Pre-hospital Provider Performance in an Anaphylaxis Simulation

Pre-hospital providers have low rates of recognition of atypical anaphylaxis and use of epinephrine as first-line therapy. Retrospective studies reveal that many qualifying cases do not receive epinephrine in the field. This study used a simulation session (SIMS) to evaluate current practice and provide education. Each SIMS was overseen by a physician and a simulation coordinator at Columbus Division of Fire stations. SIMS were offered to providers over a two-day period. Crews of two to four providers came out of active service for 30 minutes to participate. SIMS reflected a call involving a child with known food allergy who was having anaphylaxis without cutaneous symptoms (atypical). The endpoint for the simulation was Epinephrine administration. Epinephrine auto-injector (EAI) demonstration was part of the debriefing. 507 EMS providers participated in 68 SIMS. An impression of anaphylaxis was stated in 30.9% of SIMS. Epinephrine was given as the first therapy in 66.2% of SIMS. In 85.3% of SIMS, epinephrine was administered in the lateral thigh. Home EAI was used in 79.4% of SIMS. In those that did not use EAI, errors were noted in 27% of epinephrine doses. 39.7% did not perform a medication double-check. Administration technique errors were noted in 41.2% of SIMS, including those using EAIs. One-third did not treat anaphylaxis with epinephrine as first-line therapy. A majority administered the epinephrine in the correct location, but errors were noted in administration technique for both EAI and drawn up epinephrine. Dosing errors were common in those who did not use EAIs.