EpiPens are used in severe cases of anaphylaxis. So what is anaphylaxis? Merriam-Websters Dictionary defines anaphylaxis as “hypersensitivity (as to foreign proteins or drugs) resulting from sensitization following prior contact with the causative agent”. All that really means is it is a severe allergic reaction. These allergic reactions can range from moderate to life threatening and are typically the latter. Many people have pollen allergies. That type of allergy or other seasonal allergy typically doesn’t present as anaphylaxis but rather an allergic reaction. Things such as itchy, watery eyes and runny nose are not symptoms of anaphylaxis, but rather a mild allergic reaction. Most people handle these with a simple antihistamine such as Claritin. Other symptoms of more serious reactions include difficulty breathing and swelling of the airway. You need to be aware of the medical conditions people in your group have, especially allergies. Also, know how to use an EpiPen of a group member has one. It’s super easy, the instructions are written right on the pen. Make sure you have the 5 rights and if the patient can, have them administer it themselves or help them administer it themselves. There is a blue cap on every pen. This is like a gun safety, once you take it off, it’s live. The medication does not come out this end, it comes out the orange tipped end, just like bullets don’t come flying out of a gun saftey, the medication doesn’t come out of the EpiPen safety. Always, always, always grab the pen with a fist. NEVER place your thumb on either end. EpiPens are designed to be administered intramuscularly, typically the thigh. Check the injection site to make sure there is nothing in the patients pocket. Press the orange tip into the patients leg and hold for ten seconds after you hear a click. Then release, the needle automatically retracts, and massage the injection site for 10 seconds to disperse the epinephrine. Epinephrine only works for about 15 minutes so as soon as possible you need to get an antihistamine, such as Benedryl on board. If needed after the first does of epi wears off administer a second dose. EpiPens are prescribed in pairs and should be carried in pairs. Evacuate this patient if you are in a backcountry setting. In the urban world start an EMS response.

Adam Froehlich, VP Wilderness Medicine