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Is draw-up epinephrine the new norm for EMTs, EMRs?

Let us know what your EMS agency is doing to combat the EpiPen price hike


The King County EMS epinephrine injection kit.

Photo by Greg Friese

By EMS1 Staff

A steep increase in the price of EpiPens has EMS agencies around the country searching for less expensive alternatives to treat anaphylaxis, a life-threatening allergic reaction.

States such as Illinois, Ohio, New York and South Carolina have begun phasing out EpiPens and are now allowing EMTs and emergency medical responders to give epi by drawing up the medication from an ampoule or vial.

We were curious to see which other states allow EMTs and EMRs to administer an alternative form of epinephrine. Our Facebook fans did not disappoint. Here are a handful of states that allow and do not allow EMTs and EMRs to draw up epi.

And if you haven’t already, let us know what your EMS agency is doing to combat the EpiPen price hike.

  • “California just allowed ‘off duty’ EMTs to carry and administer first aid EPI (auto injector pens); i.e. Not while on duty. Ironically, the price increase took effect right after this law. Still many CA jurisdictions only allow you to ‘assist’ with a patient’s EpiPen prescription. Some counties, such as El Dorado with remote wilderness areas, have a determination based on time to an ALS intercept. BLS providers typically don’t have the amp on hand. Then you are faced with the same training errors medics make with 1:1000 vs 1:10,000 Epi ampules.” Daniele Antonio
  • “Wisconsin EMT and above has had this skill granted for a number of years now. This spring it was granted to EMR level. Nothing new at all here. The price issue was something that came up in EMS services a long time ago. $150 vs. about $10 or less.” Scott Ziegler
  • “We are an ALS state so all 911 trucks use amps and draw up epi. It a moot issue here. EMRs are usually volunteer fire and cannot draw up epi and can only assist the patient with their own personal pen.” Cameron Hickey
  • “Not in Nebraska yet. We have some of the most advanced hospitals in the world but state senators really limit our EMS system.” Jeremy Theilen
  • “All draw in Ontario. Trucks keep at least 5mg onboard in 5 x 1mL amps (at least this service). Our protocols still have pens in them, but as far as I know no one stocks them anymore.” — Matthieu St-Jean
  • “Yes, upstate New York does allow Basic EMTs to draw it up and give it. We have been doing that for almost a year now. It’s much better and so much cheaper as well.” Steve Weygand
  • “In Pennsylvania, we cannot have a glucometer on our BLS truck so I do not imagine they would let us draw from a vial.” Joseph Griffin
  • “In Oregon, basics can administer epi via vial and administer Albuterol via neb.” Justin Reisner
  • “Colorado protocol states EMTs can draw up Epi. EMRs cannot draw up epi and must be given direction by an EMT or above to administer an EpiPen.” Chris Mallery
  • “It’s standard practice in the UK. I’m not aware of any of the ambulance services here that carry EpiPens.” Neal Parkes
  • “Basics are only allowed to assist with EpiPens in Indiana and with online medical direction.” Chuck Sebring
  • “Yes, New York. A trial program called ‘check and inject’ for EMT level.” Brandon McCaughey
  • “Idaho, yes with an optional module for EMTs and advanced EMTs! We only carry vials now on our intermediate life support agency.” Zach Peterson
  • “It’s been in the EMT protocol for a while in Kentucky. I don’t think EMRs have it yet though.” Robert Osborne
  • “Iowa does not allow basic EMTs to draw up epinephrine from a vial, but I sure wish they would pass the measure that would let them. We are a volunteer service that counts on donations from the community and we spend too much on EpiPens when that money could go for other things like putting someone through an EMT class.” Jayne Harman Hintz
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