the hospital for emergency care. The precious minutes that can be bought with the proper administration of epinephrine are critical 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 reason, 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 provider, 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 an EPI-Pen are spelled out in the law. They include the establishment of a collaborative agreement with an emergency health care provider, training for 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 if you encounter any barriers.

I believe that by taking the steps necessary to become qualified to carry and use EPI-Pens, AJAX EMERGENCY MEDICAL SERVICE AMBULANCE will enhance its preparedness and serve our community even better than it has over past years.

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

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



On Jun 28, 2000

That 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!

On Jun 29, 2000

We 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.

On Jun 29, 2000

Epi,EMT's in Mono County, CA- 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. 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). The Mammoth Lake ski resort area seems to be managed seperately for emergency services.