EMS Protocol of the Week - Anaphylaxis / Severe Allergic Reaction (Adult and Pediatric)

The prehospital approach to anaphylaxis in NYC is a good refresher of the graduated responsibilities and expectations of EMS providers across levels of training, especially as we are now seeing medication administration at each level:

-          One dose of IM epinephrine may be given at the CFR (firefighter) level

-          A second dose of IM epinephrine may be given at the BLS (EMT) level; EMTs may also administer nebulized ipratropium and albuterol, if needed

-          A third dose of IM epinephrine and additional albuterol nebs may be given at the ALS (paramedic) level; in addition, paramedics may administer steroids, diphenhydramine, and crystalloid fluids

-          OLMC may permit further doses of medications as needed

Remember that these protocols are formatted such that if, for example, a BLS unit is first on scene, EMTs will perform all the necessary actions under the CFR portion of the protocol prior to starting the EMT section. Similarly, paramedics will complete the CFR and EMT sections prior to starting the paramedic section.

Also bear in mind that the threshold between pediatric and adult dosing for IM epinephrine is either age > 9 years or weight > 30kg.

Reach out with questions! www.nycremsco.org and the protocol binder for more!

Dave