How much First Aid Training is enough?

[BrentAllen 10]

Beavah turned the question into a legal issue, which is one side of it. But what if Tom now gets stung (turns out there was a nest, not just one bee/wasp/yellow jacket), and you just used his one and only Epi-pen on Bill? Now what?

 

The text book answer is you only administer the Epi-pen to the person it is prescribed for. You check to make sure it hasn't expired and, if you can see the medication, that the fluid is clear, not cloudy. If expired or cloudy liquid, do not administer. Text book answer.

 

Reality, hopefully Tom has more than one Epi-pen or he has a Twinject, and you do what you can to save a Scout's life.

 

How many of us have Benadryl in our First Aid kits? How many of us have chewable Benadryl in them? After going through this class I added both to ours. We don't have anyone in our Troop who is prescribed an Epi-pen.

[SeattlePioneer 144]

I hate to have to inform you of this, but the kid who got stung that you injected had qan allergic reaction to the drug and died from that, according to the autopsy.

 

Medical opinion is that you were irresponsible in injecting the kid and that doing so killed him. Your first aid instructor verifies that you were told never to give a prescription drug to someone other than the person for who the presciption was written.

 

You are sued for $100 million in regular and puntive damages.

[perdidochas 658]

Seattle,

 

Silly rejoinder. Impossible for an epipen (used to treat allergies) to cause an allergic reaction. If someone's about to choke to death because their throat is closing due to an insect allergy, there is really no way to make that worse.

[Eagle007 10]

[ I said as a nationally registered EMT I can't (one person's prescribed medication to help another). I also said more later.

 

Now for the "more later". I can't do this based on my scope of practice. That opens up a whole new can of worms. I didn't say I won't based on an emergency. I will do everything in my power to keep this scout from dying. Truly emergent circumstances dictate exigent decisions. If I knew that the other scout's epipen will treat the anaphylaxis and will cause no harm to the scout in need then you had better believe with all your heart that I will be using the auto-injector. I will also be getting that scout to the nearest medical facility, ASAP.

 

I will always do what is in the best interest of another person and be ready to defend my actions in court. ]

 

A few things to think on with explanations:

 

1)My scope of practice gives the 4 Rs for assisting with certain medication, epipens being on of them, Right dose (difference between adult and children dosages), Right route(ingestion, inhalation or injection), Right medication (prescribed to the patient for the illness and not expired and not cloudy), Right patient (prescribed to the patient who you are assisting in administering said meds).

 

 

2)If you take the other scout's pen will that place him in jeopardy if he gets stung? In most cases people carry 2 epipens with them. Some carry back ups for the back up's back up.

 

 

3)I said if I knew that using someone else's epipen would help... Evidently and to my demise in my last posting I deleted a part that should have been in there for clarification. "I would have been in contact with medical control, or in layman's terms, the nearest emergency room physician for orders since using someone else's epipen would go outside my scope of practice. I know that's going to bring up the question "what if no one in your party has cell phone service?"

 

 

4)If you take the other scout's pen and the boy in anaphylaxis dies because he was allergic to epinepherine, "you" are the one who will be responsible for his death because you were not authorized to give the scout this prescription medication. Forget about the money changing hands because of the civil lawsuit. Think about the next several years to life that you could be spending in prison for manslaughter. Reference #7 below for more information.

 

5)I carry benadryl in capsules and chewable if needed. I'm unaware of anyone in our troop who uses epipens.

 

6)The fact still remains that you would certainly do what is best for those in your care. Textbook answers are one thing. Reality is something different. Ethics and morals come into play also. Each one of use has to make hard personal decisions. And right or wrong, we are the one that will have to live with the outcomes and consequences of each of those decisions. It's easy for us to play armchair quarterback in these forums but in the real world we may face a whole different set of variables that we never even thought of. Do your best based on your level of training and press onward.

 

7)Epinephrine does have side effects. Here is a reference: http://www.drugs.com/sfx/epinephrine-side-effects.html(This message has been edited by Eagle007)

[vol_scouter 365]

Several comments: You try to save the person having the anaphylactic reaction unless you have reason to believe that the person with the Epi-pen is likely to have a reaction (have encountered lots of poison ivy, hymenoptera, etc.). The person suffering should be transported for care ASAP since the reactions can recur after a short period of time. If the emergency medical personnel cannot replace the Epi-pen, the person supplying pen should be evacuated.

 

Epinephrine cannot cause an allergic reaction because it is what our body produces (for some reason it is popularly referred to as adrenaline which is the British name). The other adrenergic biochemical produced by the adrenal glands is norepinephrine (British - noradrenaline) which has much the same actions as epinephrine. So do not be concerned about an allergic reaction. That does not mean that the patient cannot have adverse reactions. If someone is having a myocardial infarction (heart attack), the administration of an Epi-pen could be fatal. Thus, the reason to determine what is likely to be happening.

 

In general, you are always better off trying to save someone than to do nothing as long as you know what most likely should be done. That is morally, ethically, and legally. It would be easier to defend giving someone an injection of epinephrine and them still dying from anaphylactic shock than to watch them die.

[Eagle007 10]

I would personally like to thank everyone for their insight on these subjects and professionally thank my colleagues for adding to my continuing education.

[clemlaw 55]

>>>>>If you take the other scout's pen and the boy in anaphylaxis dies because he was allergic to epinepherine, "you" are the one who will be responsible for his death because you were not authorized to give the scout this prescription medication.

[vol_scouter 365]

ClemLaw,

 

You said: "But that's not a legal/moral issue--that's just a matter of me not knowing enough what to do."

 

That is my point with the current First Aid courses. Since the most common cause of death in the outdoors is anaphylactic shock, there should be a considerable amount of time spent in first aid training on the topic. However, the legal ramifications of appropriately treating someone with anaphylactic shock discourage books to be published with instructions and people are concerned with the ramifications as evidenced in this thread. Our legal system is the backbone of our Republic but it does not always serve the best interests of the public well as this is a case in point. Your attitude is correct - try to save a life.