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Related Experiment Videos

Anaphylaxis in the prehospital setting.

Kathleen E Kane1, David C Cone

  • 1Division of EMS, Section of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut 06519, USA.

The Journal of Emergency Medicine
|October 23, 2004
PubMed
Summary

Emergency Medical Services (EMS) lack standardized anaphylaxis definitions. While about 0.5% of EMS calls concern allergic reactions, epinephrine use varies, and anaphylaxis death rates differ significantly by state.

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Area of Science:

  • Emergency Medicine
  • Public Health
  • Anaphylaxis Research

Background:

  • Many Emergency Medical Services (EMS) systems now permit Basic Life Support (BLS) personnel to administer epinephrine auto-injectors (EAIs).
  • Several states mandate training and authorization for BLS personnel to use EAIs, reflecting a growing trend in pre-hospital emergency care.

Purpose of the Study:

  • To analyze EMS case definitions for allergy and anaphylaxis.
  • To determine the incidence of EMS calls for allergy/anaphylaxis and epinephrine administration.
  • To quantify the mortality rate associated with anaphylaxis.

Main Methods:

  • An observational study design was employed.
  • Data were collected via email, mail, and telephone surveys from state EMS directors, offices, and vital statistics/medical examiner offices.

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  • Simple descriptive statistics were used for data analysis.

    • Main Results:

    • Significant variation exists in state-level EMS protocols for defining allergy/anaphylaxis, with some lacking clear definitions.
    • Excluding outliers, approximately 0.34% to 0.82% of over 2.8 million EMS runs were for allergy/anaphylaxis.
    • Epinephrine administration rates varied widely (0.16% to 31.1%), with a cluster between 8.8% and 14.8% in reporting systems. Anaphylaxis death rates ranged from 0% to 0.94%.

    Conclusions:

    • There is a lack of standardization in EMS anaphylaxis case definitions and reporting across states.
    • Allergy/anaphylaxis accounts for roughly 0.5% of EMS calls, with epinephrine administered in about 10% of these cases.
    • Anaphylaxis-related mortality rates show considerable variability among states.