BBKA Epipen Policy

[susbees]

In Oct 2011 the BBKA produced a detailed leaflet (L002) on what to do after bee stings and more importantly after serious reactions to them.

We've discussed the risks of the untrained using Epipens at length on this forum. This new leaflet says to use a prescribed Epipen on someone on the basis of reading (and remembering under duress) the list of directions in the leaflet (as long as verbal agreement is received at the time or written if unconscious (jokes not required)).

It does not say to use an Epipen not prescribed for that individual.

What do the various paramedics/St Johns/nurses/docs think of this advice to suggest someone use an Epipen without proper training?

 

[The Cumbrian]

MY First Aid training has now lapsed, but as I have said before at my last "First Aid at work" course we were specifically told not to administer an epi-pen unless trained and that training wasn't part of the course.

At the end of the course we were given a short course (not officially part of the main course) on using the epipen.

 

[BeeMoustashe]

Did an Epipen administration course a couple of years back for work. Not that difficult at all, it's literally lid off, stab, massage site, job done. The complicated bit is caring for someone with anaphylaxis generally- but if first aid courses teach that, why not epipen?

 

[Nomadickarl]

Epi pen

The administration of the adreniline may not be the problem, the after care may be! From someone that has been trained and carries one everyday, you are own your own with the decision you make. Adreniline kills - fact. Hence after administration you need to get to hospital as quick as you can.

Interestingly, if you are not a medical professional, how do you know they are suffering from a severe reaction to a bee sting? What if by coincidence the sting just triggered a heart attack. Or the person just suffered shock and panicked which brought about symptoms to a severe allegic reaction, then someone decided in their wisdom to whack an epi-pen into them?

Good luck on this dilemma. No dilemma for me, use on those prescribed - end of.

 

[BeeMoustashe]

The administration of the adreniline may not be the problem, the after care may be! From someone that has been trained and carries one everyday, you are own your own with the decision you make. Adreniline kills - fact. Hence after administration you need to get to hospital as quick as you can.

Interestingly, if you are not a medical professional, how do you know they are suffering from a severe reaction to a bee sting? What if by coincidence the sting just triggered a heart attack. Or the person just suffered shock and panicked which brought about symptoms to a severe allegic reaction, then someone decided in their wisdom to whack an epi-pen into them?

Good luck on this dilemma. No dilemma for me, use on those prescribed - end of.

Couldn't agree more! I was trained in order to administer them to kids who were prescribed them. It's a medicine, and should be regarded as such. However if you have a person with anaphylactic symptoms and they have a pen with them.. lesser of the two evils to call 999 and give it anyway? It keeps the heart going and buys you time as I was told. It's not the cure in itself.

 

[Andy Duff]

Serious head on-

1 If and I mean IF you know someone who carries an Epipen and they collapse when you are around, DIAL 999 tell the operator clearly what you see in front of you and that the person carries an Epipen, they will direct your call to somebody who can ask you for the symptoms and tell you what to do.

2 see above.

The above does not apply to anyone who has been trained to use an Epipen, they know what to do, and it still involves dialling 999.

 

[BeeJayBee]

Could I ask a question please, even though I'm sure the answer has already been covered somewhere else.

... if you have a person with anaphylactic symptoms and they have a pen with them.. lesser of the two evils to call 999 and give it anyway

Where we live mobile signals are unreliable, so calling 999 might not be possible.

If you are not trained, are the only person available, and are out of range of mobile signal, what would/should you do if you think your bee buddy is suffering from anaphylaxis? (Assuming you know they are allergic; know they carry an epipen; know where it is.)

 

[bobster]

My interpretation of the advice on the NHS website is that it should be administered. But the Epipen should only be used on the person it is prescribed for. ie don't use Billy's EpiPen on Berty.

Bobster

 

[BBG]

It would be helpful if someone knew how lon after a bee sting, that results in a shock, does somebody have before they die or have lasting damage.

This would help greatly in knowing if there is in fact time to get and ambulance, and experience on the scene.

 

[drstitson]

"It would be helpful if someone knew how lon after a bee sting, that results in a shock, does somebody have before they die"

sorry to not be more helpful but answer is "how long is a piece of string?"

any form of collapse (shock, heart attack, panic/faint) needs ambulance asap.


re one of the previous threads and definitely not advising/condoning any particular action on behalf of member of the public - a collapse due to "heart attack" precipitated by the sting incident would probably benefit from a bit of adrenaline - after all that is what'll be given (albeit in bigger dose) during formal CPR!!!!!

 

[MandF]

My interpretation of the advice on the NHS website is that it should be administered. But the Epipen should only be used on the person it is prescribed for. ie don't use Billy's EpiPen on Berty.

Bobster

The advice clearly says that if anaphylaxis is SUSPECTED, then an injection of adrenaline should be administered AS SOON AS POSSIBLE.

It then says that if the person has a history of it, they may have a self-injector. If they do, you can inject it. The only relevance to "being trained" is to ensure you inject it into muscle, not fat. Which you can see from the instructions anyway.

I cannot see anywhere where it says that a person should only be injected with their own prescribed adrenalin.

So, the NHS are saying that anyone can/should administer it (or else why tell us that the person may have an epipen, and give us instructions on use), and they dont mention anywhere that you should only use an epipen prescribed to that person.

After reading that I am therefore confident the advice is, when you have someone suspected of anaphylaxis;

1. dial 999
2. if anaphylaxis is SUSPECTED (from speaking with friends/relatives of victim, and/or seeing wasp/bee sting, and/or speaking with 999 operator) then inject with adrenalin asap. Whether that is the victims, yours, someone elses doesnt matter.

If you are told the ambulance is around the corner, then I might decide to not inject someone elses epipen. If I am told they are 5-10 mins away, and the victim is clearly dying, I would.

 

[BBG]

"It would be helpful if someone knew how lon after a bee sting, that results in a shock, does somebody have before they die"

sorry to not be more helpful but answer is "how long is a piece of string?"

any form of collapse (shock, heart attack, panic/faint) needs ambulance asap.


re one of the previous threads and definitely not advising/condoning any particular action on behalf of member of the public - a collapse due to "heart attack" precipitated by the sting incident would probably benefit from a bit of adrenaline - after all that is what'll be given (albeit in bigger dose) during formal CPR!!!!!

Yes, all v vague and an air of inject and hope pervades!

A child I knew carried a pen and threw an alleged 'fit' due to eating nuts (he said). In the melee of an attendant trying to inject him, the little 'B' managed to get her to stick it in her own leg and inject the lot..

I was told the woman "almost died" and indeed was very unwell for a while.

Thus, I am pensive about all this speculation, particularly as I endured an episode due to being stung 4 or 5 times on the hand one August years ago. It was 'a looks like the end might be nigh moment for me'.

My wife phoned the doctor who said "He'll probably get over it" !! I did and through the Forum pointing out the BMJ article, in 92 I think, realise it was most likely due to being on NSAIDs at the time.

 

[BeeMoustashe]

I think perspective and common sense needs to be used. If you have someone clearly dying in front of you, do the injection.

You could kill them with the adrenaline if they happen to have an underlying health problem (but would they have it prescribed then?), but you will more likely kill them by not injecting. End of really. Finding a fella in a beesuit in a bad way next to a beehive holding an epipen is a good indicator you need to give him/her an injection.

Mrs Miggins lying on the pavement by the bus stop- probably not.

But choosing the right first aid for the evidence in front of you is taught in first aid courses. It's up to you how you impliment that.

 

[AmericasBeekeeper]

Master Beekeepers in Flroida are licensed by the state, following training to administer epinephrine. I carry the license and have additional training through the military in Combat Life Support. It takes about 6 minutes for brain cells to die from lack of oxygen. How long does it take to get correct answers, make a decision and the ephinephrine to get into the blood stream and work. If the heart has already stopped or circulation is compromised it is too long.

 

[BeeMoustashe]

Master Beekeepers in Flroida are licensed by the state, following training to administer epinephrine. I carry the license and have additional training through the military in Combat Life Support. It takes about 6 minutes for brain cells to die from lack of oxygen. How long does it take to get correct answers, make a decision and the ephinephrine to get into the blood stream and work. If the heart has already stopped or circulation is compromised it is too long.

It's like CPR. If you can't feel a pulse, do it. If you can't be sure you felt one- do it anyway. Risks of not doing it far outweights the risk of doing it.

 

[MandF]

Master Beekeepers in Flroida are licensed by the state, following training to administer epinephrine. I carry the license and have additional training through the military in Combat Life Support. It takes about 6 minutes for brain cells to die from lack of oxygen. How long does it take to get correct answers, make a decision and the ephinephrine to get into the blood stream and work. If the heart has already stopped or circulation is compromised it is too long.

A few people here seem to be suggesting that injecting someone with adrenaline is likely to cause them problems (ie kill them) if they were NOT in anaphylaxis - Im curious as to whether you were told this on your course?

ie "only administer adrenaline if you are sure they are in anaphylaxis or else you could kill them"?

The overriding advice from everywhere I have read seems to be, it can cause some problems, but if someone is dying, use it.

Like this quote from a doctor

"EpiPen (epinephrine injection) is the treatment of choice for life-threatening allergic reactions. EpiPen must be used with caution in people with certain heart diseases, high blood pressure, diabetes, Parkinson's disease, and thyroid disorders. EpiPen must also be used with caution in people taking certain medications including digoxin, some antidepressants, and antihistamines. For these people, using EpiPen may cause effects such as irregular heartbeats or severe chest pain; however, EpiPen should still be used to treat life-threatening allergic reactions."

 

[region2]

Hmm, do nothing and they will die, do something and they might live!

I remember arriving at a crash scene to see a motorcyclist face down in a pool of blood with no-one near him. As I approached him someone called out "don't touch him!" Right! I simply checked ABC (I'm trained you know) - he was breathing (well snoring due to a broken nose) and unconscious. Ambulance arrived some time afterwards - if I wasn't there and that advice was followed he'd have been dead if he wasn't breathing!

R2

 

[drex]

OK, so I know I am medically trained but I think this is a bit of a storm in a teacup.

We all, doctors included, in such situations have to do what we ourselves feel comfortable doing.

If I collapse ( and I do have heart problems as well) after a sting near my hives, I would be grateful if anyone would stick me with an epipen. If you do not know what to do, read the instructions, they are very simple.

Dr Ex

 

[MandF]

Exactly. We could do without the scare stories, as that is more likely to end up killing someone, by preventing someone from acting for fear of doing the person more harm, and/or being done for manslaughter!

 

[BBG]

Exactly. We could do without the scare stories, as that is more likely to end up killing someone, by preventing someone from acting for fear of doing the person more harm, and/or being done for manslaughter!

I want to hear you maintain this after the first negligence claim against a person, doing exactly what you have said and resulting in loss of that person's house, money and bees to compensate the bereaved.

I imagine these high ideals will seem a little over-rated then. IMHO of course.

Scarey - or what!