Anaphylaxis Knowledge Among Paramedics: Results of a National Survey

Jacobsen, Ryan C.; Toy, Serkan; Bonham, Aaron J.; Salomone, Joseph A.; Ruthstrom, Jacob; Gratton, Matthew

doi:10.3109/10903127.2012.689931

Cited by 35 publications

(30 citation statements)

References 10 publications

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“…17 That study was done at a single urban tertiary hospital receiving center. Our study is markedly different in that it covers two distinct geographic areas with multiple types of receiving hospitals (urban, suburban, teaching, HMO) and represents a dispatch area encompassing over 1455 square miles and 2.5 million people.…”

Section: Discussionmentioning

confidence: 99%

“…A nationwide survey of paramedics showed that less than half of those who were able to recognize a classic case of anaphylaxis could correctly identify epinephrine as the primary drug of choice. 17 Even when epinephrine was correctly chosen as the drug of choice in simulated pediatric anaphylaxis cases, only half of the providers were able to give the appropriate dose and route. 18 A recent retrospective analysis of prehospital rates of epinephrine administration in an urban tertiary care pediatric ED demonstrated that among children with anaphylaxis, only 36% were given epinephrine by EMS providers prior to their arrival in the emergency department, findings largely consistent with an earlier retrospective study of epinephrine administration in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

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Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Carrillo¹,

Hern²,

Barger³

2015

Prehospital Emergency Care

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Anaphylaxis in the pediatric population is both serious and potentially lethal. The incidence of allergic and anaphylactic reactions has been increasing and the need for life saving intervention with epinephrine must remain an important part of Emergency Medical Services (EMS) provider training. Our aim was to characterize dosing and timing of epinephrine, diphenhydramine, and albuterol in the pediatric patient with anaphylaxis. In this retrospective chart review, we studied prehospital medication administration in pediatric patients ages 1 month up to 14 years old classified as having a severe allergic reaction or anaphylaxis. We compared rates of epinephrine, diphenhydramine, and albuterol given to patients with allergic conditions including anaphylaxis. In addition, we calculated the rate of epinephrine administration in cases of anaphylaxis and determined what percentage of time the epinephrine was given by EMS or prior to their arrival. Of the pediatric patient contacts, 205 were treated for allergic complaints. Of those with allergic complaints, 98 of 205 (48%; 95% CI 41%, 55%) had symptoms consistent with anaphylaxis and indications for epinephrine. Of these 98, 53 (54%, 95% CI 44%, 64%) were given epinephrine by EMS or prior to EMS arrival. Among the patients in anaphylaxis not given epinephrine prior to EMS arrival, 6 (12%; 95% CI 3%, 21%) received epinephrine from EMS, 10 (20%; 95% CI 9%, 30%) received diphenhydramine only, 9 (18%, 95% CI 7%-28%) received only albuterol and 17 (33%, 95% CI 20%-46%) received both albuterol and diphenhydramine. 9 patients in anaphylaxis received no treatment prior to arriving to the emergency department (18%, 95% CI 7%-28%). In pediatric patients who met criteria for anaphylaxis and the use of epinephrine, only 54% received epinephrine and the overwhelming majority received it prior to EMS arrival. EMS personnel may not be treating anaphylaxis appropriately with epinephrine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Carrillo¹,

Hern²,

Barger³

2015

Prehospital Emergency Care

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“…Provider A drew 10 mL of epinephrine (10 mg) from the vial and delivered the second dose, which is more than 50 times greater than the correct dose. 15 Eighty-three percent had personally cared for an adult with anaphylaxis; 98% were confident that they could recognize anaphylaxis and 97% that they could manage it. Only 46% identified epinephrine as the initial drug of choice.…”

Section: Table 5 Synergistic Sequence Of Errorsmentioning

confidence: 99%

“…The simulated patient in this scenario met the diagnostic criteria for anaphylaxis: acute onset of illness with skin involvement (urticaria), respiratory involvement (wheezing and shortness of breath), and hypotension (>30% decrease in systolic blood pressure). 15,16 The child's length measured at the border of the white and blue color zone on the Broselow-Luten tape, which corresponded to an estimated weight of 18-19 kg. Hives were represented with circular, pink plastic bandages (see Figure 1).…”

Section: Study Protocol Simulationmentioning

confidence: 99%

Medication Errors in Prehospital Management of Simulated Pediatric Anaphylaxis

Lammers¹,

Willoughby-Byrwa²,

Fales³

2014

Prehospital Emergency Care

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“…In a blinded, cross-sectional online survey of a random sample of emergency medical service personnel, 99% of paramedics correctly identified a classic presentation of anaphylaxis; however, only 3% recognized an atypical presentation of anaphylaxis in a patient with abdominal pain, hypotension, and no skin signs [67]. …”

Section: Long-term Management: Self-treatment In Community Settingsmentioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

247

181

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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Anaphylaxis Knowledge Among Paramedics: Results of a National Survey

Cited by 35 publications

References 10 publications

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Medication Errors in Prehospital Management of Simulated Pediatric Anaphylaxis

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

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