Questions Concerning EpiPens

[cnolan]

Hello! My name is Charity, I've been a peds nurse for 3 years and am going to camp this summer for the first time. (Very excited!) I do have one concern - apparently our camp physician (whom I have not yet met, but will do so on the 30th) has decided it is more of a liability to have EpiPens on site than to NOT have them. So this year, we will be without EpiPens, unless the kids bring their own.

My question is this:

We are 8 minutes out from EMS, and if a kiddo were to have a reaction, there's not much I can do, and 8 minutes is an eternity if someone is having a true anaphylactic reaction. Do you think it's unreasonable that I question the doctor about his new thinking? People come into contact with things every day that they had no idea that they were allergic to. Apparently just last year they had a new reaction to peanuts with a girl and administered it to her.

Thoughts?

PS: If you're an RN, did you feel is necessary to also take a first aid class? (I currently work ortho and pulmonary, so I am adept at soft tissue and bone injuries, as well as asthmatics and nebs!)

[KylesScreenName]

I personally would be VERY concerned if I was seeing patients without an epipen in my reach. It seems to me that the benefit of epi (a saved life) greatly outweighs its detriments (which are rare in younger pts anyways). 8 minutes without epi sounds stunningly similar to "dead kid."

Bringing it up to your medical director might be tricky - because you need to be forward enough to let him/her know how important this is, but respectful enough to let him/her still be the medical director. Definitely ask what he/she would recommend doing if an anaphalactic pt didn't have a prescribed pen, which will hopefully get him/her to think about the issue enough to resolve it. So, basically, I don't know if "questioning" the doctor is the best idea, but definitely get dialog going.

Luckily, most kids with a known allergy will probably have it prescribed. Remember, a first exposure can never be an allergic reaction. It's not something to get too worried about, but I would definitely be concerned.

[BonnieSc]

I would definitely talk to the doctor about it--write down your thoughts and the facts so you have it organized in your head. Is he an onsite physician or just a consultant? Our MD doesn't have much of an idea of what we do at camp, and it's possible yours doesn't, either.

First aid--you sound fine to me. To be honest I've never found the first aid class very useful, even way back before I was a nurse. Some people suggest "wilderness first aid" for camp nurses, but that course is meant for people who are giving first aid on wilderness trips, not in established camps.

[NRSKarenRN, BSN, RN]

Open a dialogue with camp director re your concerns. Document concerns to Camp Director owner too if needed.

Having involved in 2 major events, one delayed reaction beesting, glad to have epi and Prednisone on my emergency shelf ---also that camp owner was an expert Pediatrician herself!

[Allana]

I'm not sure what the liability would be...thinking about the risk vs. benefits. I would not be comfortable being there without both a adult epi pen double kit and Jr double kit. I would suggest discussing with the camp physician what the specific liability he's concerned about is. Wonder if money may be a factor the double kits are anywhere from $120.00 - $140.00 each. Every year I have to purchase new kits and some have questioned the need but the benefit of having the epi available far outweights the cost.

[Nur_1996]

You do need a epi-pen just in case, talk to the camp Dr. regarding your concerns.

[JoshuaAdamsRN]

The Epi-Pen is included in the BLS protocols of many states so that even EMTs can give it without a doctor's order upon recognizing signs/symptoms of anaphylaxis.

The 2 camps I have worked at have had Epi-Pens in locked cabinet accessible only to the registered nurse. I have had to administer epinephrine on two occasions at camp when the patient had a previously undiagnosed allergy.

P.S. I am trying to find some articles to help support your case. I'll send links to whatever I find.

[vampiregirl, BSN, RN]

Your thread caught my eye. As an EMT-A and having food allergies myself, I fully understand the importance of having an epi-pen (actually 2) immediately available. Another poster referred to EMT's in many states being able to administer epi-pens. It might be helpful to you if you can find out ahead of time what level of EMS provider services your camp, also the anticipated response time to your camp. It's also a great idea to collaborate with them on an emergency response plan in the unlikely event that an emergency response is needed.

Also, a great source of allergy info is http://www.foodallergy.org. This organization offers advocacy materials, educational materials and is a fantastic resource for both patients and caregivers. They even have a camp brochure, but also many of the resources available for schools might help you too. Good luck!

[BeenThereDoneThat74, MSN, RN]

I don't know if it differs from state to state, but I know we are required to have one on site. One year, I was fortunate enough to be there when the state camp inspector came, and that was one of the key things he asked for. I am in NY.

I can't see any harm in asking, just play dumb (although you are not being dumb by wanting to know). I don't think you are disrespecting the doc by asking. Also, is this the doc who is 'writing' your orders? If so, as a nurse, you can only do what you have orders for, especially given the remoteness and lack of equipment and supplies you have.