Community Presentations of Anaphylaxis in Tasmania: Who is Administering the Adrenaline?

Abstract

<jats:p>Background: Anaphylaxis is a significant health concern within the community. The early administration of adrenaline to patients experiencing anaphylaxis has long been recognised as the cornerstone of treatment. Health-care providers, including general practitioners, nurses and paramedics, are well equipped to manage anaphylaxis through the administration of adrenaline. Patients themselves also often have adrenaline auto injectors, allowing early self-management. The objective of this study was to determine the rates of adrenaline administration and identify the administering persons for all anaphylaxis patients presenting to ambulance services in Tasmania from January 1st 2008 until December 31st 2011 by using a retrospective chart review. Methods: Ambulance Tasmania electronic case reports (n=226 421) from the period January 1st 2008 to December 31st 2011 were searched for all cases fitting the parameters of anaphylaxis, allergy or allergic reaction. Of these cases, 373 were given a final paramedic diagnosis of anaphylaxis and constituted the primary data for this report. Results: Ambulance Tasmania attended 373 patients during the study period that were given a final primary diagnosis of anaphylaxis - of these 59 (15.8%) were excluded, leaving 314 electronic records for analysis. Of the cases identified, 71.7% (n=225) were administered adrenaline according to paramedic records. Adrenaline was administered by a range of health professionals, including general practitioners (n=27), paramedics (n=159), ambulance volunteers (n=4), nurses (n=1) and other health professionals (n=3). Adrenaline was self-administered by 12.4% (n=28) of patients, with an additional 11.6% (n=26) receiving adrenaline from a non-health care worker (layperson). In 10.2% of cases (n=23) adrenaline was administered by more than one provider. Administration of adrenaline prior to paramedic arrival was evident in fewer than 10% of cases treated with adrenaline (n=22). Conclusion: The early administration of adrenaline in anaphylaxis is often vital for patient recovery. This study shows that adrenaline is administered by a number of different providers, with early administration accounting for only 9.8% of presentations treated with adrenaline. These findings raise the question, is adrenaline being administered early enough and often enough to improve health outcomes?</jats:p>

Emergency department childhood anaphylaxis presentations in regional/remote Australia

“…The most common trigger for anaphylaxis in our study was food‐related, similar to the local ‘State’ paramedic study 8,9 . However, food‐related anaphylaxis is significantly more common in urban areas 5 .…”

“…In the current study, children presenting with anaphylaxis were promptly assessed in ED, that is, within an average of 13 min. However, a minority received self‐administered adrenaline prior to ED presentation, which is consistent with the local ‘State’ paramedic study 9 . This is in contrast to those presenting to an Australian metropolitan ED study where the majority of children received adrenaline autoinjector prior to presentation to hospital, 16 and in ED, a quarter of children received adrenaline, with the vast majority (88%) receiving intramuscular adrenaline.…”

“…We further reported a 20% increase in food‐related anaphylaxis over a 7‐year period, while metropolitan Victoria increased by 78% and 38% in rural Victoria 5 . We report high prevalence (21%) of anaphylaxis related to insect bites and stings, similarly reported in the paramedic study, 8,9 which is significantly higher than reported in metropolitan areas (4%) 16 . The major offending insects reported in our study were jack jumpers, bees and bull ants.…”

“…In 2015, a Tasmanian study, a regional/rural area, reported on anaphylaxis presentations to paramedic ambulance staff. 8,9 These studies present potential bias as a minority of anaphylaxis episodes trigger a call to paramedics and it is likely that ED presentations will more accurately reflect the local prevalence of anaphylaxis as severe life-threatening systemic reactions are more likely to trigger hospital presentations. Many studies have reported poor adherence to anaphylaxis treatment guidelines, such as lack of administration of adrenaline autoinjectors, poor referral patterns to allergy clinics, lack of anaphylaxis action plans and follow-up allergy tests.…”

“…However, there is a lack of published reports of anaphylaxis in regional or rural areas to assess clinical presentations and risk factors in the childhood population. In 2015, a Tasmanian study, a regional/rural area, reported on anaphylaxis presentations to paramedic ambulance staff 8,9 . These studies present potential bias as a minority of anaphylaxis episodes trigger a call to paramedics and it is likely that ED presentations will more accurately reflect the local prevalence of anaphylaxis as severe life‐threatening systemic reactions are more likely to trigger hospital presentations.…”