S.C. EMTs Now Allowed to Administer Epinephrine via Injection

Sept. 23--The scope of practice for emergency medical technicians, or EMTs, in South Carolina was updated last month, changing the ways in which first responders can administer epinephrine in life-threatening situations.

The changes allow EMTs to administer epinephrine by injection, meaning the drugs is drawn into a needle from a vial, as opposed to using an auto-injector like the name brand EpiPen device.

Epinephrine is used in life-threatening cases of serious allergic reactions. Allergies to insect bites, foods and medications can cause severe reactions that could lead to anaphylaxis, a potentially fatal condition which includes a sudden drop in blood pressure and narrowing of airways due to swelling.

According to Robert Yanity, S.C. Department of Health and Environmental Control public information officer, "As a national standard, drawing up medication from a vial to administer is usually a paramedic skill."

Yanity said the EMT scope of practice is set by the State Medical Control Physician who worked with the Bureau of EMS and other state medical entities to add epinephrine administration to the EMT list of life-saving options.

According to Yanity, the shelf-life of the EpiPen auto-injectors is about two years, and the rapidly rising cost of the EpiPen kits over the last several years played a role in decisions to extend the EMT scope.

"The requests came chiefly due to the cost of stocking and restocking the EpiPens for their EMTs and AEMTs to use in anaphylaxis situations," he said. "The recommended Anaphylaxis Emergency Epinephrine kit costs just under $10 versus $600 or more for a kit of 2 EpiPens. Many rural EMS primary 911 providers and rescue squads cannot afford to stock the EpiPens at $600 a kit, which expire typically within two years. EMS does not get a special price to purchase these devices."

As for costs trickling down to customers, Yanity said the bureau does not determine prices emergency response agencies charge for their services, including the use of epinephrine.

For those with severe allergies, DHEC still recommends carrying an epinephrine auto-injector, as the EMT application isn't a replacement but an emergency, life-saving option. Yanity said the EpiPen does have an off-brand competitor with a lower-priced device and that several options for similar devices are in the works.

Thomas Gardiner covers science, health and energy topics for the Aiken Standard.

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