Research Analysis: Check and Inject program is safe and cost effective

King County, Washington successfully introduced hand-drawn epinephrine to EMTs for severe allergic reactions and anaphylaxis


Inspired by the rising costs of epinephrine auto-injectors, King County Emergency Medical Services decided to implement a “Check and Inject” program in 2014. Recently published research in Prehospital Emergency Care has shown that this switch was not only safe for patients but saved the region at least $1 million over a three-year period. This research was also presented at the 2018 National Association of EMS Physicians Annual Meeting.

Starting in April 2014, 3,500 EMTs across King County were trained to administer intramuscular epinephrine from specially made kits. Training included an in-person practical session in which the EMTs demonstrated competence to an instructor.

Once the program was live, any use of the Check and Inject kits resulted in a special alert to the preexisting quality improvement team. Every case was then independently reviewed by two physicians for clinical appropriateness.

EMTs administered epinephrine 422 times from July 2014 to December 2016. Of those cases, 11 records were missing. Thus, 411 cases were included in the final analyses. The original protocols were followed 89.3 percent of the time. However, the physician review provided additional context.

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