September 28, 2001
EPINEPHRINE USE AT CAMPS
By: John Kasprak, Senior Attorney
You asked if any states allow camp staff to use epinephrine auto-injector devices (“epi-pens”) when the individual receiving it does not have a prior diagnosis.
New York passed legislation in 1999 that allows camps as well as other “eligible organizations,” to administer epi-pens in emergency situations under written collaborative agreements with health care providers. The person actually administering the epi-pen must successfully complete a training course approved by the New York state health department. Administration of the epi-pen under such circumstances would fall under the state's “good Samaritan” law, exempting the provider of this emergency first aid from most liability.
An “epi-pen” is a preloaded syringe of adrenalin or epinephrine in either an adult or pediatric dose. Some individuals have severe allergies to insect stings or certain foods or drugs. For them, the allergic reaction is sudden and severe, and may cause difficulty in breathing and a drop in blood pressure (“anaphylactic shock”). An anaphylactic shock reaction is a medical emergency necessitating prompt care. Physicians suggest that a person carry an epinephrine syringe (epi-pen) if he previously has had a severe allergic reaction so that a shot can be self-administered to decrease the severity of the reaction.
It is estimated that 1-2% of the general population is at risk for anaphylaxis from food allergies and insect stings, with a lower reported prevalence for drugs and latex. Asthmatic subjects are at particular risk. The American Academy of Allergy, Asthma, and Immunology (AAAI) reports that “data clearly show that fatalities more often occur away from home and are associated with either not using epinephrine or a delay in the use of epinephrine treatment” (AAAI position statement 34).
NEW YORK LAW
In 1999, New York state passed a law (Chapter 578) that permits the use of epi-pens by personnel trained in their use who have a collaborative agreement with a physician or a hospital. It adds emergency health care providers with collaborative agreements to the existing “good Samaritan” protection under New York's Public Health Law. The new law also establishes a procedure allowing EMTs, camp employees, and other persons designated by the health commissioner to possess and use an epi-pen after completing appropriate training and having a collaborative agreement with a physician or hospital. As defined in the law, “camp” means a children's overnight camp, a summer day camp, or a traveling summer day camp. The collaborative agreement must be written and include practice protocols, and policies and procedures ensuring compliance with the law. The agreement must be filed with the state health department. (A copy of the law is attached. (New York Public Health Law, § 3000-c).
A New York Senate memorandum in support of the law states:
For persons experiencing severe allergic reaction, the availability of a epi-pen is matter of life and death. While persons with known allergies often carry such devices, sometimes they do not and in rare instances persons with unknown allergies have severe reaction. This legislation would help make these devices available in settings such as summer camps and schools, while maintaining appropriate medical oversight and patient protections.