EMT-Basic and Paramedics-Performed Simulated Pediatric Anaphylaxis—Standard Syringe/Color-Coded Syringe/Epi Auto-Injector

Introduction—Onset of anaphylaxis requires prompt treatment with an intramuscular injection of epinephrine. Much of the rural public is only served by EMTs. Autoinjectors are typically the only mechanism within the EMT scope of practice. Autoinjectors have recently become prohibitively expensive and only provide discrete doses. A color-coded syringe (CCS) that corresponds to a pediatric tape-based dosing system might provide a facile EMT “check and inject” mechanism.

Objective—To determine if EMTs would perform equally to paramedics in the administration of epinephrine using three delivery devices: EpiPen, standard syringe (SS), or CCS.

Methods—This was a randomized three-period, three-sequence, three-treatment repeated-measures full-consent crossover study of the EpiPen (standard and EpiPen Jr), SS, and CCS. Participants were educated on all three delivery mechanisms by a member of the study staff. The subjects were randomly assigned a training manikin to simulate either a 6-month-old or 8-year-old child. The administration order was randomized, and each participant delivered three doses of epinephrine to the assigned manikin. Study staff visualized each dose before administration. Dosing errors and critical dosing errors were documented.

Results—The study recruited 12 EMTs and 12 paramedics. There was no difference in age or experience between the EMTs and paramedics: 39 vs. 41 years old, and 13±8 vs. 15±6 years of experience, respectively. In all cases subjects using the CCS administered the epinephrine dose closest to the expected dose of the SS or autoinjector. The autoinjector uniformly overdosed the 6-month-old by a factor of more than 2, and the SS had the highest degree of deviation from expected. There was no difference between EMT and paramedic with respect to the dosage delivered by any device. Five autoinjector administrations had to be excluded due to early removal. There was no difference between EMTs and paramedics on the number of dose errors.

Conclusion—EMTs performed equally to paramedics in the delivery of epinephrine to a child, and both performed best using a color-coded syringe versus standard syringe or auto injector.