When did publicly available epinephrine become available?
We were able to place publicly available epinephrine in 28 sites during a pilot project in the community of Sussex, New Brunswick in 2014 and with the overwhelming response and requests for help and assistance we initiated our small business in hopes that we could grow this idea everywhere. In fact, since we began 4 lives have been saved. We believe this was the first project of its kind in the world.
Why is publicly available epinephrine important?
Anaphylaxis is the most serious type of allergic reaction. It is life-threatening, severe, happens quickly and requires immediate attention. A severe allergic reaction can develop in minutes to hours. Many people with severe allergies do not carry their own epinephrine as they forget it at home or maybe never fill their prescription. There are also many people who do not know they have an allergy. People can die before an ambulance ever arrives. Having publicly available epinephrine centrally located and highly visible is essential during a severe allergic reaction. It also provides the opportunity for an entire community to be educated regarding response to severe allergic reactions. This is analogous to having Automated External Defibrillators (AED’s) in public places.
What types of sites would have publicly available epinephrine?
To date we have over 20 communities that have started to embrace our concept and there are over 160 sites in NB and NS that have installed our alarmed cabinets containing the epinephrine auto injectors (EAI).
Publicly available epinephrine has been placed in several venues such as schools, restaurants, churches, hotels, sports/recreation facilities (rinks, curling clubs, golf courses, ski hills, near ball fields, YMCA’s), daycare centres, funeral homes, dental offices, medical clinics, community centres, correctional/jail services.
It is appropriate to have wherever there is food, medications, insects that can sting and where exercise occurs.
What are the cabinets made of?
The cabinets are made of a highly durable polycarbonate material and are lightweight for easy attachment to any wall. They are brightly coloured to stand out with a clear window to view the epinephrine auto injectors and they are alarmed to raise attention to the emergency.
Where are the cabinets manufactured?
The cabinets are manufactured in New Brunswick, Canada and will hold up to 4 EpiPens.
What is currently the cost of the cabinet?
Cost of the cabinets are $225, but for large volumes our manufacturer will offer discounts that we will pass along. To defray cost some communities have partnered with a corporate sponsor and if that is possible we can place their logo on the cabinet in acknowledgement of their support.
Are the epinephrine auto-injectors included with the cabinet?
No. Epinephrine auto-injectors (EAI’s) are available separately from any local pharmacy behind the counter. The cost varies between pharmacies. They can be included with the cabinet for “at company cost”
What brands of epinephrine auto-injectors are available?
Currently in Canada there is only one brand of EAI available – EpiPen. In the United States there is EpiPen, Allerject.
What are the laws regarding administration of Publicly Available Epinephrine?
Publicly available epinephrine is protected under the Good Samaritan Law. Is it more a question of what will happen if you do not provide the treatment for anaphylaxis. Epinephrine Auto-Injectors are available behind the counter at any pharmacy across Canada. Any person who has been educated and trained can give themselves or another person an epinephrine auto-injector.
In the United States, the laws vary from state to state regarding the purchase of an EAI’s.
There are multiple states that have passed legislation permitting, but not requiring various public venues (entities), to stock undesignated epinephrine for use in cases of anaphylaxis response.
The definition of venues (entities) does vary from state to state and may include recreation facilities, restaurants, daycare centres, theme parks, day camps and college campuses.
A small number of states have passed laws specific to colleges and universities that allow, but do not require, post-secondary education venues to stock undesignated epinephrine.
These laws may provide exemption from civil liability and outline specific requirements for educating and training personnel, as well as how to obtain, maintain, store and administer epinephrine. The following is an outline of the current situation for each state.
A document outlining the current states with specific laws for each state can be found on the Food Allergy Research and Education (FARE) website.
The following website provides very specific stories about deaths in relation to anaphylaxis.
Any litigations in the US are because epinephrine was NOT administered.
Is it safe to administer epinephrine if I am not a professional?
It is safe to administer an epinephrine auto-injector. It has become mainstream first-aid to have epinephrine available in public places. If a person is dying from anaphylaxis it is better to give epinephrine that the consequences a severe allergic reaction. A person who has received an epinephrine auto-injector should always be sent to the hospital and stay near a hospital for 48-72 hours. You can assist the person in trouble and save a life.
Typically, how are epinephrine auto-injectors acquired to stock the alarmed cabinet since they are not prescribed to a particular person?
Epinephrine auto-injectors are available behind the counter at any pharmacy in Canada. In the United States and other countries the laws vary. The reason that a person requires a prescription in Canada is for it to be covered by their health insurance plan. We have some schools where the parents or businesses purchase the epinephrine auto-injectors and/or the alarmed cabinet as a donation. If there is a pharmacist associated with the school, that is always helpful and some pharmacies have donated to communities, schools or organizations. Many Parent committees or home and school associations have also contributed schools. Local foundations have provided grants within communities as well.
Since you are in Eastern Canada and will not be able to physically visit a site or location wanting to have publicly available epinephrine, how do you decide where the alarmed cabinet (s) should be located?
The cabinet should be located in an easily accessible, centrally located area of the site. Many have chosen to place them next to the AED if there is one on site. In schools, they can be placed close to administration office/cafeteria/gym. Some schools have purchased up to 3 cabinets depending on the size of the school. We are happy to consult with any site and discuss options. What we do know is that they should NOT be placed in a locked area.
If school staff already receive education/training regarding administration of epinephrine auto-injectors is there additional education/training regarding the use of the alarmed cabinet?
The cabinet is very easy to use. You just pull off the front and it automatically alarms. Then you take the front to the person in trouble. The epinephrine auto-injectors are encased behind the front cover of the cabinet. Installation instructions and battery replacement type come with the cabinet. Teleconferencing or videoconferencing are also available if a site is interested.
Do the sites with these alarmed cabinets typically have information alerting and stating the presence and location of the alarmed cabinets? I have seen these when sites have AED’s.
There is a cling sticker that will come with the cabinet that says EpiPen on site. It can be placed on the entrance (s)of the site that has the alarmed cabinets and EAI’s.
Is there typically information also posted with the cabinets on recognizing symptoms of anaphylaxis?
There are instruction posters available and can be included with the cabinet as well as a small square card that inserts in the cabinet easily. Some areas have chosen to Velcro the poster beside the cabinet.