title: Pre-hospital management of anaphylaxis in one Canadian Urban Centre.
abstract: OBJECTIVE
  Anaphylaxis requires prompt recognition and management to improve patient outcomes. This study examined the diagnosis and treatment of anaphylactic reactions by the Emergency Medical Services (EMS) in a Canadian urban centre.
  
  
  METHODS
  Electronic patient care records (ePCRs), identifying allergy-related calls in the Edmonton-Zone for the year 2011, were retrospectively reviewed to confirm anaphylaxis diagnosis and record treatments. Data were abstracted and entered into the REDCap electronic platform. Descriptive and multivariable analyses were performed. Pre-hospital management included any care provided by paramedic personnel and/or first-aid treatment received prior to EMS arrival.
  
  
  RESULTS
  From 481 identified allergy-related case records, 136 (28%) met guideline criteria for anaphylaxis. Seventy-six (56%) of these confirmed cases were deemed high acuity by medical dispatchers. Self-medication and bystander first-aid was recorded in 60 (44%) anaphylactic events; 34 (25%) received epinephrine. Paramedics administered epinephrine in an additional 49 cases (36%); only 7% received all three primary pre-hospital anaphylaxis treatments: epinephrine, corticosteroids, and antihistamines. Factors associated with pre-hospital epinephrine administration included: previous episode of anaphylaxis (adjusted odds ratio [aOR]=4.9, 95% confidence interval [CI]: 1.30, 19.21); administration of corticosteroids by bystanders or EMS personnel (aOR=3.8, 95% CI: 1.36, 10.65); and transport severity (aOR=3.2, 95% CI: 1.21, 8.36).
  
  
  CONCLUSIONS
  Paramedics in this region demonstrated higher use of epinephrine than reported elsewhere; however, almost half of all patients meeting anaphylaxis criteria did not receive pre-hospital epinephrine. Instead, more patients received antihistamines. Efforts to improve adherence to anaphylaxis protocols and guidelines appear warranted.
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada; University of Toronto, Toronto, ON, Canada; Centennial College, Toronto, ON, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Gaudet
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Vandenberghe
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Couperthwaite
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sookram
authors.affiliation: Emergency Medical Services, Alberta Health Services (AHS), Edmonton, AB, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Liss
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada; Emergency Strategic Clinical Network, Alberta Health Services (AHS), Edmonton, AB, Canada. Electronic address: brian.rowe@ualberta.ca.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta; D000707:Anaphylaxis / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019468:Disease Management; D004632:Emergency Medical Services; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine
keywords: Allergy; Anaphylaxis; Emergency medical services; Epinephrine