title: Epinephrine use by emergency medical technicians for presumed anaphylaxis.
abstract: OBJECTIVE
  The use of epinephrine for the treatment of anaphylaxis by emergency medical technicians (EMTs) has not been rigorously evaluated. The aim of this study was to determine whether first-tier EMTs use epinephrine safely and appropriately for anaphylactic reactions.
  
  
  METHODS
  The study used a case-control design. Cases were persons treated by EMTs with epinephrine for presumed anaphylaxis from January 1, 2000, through January 31, 2003, in King County, Washington (n = 22). Controls were emergency medical services (EMS)-treated persons matched to cases by diagnosis category, patient age, fire department, and year, but who had not been administered epinephrine by EMTs (n = 44). Cases and controls were compared with regard to history, symptoms, and examination characteristics. In a second assessment, physicians blinded to treatment (case/control) status reviewed events to determine whether they would have treated the patient with epinephrine
  
  
  RESULTS
  When cases were compared with controls, cases were more likely to report a history of anaphylaxis (27% vs. 2%), upper airway symptoms (59% vs. 18%), and shortness of breath (77% vs. 27%). Cases were also more likely to have tachypnea (32% vs. 5%), hypotension (41% vs. 9%), decreased level of consciousness (32% vs. 2%), abnormal breath sounds (46% vs. 16%), and rash (50% vs. 23%) (p < or = 0.01 for all comparisons). The physicians agreed with the EMTs' decisions regarding epinephrine use (or nonuse) in 86% (57/66) of events: 86% (19/22) in which the EMTs used epinephrine and 86% (38/44) in which the EMTs did not use epinephrine.
  
  
  CONCLUSIONS
  In this EMS system, the EMTs used epinephrine for presumed anaphylaxis in a discriminating manner that typically agreed with physician review.
authors.affiliation: Public Health-Seattle and King County, Emergency Medical Services Division, Seattle, Washington 98104-4039, USA. rea123@u.washington.edu
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.forename: Catherine
authors.initials: C
authors.lastname: Edwards
authors.forename: John A
authors.initials: JA
authors.lastname: Murray
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Cloyd
authors.forename: Mickey S
authors.initials: MS
authors.lastname: Eisenberg
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D016022:Case-Control Studies; D002983:Clinical Competence; D004634:Emergency Medical Technicians / Q000193:education; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D018579:Patient Selection; D017751:Safety Management; D013566:Sympathomimetics / Q000627:therapeutic use*; D014861:Washington
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine