Dilemma

Dilemma

Soyou are out hiking with a bunch of people and someone gets stung by a bee. Within moments the person is having trouble breathing and other symptoms of anaphylactic shock are evident (I wasnt actually trying to be poetic here I simply forget the other symptoms) As everyone turns to the victim asking where they keep their EpiPen the person looks at them with eyes wide with panic and says I dont carry one, Ive never been stung beforeI didnt know I was allergic! (Oh crap) what do you do?

My question is something the oc officers (those who are already certified that is) have been talking about for a while. While WFRs are trained to use EpiPens can they actually legally obtain and carry them in case of extreme emergency?

We are in the process of reorganizing, regrouping and re-buying things for the clubs first aid kit. Now, the club hasnt had one in years (and I mean years!) because anyone who comes with us comes at their own risk we are not held responsible for anyone as noone is technically a guide and we are all peer hikers (yadda yadda yadda). Because of this we arent required to have anything for anyone (so tough luck!) however since the majority are WFRs a first aid kit has been deemed a necessityafter all peers or not if someone gets hurt the person with the most medical training would naturally step in and to protect their own interests they would rather have a first aid kit. Our logic was its one thing for someone who knows they are allergic to bees to bring an EpiPen and have someone (who knows how obviously) use it in the event that they cant. But can we carry epinephrine in the kit in the event that someone who has never been stung before has a reaction?

There are tons of legal stuff surrounding this I am surebut anyone know an answer? Granted, it would be different if you were an adult leader with children, you would have wavers, and medical forms and such...keep in mind we don't have any of that...Our options all seem to come to a dilemma.

If we don't have an EpiPen and are out in the middle of nowhere they most likely will die.

If we give them epinephrine (i like using that word...makes me feel smart...just don't ask me to pronounce it!) and it isn't administered right or there are complications or something they could also die.

I've seen people starting to go into anaphylactic shock before it's not a pretty sight and no one just stands there and does nothing (especially those who have advanced first aid training) the only problem is unless you can get them to the ER or unless you have an EpiPen you really can't do much for them....I don't know.

We had heard that it is possible for organizations (such as ours) to obtain EpiPens from a licensed physician who would give them to us at their own discretion (and most likey would get the hot pot if anything bad happened) but I highly doubt any MD is going to be enthused about helping a group of college aged kids obtain EpiPens (be honest...would you...I sure as heck wouldn't!) especially when it could potentially effect their career.

What do you guys think?

Unfortunately I don't know the answer to your question. But, does your campus have a health center? If so, can you and the leader of your club make an appointment to meet with someone on staff there to discuss this? If you don't have a health center (which most campuses do these days), you might also consider setting up an appointment with the prof who is instructing your WFA class. They may or may not be in a position to give you a definitive answer, but I bet dollars to donuts they can help point you to good local resources to help you figure this out.

One thing that comes to mind is that state laws probably differ from one state to another, and so it would be a good idea to have this conversation with someone who is conversant both with the medical issues and with the local legal issues.

I have always been told you must have a prescription to get an EpiPen. You can carry benadryl, however. Sure, it's not the same, but it is better than nothing.

In our WFA courses, we teach the law of the jungle is YOUR first aid kit will be used on YOU, so YOU decide what you want to carry in it. Reason being, if another hiker gets hurt and I use my first aid kit on him, and he gets evacuated with all his gear (including his first aid kit), mine is now depleted. Something I might need later may have been used on that hurt hiker, leaving me short. So, when possible, use the victim's kit to give aid.

With that being said, most troops/crews will carry a larger group kit with them. Just don't rely on that one kit, and not take your own. How many hiking groups actually stay together during a hike? Some get spread out pretty far, and odds are if someone gets hurt, the group kit will be far away. Just Murphy's Law.

Make sure everyone knows who is carrying the group kit, and where it is located. We teach to put a large red ribbon/zipper pull on the pack pocket where the first aid kit is located. This is a good idea for everyone who is carrying their own kit as well.

I now also carry a small "first response kit" on the outside of my pack that has gloves, a few 2" sterile pads, an elastic bandage and a CPR face shield. That will take care of most severe immediate emergencies, without me having to get into my pack for the full first aid kit. I don't remember where I got mine, but it is similar to these:

http://www.cpr-savers.com/Industrials/Cpr%20prod/cprkeychain2.html(This message has been edited by BrentAllen)

As for administering an epipen you just take off the top and stab it in the until you hear a click. Right through clothing, etc.

My suggestion is to talk to go to council or talk to emergency personnel. There are individuals you can't give this to and you may not know that.

Also they have those benedryl quick dissolves now so you don't have to swallow a pill or get messy- also those 1 dose packs. so yes-- in the absense of epi-pen use the benedryl-- better than nothing at all.

Also many reactions for first-timers may not be as severe as the 2nd time- it's the multiple exposure that causes the extreme reaction.(I'm not saying you can't have a severe reaction your first time- more likely you've had one before though). You should advise anyone going if they've had ANY sort of reaction to a sting of any sort to get a presciption and bring it along.(or even something else). It's the next exposure that could be life- threatening.

Don't know if you could get one for the kit in those cases. The laws may vary in states-- don't know.

"There are individuals you can't give this to and you may not know that."

That's why Epinephrine is a controlled substance and should only be given to the person for whom it was prescribed. In the scenario described, I think the only recourse is to call 911, give the benadryl (diphenhydramine) to buy some time, try to maintain a patent airway and hope for the best.

I am unsure what the dimemma is here? Are you aware of someone in your group who is highly allergic to bee venom, or for some other reason requires to have epinephrine on hand? If so wouldn't they have a prescription and epi-pens on them?

If you want it as a precaution just in case you should need it, then wouldn't this be one of many pharmaceuticals you would have to take with you just "in case" something happened? Probably not the best way to be prapared. You need to look at the activity and learn what the must common injuries will be and prepare foor them.

Side story:

Camping one fall at a state park the scouts noticed several yellow jackets flying in and out of a burrow nearby. An assistant Scoutmaster felt that we should mark the area to keep the scouts away from the activity. Before anyone could stop him he had grabbeded a stake, a hammer, and some flagging tape...and began hammering a stake in the ground near the undergound hive.

The yellow jackets did not appreciaite the vibrations. We counted 11 stings on him in all. He was not a "happy camper". His actions did however serve the purpose of keeping the scouts away from the hive. No one went anywhere near it after they saw what happened to him.

Prevention is the best medicine, leading by example was a painful sustitute.

"I am unsure what the dimemma is here? Are you aware of someone in your group who is highly allergic to bee venom, or for some other reason requires to have epinephrine on hand? If so wouldn't they have a prescription and epi-pens on them?"

BobWhite I am confused by what you mean?

What I'm trying to say is what if someone who has never been stung before gets stung and has a reaction....I know that I have never been stung by a bee I hate any kind of bugs and avoid them (also, I have lots of relatives who are allergic to bees in my family). If I've never been stung then I wouldn't know if I were allergic or not util I started having an allergic reaction and then it's kinda to late to be thinking about it. What we were thinking of was that most people don't think about getting stung when hiking and quite a few people have never been stung before...we won't know everyone who comes hiking with us (probably around 28 people) and since we are all 'peer' hikers we can't very well ask people for medical information. Yes, If someone knows they're allergic they should bring an EpiPen in case they get stung but most people don't thing "hey, I've never been stung before I should take some benadryl and an EpiPen just in case!"

I think part of the dilemma is the legal side of things as I said we aren't required to have a first aid kit but if someone gets hurt as a certified WFR you would be the one to try to help them and in case that happens we want a first aid kit. We aren't going to be advertising this info to everyone on the hike...they can take care of their own scratches scrapes and blisters...this would be in case of real emergency (severe bleeding, trauma, broken bones etc...) and anaphylactic shock rates under real emergency. I suppose are real question could be if you are certifed and don't do anything to help someone can't you be held liable...isn't there a law of action one must take? However, if this action requires giving an EpiPen to someone who has never been stung before goes wrong (like they are allergic to the epinephrine) and they die you could be held liable too.

I do know that Benadryl will be in our kit at least but if you are five to eight miles away from help how much good would that actually do? Also, EpiPens actually only work for a while until second reaction so you would have to evac anyways you just might have more time to play with.

As I said we never really finalized what we were doing in the meeting...got to complicated. Does anyone on here know the laws of things like this in GA?

As a survivor of a rather severe case of anaphylactic shock, to a stimuli I had never had problems with before that incident. I can tell you that in my case I would not have made it to the hospital without a properly placed Walgreens and a clear headed spouse.

A little benadryl, timely administered can buy a lot more time than you might think. Your patient may still be in extremis but has a much better chance of surviving if you can get them out. And with the Benadryl you can give multiple doses over time - the epi-pen solution can often preclude other medication or re-administration.

I went on to do the allergen therapy and still try to avoid that stimulus but am not supposed to be subject to as severe a reaction - I'm not planning on testing it however.

Yah, high Wilderness!

Good question you ask.

Da answer is that most volunteer and professional outdoor programs carry epinephrine in their first aid kits for just such a circumstance, either as an Epi-Pen or as an injectable ampule with syringe. Other emergency meds as well, eh?

The way you do this, is you approach a friendly physician and ask him to write the scrip and the "standing orders" for its use. That physician effectively becomes "medical control", and you as a first responder are operatin' legally under his/her medical license so long as you follow the protocol the doc establishes.

It's fairly straightforward to do, and I would strongly recommend it for your program (or for that matter, for any Scouting/Venturing program goin' into remote areas, particularly on international trips).

Yeh can PM me or ask here if yeh have any additional questions.

Beavah

As some one with severe allergies in the family, I carry an epinephrine amp and a syringe in our kit at all times. I'll use it on my family members, according to my own judgment. I'll use it on Scouts or Scouters, per 911 counsel, unless there's clear evidence of anaphylaxis and difficulty reaching medical emergency staff via a cell.

But . . . you may want to look into the quick dissolve Benadryl formulations that can be used sublingually. Not only does this side step problems with pills and nausea, it will tend to be faster acting than the pills.

GaHillBilly

WildernessStudent,

Another legal matter being asked of non lawyers...

since this is a liability question a medical/malpracice attorney would be the best place to start...And find out where the Peach State comes down on the subject...GET IT FROM THE HORSES MOUTH! And then you have to understand that if you are treking in Virginia the law there prevails so you need to be prepared...unless we have a Ga lawyer on board here -most forum legal opinions are worth less than a grain of salt...Get the legal reading from someone who knows the law...not a forum.

Epipens are great things and all leaders should know how to use them to assist an epipen owner who has lost the ablity to help themselves. Epipen owners should provide those leaders (in writing) all necesary instructions and permission to administer in the event they can not do it for themselves.

That said, in a small number of cases epipens can also kill someone with an undiagosed heart problem or hyper-tension can cause problems with diabetics and some folks are even allergic to the medicine itself.

In a serious anaphylactic reaction you might need to re dose in 15-20 minutes...and if you don't have another epipen- benedryl and other antihistamines are usually not recommended after an epinephrine dose. So you are only "buying" 15 minutes...if you are in the boonies is that enough? If someone has a heart attack after a dose...due to undiagnosed heart problems...you haven't bought any time at all, have you?

'course you could ask everyone to see an allergist before joining in the fun...couldn't you?...if the question is that important.

In the end risk has to be managed...it can not be eliminated. Your oc club members need to determine for themselves what risks they will take...not the "leaders". If you decide to carry epinephrine be sure you know how to use it, check it often, (expiration date and cloudy contents, etc., -epinephrine/pens themselves do not hold up well if stored in high heat or cold environments...)

If this is really eating you up -I might suggest each trek member visit their doctor and request a prescription for an epipen... if the doctor will not cooperate with the request then you have no responciblity...I am just guessing here, but I'll bet a lot of Docs will refer members to allergists (or shrinks! ;>) )

anarchist

WildernesStudent,

Laws may be different down under but here is what we do.

All of our staff are seven day FA trained. That includes epipen. But -we operate in places that definitive med care may be some hours from. Not far - just a thick canopy so no helo assistance gauranteed. An epipen may only last 5-15 minutes. Then you need a second. + 20 minutes and a third etc etc. How many to carry?

We carry syringes and 3 vial(2 shots per vial = 6 shots) of adrenalin, Also cortizone and antihistamine. While adrenalin is working get the others in. They build up slowly but by the time we have used all six shots they should be working and anaphalaxis is beaten for long enough to evac.

How?

We got protocol from leading wilderness expedition company's and handed them to an outdoor type Dr. Scouter by the way. He wrote a protocol based on paramed protocols. We 7 day trained couldn't understand it and it also didn't meet the 2am in rain rule for simplicity. I re-wrote it. He re-wrote it tc.

He comes out to train our staff annually. We all jab each other and run through teh procedure that tells us when to prepare, when to inject and when to simply give the other drugs.

If someone is dying and cannot get drugs down throat - inject. It will not hurt them if you are wrong but blue is a leading colour. So is the noise they make when not breathing more than keeps a fly alive. Not much room for doubt apparently. If we inject and give all the drugs at once their heart will race and they will be looking arounhd for wild elephants but no harm will have been done.

Drawing up a needle is not hard and the Dr teaches and tests us. Signed doc etc. We all get and train on teh protocol. We get a cheat sheet laminated in a shaprs container with two needles and three vials along with drugs as described. All separaately wrapped and labelled. All in sharps container. Costs about $20 to kit someone out and shelf life is up to 18 months.

Needs prep work but is cost effective. Our med forms have a waiver that allows our staff to administer one dose of over the counter meds; also to operate to extent of training.

It was not that big a deal getting it all done.

Haven't used it but I would explain what I can do and get their bulging eyed panic permission before things get unconscioius.

Much as there's a soft spot in my heart for da law and those who practice it, it's also worth bein' aware of its limits.

An attorney is professionally bound to give you the best legal advice he or she can, eh?

That isn't always (or often) the best medical advice, or business advice, or even ethical advice.

The theory is that it's up to you to make those other decisions, and to disregard your attorney whenever other considerations are more important. Those other things aren't the attorney's responsibility, they're yours. An attorney is only a counselor. And that theory works just fine, as long as you understand, as a client, the limit of the attorney's competence, and don't get all twitchy about "liability."

I reckon this kind of thing falls more in da realm of competence of physicians, wilderness/emergency medicine practitioners and outdoor educators, eh? Even in Georgia.

Beavah

Wilderness student. My point I was working toward is that to carry every medication t=you might need for any possible emergency is not practical, especially for your level of experience.

You have stated in earlier posts that you are a novice at the outdoor stuff. So perhaps finding back door ways to carru controlled phamaceuticals is a little more than you and your group should be biting off at this time.

One poster says that "most" volunteer groups of this sort carry epi-pens. Not only am I sure that it is untrue, I am sure it is unprovable. I would welcome the poster to provide us the reference source of that data, as I am confident no such data exists.

This is not the greatest danger you will find in the outdoors. http://www.theallergyauthority.com/allergy/articles/allergy-bee-sting.asp

only 1% of children and only 3% of adults are likely to have a serious reaction. In fact only 50 people die annually from such stings. The odds that it will happen on one of your outings is minuscule at best. You have a greater danger from broken bones, bleeding wounds, or infection, than from stings.

Sure carrying an epi-pen seems a lot cooler than carrying a tube of anti-biotic, but the anti-biotic is something you will probably need.

Consider learning more about camping and get some entry level adventure experience under your belt before you start trying to obtain controlled pharmaceuticals and heading into the wilderness.

I don't carry an Epipen, because I'm not prescribed one and can't get one. I do carry a Glucagon kit, not because I'm prescribed one, but because my son is.

If in the wild, someone in my group is turning blue because their throat is swollen shut due to a bee sting, and someone has an Epipen, I will use it on them. Whether they were prescribed it or not. I wouldn't worry about lawyers. If I don't react they WILL die. If I do react, they might live.

Likewise, if I come across an unconscious victim wearing a Diabetic medic alert, I'm giving him my Glucagon.

Sue me.