As of April 1, emergency medical technicians in South Central Wyoming Emergency Medical Services may have one less tool in their lifesaving toolkit. The epinephrine auto-injectors, or EpiPens, used by EMT’s to treat potentially fatal allergic reactions are set to expire, and new supplies have yet to be secured.
Epinephrine is one of the only medications that can stop rapid swelling that accompanies severe cases of anaphylactic shock. Though rare, this swelling is dangerous because it can close a patient’s airway, choking them to death.
As critical as they can be in an emergency, in the words of ambulance director Heidi Sifford, “EpiPens are outrageous.” She recently returned a shipment of the auto-injectors when she learned that they had cost $680 a piece — $120 more per unit than had been expected. They also have a shelf life of only one year.
Restocking would have cost “a quarter of our budget for supplies,” Sifford said. With limited resources, it was an expenditure the director just couldn’t justify.
Epinephrine is orders of magnitude cheaper when purchased in bulk and loaded by a doctor into syringes for future use (as opposed to when purchased in the pre-loaded auto-injectors). State regulations stand in the way of these savings. “A lot of states allow EMT basics to use [much cheaper] pre-filled syringes, but Wyoming doesn’t,” Sifford said.
There are three different ranks of EMTs — “basic,” “intermediate” and “advanced.” Each requires a different level of training, and only the most highly skilled “advanced EMTs,” or paramedics, are allowed to administer the drug with pre-filled syringes.
These seasoned paramedics are in short supply. Although there are about 10 basics and 15 intermediates in SCWEMS, there is only one full paramedic, by Sifford’s estimate. He is likely to allow his license to lapse back to the intermediate level soon.
In Sifford’s words, “the state has my hands tied behind my back.” Purchasing EpiPens is a huge financial burden, but Sifford isn’t allowed to procure a cheaper alternative because of restrictions on her personnel.
This news was upsetting to many of the first-responders at the meeting. “Not only is it frustrating — it’s frightening,” said Kelly Ralston, a basic EMT who represents Riverside on SCWEMS’ Joint Powers Board.
The EpiPens “are terrifyingly expensive,” Ralston allowed. To prepare for the possibility of their absence, Ralston said “our ambulance director [Sifford] is really focusing on figuring out how to train us to deliver ALS [Advanced Life-Saving] without them.”
Paul Hayes, a basic EMT from Elk Mountain, seemed skeptical of this strategy when Sifford put it forth at the SCWEMS meeting.
“You can’t train to manage [anaphylactic shock] as a basic, because there is no managing it as a basic,” Hayes told the room. “You just drive really fast, because when their throat swells shut…” Hayes was cut off before he could finish his thought.
Operating without EpiPens would be nothing new for most of the EMTs in Carbon County. “Up until two years ago, we never ran with EpiPens,” Sifford said.
There’s no doubt, though, that losing them would represent a step backwards for the region’s emergency medical services. “There are a lot of solutions, but they all cost money,” Ralston said of the situation.
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