Can EMT-Bs give 2nd dose from Twinject?

[NHBasic25]

This came up in training recently: Can EMT-Bs give the 2nd dose of epinephrine from a Twinject, which is a manual injection? The first dose from a Twinject is an auto-inject, like an Epi-pen, but the second dose involves disassembling the unit and using what's effectively a small preloaded syringe.

We've got statewide protocols, and the question has bounced all the way up to our state board. I was wondering how other systems have handled this.

[emt161]

Stock answer: it depends on YOUR local protocols. Nobody on an internet bulletin board is going to be able to answer that question for you.

Now, I've never seen these things before, but in my area I don't think it would be an issue. Especially since our Basics are allowed to draw up and administer their own Epi- no auto-injector necessary.

[NHBasic25]

[QUOTE=emt161;2259920]Stock answer: it depends on YOUR local protocols. Nobody on an internet bulletin board is going to be able to answer that question for you.

I know that. As I said, the question is being considered by our state protocol board. We don't have different local protocols. I was just curious how other systems handle it.

http://www.twinject.com/patients/twinject_training3.html

http://www.nh.gov/safety/divisions/fstems/ems/advlifesup/documents/NHEMSprotocolsV3.pdf

[mikie333]

Especially since our Basics are allowed to draw up and administer their own Epi- no auto-injector necessary.

Where are you from, if you don't mind my asking?

So they (basics) can take an empty syringe and draw the epinephrine, 1:1000(?) or is it different and then inject? I assume (but shocked already) it's IM?

But I'm not against ^

[redcrossemt]

Are you thinking about adding this to your ambulances, or is this an "assist-the-patient" kind of thing?

EMT-B's should be able to give the second dose of the Epinephrine Twinject if they are "assisting a patient" with the patient's own device. There are easy to follow instructions provided with the Twinject, and we expect lay people to be able to use it with very limited instruction. Approval of this should be via local protocols from your Medical Control Director/Authority.

Of note, many many more Epi-Pen kits are being dispensed nowadays than the Twinjects. If you are already using Epi-Pens on your basic units and considering replacing with the Twinjects, I would highly recommend just adding a second Epi-Pen. The training and protocols for it are already there.

[MedicInLA]

The basic crews for the company I work with are required by the state to carry Epi pens. They are just so easy and quick to use. Although to be perfectly honest our company would never allow a basic to use one since they don't even let them respond to emergencies...

[CamMedic]

Although to be perfectly honest our company would never allow a basic to use one since they don't even let them respond to emergencies...

Even if that basic truck is the only unit available to respond?

[emt161]

Where are you from, if you don't mind my asking?

So they (basics) can take an empty syringe and draw the epinephrine, 1:1000(?) or is it different and then inject? I assume (but shocked already) it's IM?

But I'm not against ^

I'm from the Northeast. ;)

Yes. Our EMT-Bs can take an empty needle/syringe and draw up Epi 1:1000 from an ampule or multi-dose vial and administer it. Actually according to the letter of the law it's supposed to be SC but I can't see anyone caring. If the patient is over 50 or has a cardiac history, they have to call in first (goes for all levels). (That one CAN get you in trouble, because I know somebody it happened to.)

With Med Control, they may also nebulize 5mg of 1:1000 for epiglotitis and inhalation burns.