"Every EMS provider in King County, as well as all of Seattle. Montana, Alaska, Colorado... 5000 kits in New York... in some departments, 75% of the EMS budget is EpiPens."
The cost of epipens really is hitting some ambulance services hard. In my state, advanced EMTs and Paramedics can draw up and administer Epi from ampules like this, but basic EMTs only have epipens. There's some rumors floating around that our state protocols may change to let basics do it, mostly because an amp of Epi + an IM needle is ludicrously cheaper than an epipen. I'm a basic and I'll welcome it if it goes through, but it's sad to see our protocols change based on med prices and not research.
That's the game, though. Whenever you have capitalists making money off of a social service there will be jousting across the 50 yard line. - Army develops Mark IV as a way for total newbs to deliver life-saving neurotoxin antagonists - Private sector spins that technology off as a way for total newbs to deliver life-saving steroids to prevent anaphylaxis - Public sector adopts private sector solution - Private sector sees monopoly opportunities, extends monopoly in order to increase profit - Public sector bends under the weight of the private sector and adopts It's like with cholesterol. Under heavy lobbying the cholesterol guidelines were lowered in 2008 right about the time a new class of statins came out. 13 million more people were put on anti-cholesterol medication. Those statins got more and more expensive and fewer and fewer doctors stuck to the guidelines so eventually the guidelines changed again. It's not like all of a sudden cholesterol was worse for you and then suddenly better; it's that all of a sudden, someone wasn't making enough money and then suddenly they were making too much.
But seriously, how difficult is delivering a shot? You could learn it in five minutes. Epipen price is now reflective of regulatory arbitrage than any thing else. If I were in a situation where my life was in danger, if wouldn't care if a "basic" EMT administered my medicine.
Source: my mother, recently retired medical doctor. You guys got a "Hello" from her by the way. Feel free to ask follow-up questions, just keep in mind standard disclaimer that this is not in any way a medical advice, just fact checking. Intramuscular injections that are recommended for adrenaline/epinephrine in case of shock are up there among the easiest ways for untrained person to break needle. It's not common, but happens mainly due to lack of experience. Neither of us knows precisely what are the competences of 'basic EMT' in USA, but through know-how on IM injections is a must. Panicked person who probably does it for the first time in a life-threatening situation is much more likely to mess up than fairly used to it nurse or EMT. Main problem with needle breakage is the fact that it can be brushed off as pronounced after-effects of condition that required fast administration of medications (seizure, anaphylactic shock). Muscle pain, general discomfort, muscle spasms or cramps (EDIT: and in case of anaphylaxis it can even potentially not show a typical immune response for foreign object) that often occurs after such situation can 'hide' the pain caused by needle tip in some cases. We don't know how it looks in USA, but in Polish hospitals it's among reasons why many routine procedures are done in pairs. For example one nurse preps the patient, the other prepares and makes an injection and in the end you have two sets of eyes capable of catching errors. In this case: procedural errors and results like the mentioned needle breakage.But seriously, how difficult is delivering a shot?
Devac, b_b, you're both right. Prepping an IM Epi injection isn't super difficult, and some AlS(AEMT and paramedic)providers I know say basics should already have it. Five minutes to mastery is low-balling it though. Where the difficulty would likely arise is in training a state's worth of basics on a new skill that involves sharps and one of the more powerful meds we keep on the truck. Given the potential complications like Devac mentioned, you want to be well practiced at it. Lots of my state is covered by volunteer EMS services that don't get a ton of calls, and even fewer anaphylaxis calls. Staying sharp with your sharps can be a little difficult in that kind of situation, but it will probably be ultimately doable.