Wilderness Medical Society Endorses Emergency Treatment of Anaphylaxis with Epinephrine by Trained Non-Medical Professionals

Philadelphia, PA, 28 September, 2010 –The Epinephrine Roundtable was convened during the 25th Annual Meeting of the Wilderness Medical Society (WMS) in 2008 to explore areas of consensus and uncertainty in the field treatment of anaphylaxis. The panel endorsed the administration of epinephrine to treat anaphylaxis in the field under emergency conditions by trained non-medical professionals.
Anaphylaxis, an acute allergic reaction, is sudden in onset and requires immediate treatment. The recommendations of the panel are published in the September issue of Wilderness & Environmental Medicine.

There are approximately 150 recognized anaphylactic deaths from food allergies or insect stings per year in the United States. For decades, established schools in outdoor education have been carrying epinephrine into the field to treat the rare but potentially life-threatening condition of anaphylaxis. Recently, the legality of this practice has been questioned. Is it legal for a physician to write a prescription for an organization rather than a specific individual? Moreover, is it legal for a non-medical professional with first-aid training to administer epinephrine, an injected medication, in a medical emergency? The law on these questions varies state by state.

WMS Epinephrine Roundtable participants, with expertise in multiple facets of wilderness medicine, issued the following position statement:

The field treatment of anaphylaxis with injected epinephrine can be a life-saving procedure. This is true especially when access to standard medical care will be delayed due to weather or geography. We therefore support the concept that properly trained, non-medical professionals, whose work responsibilities require them to provide emergency medical care, be trained to appropriately administer epinephrine for the treatment of anaphylaxis.

Furthermore, WMS advises organizations that choose this expanded scope of practice for non-medical staff to consult with legal counsel and encourages these organizations with responsibility for students at risk for anaphylaxis, for example children with asthma or food allergies, to require such students to carry personal epinephrine auto-injectors.

“In time, legislative change on the federal level should establish uniform protection in all 50 states,” according to consensus panel participants. “It may take parents who have lost a child to anaphylaxis because epinephrine was not available to push through changes in state and federal laws, as happened in the Canadian school system with Sabrina’s Law.”

These practice guidelines also feature recommendations for an organization’s operating procedures and staff training curriculum, sample protocols from three outdoor schools on the field use of epinephrine, and an edited transcript of the roundtable discussion.

The article is “Recommendations on the Use of Epinephrine in Outdoor Education and Wilderness Settings” by Flavio Gaudio, MD, Jay Lemery, MD, and David Johnson, MD. It appears in Wilderness & Environmental Medicine, Volume 21/Issue 3 (September 2010) published by Elsevier. As a service to the medical community the article is freely available at http://www.wemjournal.org/article/S1080-6032(10)00202-4/fulltext.

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Notes For Editors
Full text of the articles is openly available online at http://www.wemjournal.org/article/S1080-6032(10)00202-4/fulltext.

Journalists wishing to set up interviews should contact Jay Lemery, MD, President Elect, Wilderness Medical Society, Weill-Cornell Medical College, Tel: +1 917-861-0272 (office), lemery@med.cornell.edu.

The Epinephrine Roundtable took place on July 27, 2008 during the 25th Annual Meeting of the Wilderness Medical Society (WMS) in Snowmass, CO. Panelists were:

Flavio Gaudio, MD
Assistant Professor, Emergency Medicine, Weill Cornell Medical College, New York; Physician Advisor, Cornell Outdoor Education

David Johnson, MD
Emergency Physician, Maine; President, Wilderness Medical Associates (WMA)

Jay Lemery, MD
Secretary, Wilderness Medical Society; Assistant Professor, Emergency Medicine, Weill Cornell Medical College, New York

Frances Mock, JD
Attorney in recreation law, North Carolina

Tod Schimelpfenig, EMT
Curriculum Director, Wilderness Medicine Institute, National Outdoor Leadership School (NOLS), Wyoming

Joanne Vitanza, MD
Physician in Asthma, Allergy, and Immunology, Colorado

Carl Weil, EMT
Director, Wilderness Medicine Outfitters, Colorado

About Wilderness & Environmental Medicine (www.wemjournal.org)
Wilderness & Environmental Medicine (WEM), the official journal of the Wilderness Medical Society, is a peer-reviewed international journal for physicians practicing medicine in austere environments. It isdevoted to original scientific and technical contributions on the practice of medicine defined by isolation, extreme natural environments, and limited access to medical help and equipment. Sampling of topics covered: high altitude and climbing; hypothermia and cold-induced injuries; drowning and near-drowning; hazardous plants, reptiles, insects, and marine animals; animal attacks; search and rescue.

About The Wilderness Medical Society (www.wms.org)
Founded in 1983, the Wilderness Medical Society (WMS) is the world's leading organization devoted to wilderness medical challenges. Wilderness medicine topics include expedition and disaster medicine, dive medicine, search and rescue, altitude illness, cold- and heat-related illness, wilderness trauma, and wild animal attacks. WMS explores health risks and safety issues in extreme situations such as mountains, jungles, deserts, caves, marine environments, and space.

Society members have a long-standing commitment to education and research. WMS sponsors accredited continuing medical education conferences that combine exceptional educational presentations with a variety of hands-on workshops. The Society publishes a peer-reviewed medical journal, a quarterly newsletter, educational presentation series on wilderness medicine topics, and practice guidelines for wilderness emergency care. Each year the Society awards research grants, advancing academic careers and expanding the knowledge and understanding of wilderness medical issues. WMS also fosters Student Interest Groups (SIGs) on seventy-one medical school campuses.

About Elsevier
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