D2.279 - In an emergency, can YOU really give that adrenaline pen? – the need for structured, further and improved training in Ireland

Anaphylaxis is an immediate, time-sensitive, life-threatening emergency. The first line treatment is intramuscular epinephrine, however Irish law only permits trained non-medical (and medical) persons to administer epinephrine on successful completion of an approved CFR and Adrenaline training course. The Irish pre-hospital regulator, PHECC3 authorise some training institutes to deliver this course. A cursory glance on internet search engines shows a plethora of entities offering “anaphylaxis training”. It appears these do not satisfy the law and in the event of a negative outcome event, civil and criminal medical negligence claims may follow.

Literature Review indicates a strict legal and training approach post SI No 449 of 2015 enacted by PHECC. Review of training and education standards identifies a singular approved legal training framework with 14 approved training institutes. Review of internet search engines identifies a number of unapproved agencies offered “anaphylaxis training” which is not in accordance with the requirements of the Statutory Instrument. The challenge of quantifying and qualifying the programmes both on-framework and off-framework (unapproved PHECC courses) is on-going and will be considered in detail on conclusion of this work.

A corollary legal issue will arise for off-framework courses which are being offered with respect to compliance with SI 449 of 2015 and with indemnities presently in being in the public.

The challenge of correlating data with respect to adrenaline auto-injector (“AAI”) prescriptions per geographic region, and further broken down into age cohort (0-18years) is awaited.

The challenge of observing trends between available allergists and AAI prescriptions (“AAIp”) is also expected to yield positive results and identify geographical regions where AAIp is high and low. This data is expected to assist in identifying geographical black spots where AAI may be identified but not covered my specialist oversight.

Results are expected to yield an improved roll out and consequent supervision of “CPR and Adrenaline” courses; Appropriate identification of non-approved courses; A clear data set of AAIp’s per region and further broken down by age (0-18years) and a clear understanding of AAIp levels to identify areas where there is an absence of consultant oversight and subsequent access to allergy clinics.

Having a clear understanding of AAIp levels per county/region will assist in understanding pressures in the health care system and may help to inform health providers of staffing and resourcing needs per region. Clear identification of non compliant course providers will be fundamentally important as CPR/Adrenaline courses are rolled out. Given that most AAI are used in a public setting (within the meaning of SI 449 of 2015), having a correct, uniform training programme will be vital in improving the changes of a successful outcome by identification, activation, administration of AAI and management of a patient.