EMTs and Epinephrine

One of FARE’s ongoing initiatives is to help ensure that all ambulances are equipped with epinephrine and that all levels of emergency medical technicians (EMTs, or 911 personnel) are fully authorized to administer the medication during an anaphylactic emergency. Although we’ve made considerable progress since the late 1990s, there is still much work to be done.

States generally have three types of EMTs: Basics, Intermediates and Paramedics. Basics are usually the most numerous, yet their scope of practice is more limited than that of an Intermediate or Paramedic.

Depending on where you live, EMT-Basics may not have access to epinephrine and/or may not be able to administer the medication in the field. Instead, Basics may be allowed only to “assist” in administering a person’s own prescribed epinephrine device.

Such a policy overlooks the possibility that an individual’s prescribed epinephrine may be unavailable at the time of a reaction. In such a situation, EMT-Basics responding to an anaphylactic emergency would be forced to transport the individual to the nearest hospital or call for EMT-Paramedic or EMT-Intermediate backup. Either scenario delays treatment and could result in tragedy.

To complicate the matter is the possibility that only certain ambulances may be required to have epinephrine on board. In most states, there are two types of ambulances: Advanced Life Support (ALS) and Basic Life Support (BLS). ALS vehicles are generally staffed by Paramedics and equipped with epinephrine in ampoule/syringe form and/or auto-injectors. Whether or not BLS vehicles are equipped with epinephrine is often left to the discretion of local Medical Directors and/or local EMS entities. 

FARE encourages people to visit their local ambulance provider and learn about the EMT/epinephrine coverage in your area. Good questions to ask include:

  1. What types of EMTs respond to a 911 call?
  2. What types of EMTs can administer epinephrine, and in what form?
  3. Are all ambulances equipped with epinephrine, and in what form?

View a webinar recording about issues of epinephrine availability and administration by EMS providers