title: Use of epinephrine for anaphylaxis by emergency medical technicians in a wilderness setting.
abstract: OBJECTIVE
  To describe a case series of emergency medical technician-basic (EMT-B)-administered epinephrine for anaphylaxis in a wilderness setting.
  
  
  METHODS
  Case series of patients in anaphylaxis who received epinephrine subcutaneously from EMT-Bs.
  
  
  METHODS
  National park rural/wilderness emergency medical service system covering 863,000 acres and serving approximately 2 million annual visitors.
  
  
  METHODS
  Prehospital care providers were National Park Service rangers with EMT-B training. Patients in the series were visitors to Sequoia and Kings Canyon National Parks with anaphylaxis resulting from insect stings.
  
  
  METHODS
  Subcutaneous administration of epinephrine by EMT-Bs trained in recognition, understanding, and treatment of anaphylaxis.
  
  
  RESULTS
  Eight patients with anaphylaxis resulting from Hymenoptera stings, from June 1992 through September 1993, received EMT-B-administered epinephrine. All patients improved clinically after treatment with epinephrine within 25 minutes. No major side effects occurred.
  
  
  CONCLUSIONS
  Our data suggest that EMT-B-administered epinephrine is safe when used by EMT-Bs in the rural/wilderness setting, with appropriate physician supervision. Further study in large trials will be required to demonstrate safety and efficacy.
authors.affiliation: San Francisco/Fresno-Central San Joaquin Valley Medical Education Program, University of California.
authors.forename: J E
authors.initials: JE
authors.lastname: Fortenberry
authors.forename: J
authors.initials: J
authors.lastname: Laine
authors.forename: M
authors.initials: M
authors.lastname: Shalit
mesh_terms: D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy* / Q000209:etiology; D000818:Animals; D002648:Child; D004634:Emergency Medical Technicians / Q000193:education; D004777:Environment; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D006927:Hymenoptera; D007279:Injections, Subcutaneous; D007299:Insect Bites and Stings / Q000150:complications*
chemical_list: D004837:Epinephrine