February 10, 2022
Please can you advise on a couple of questions that have arisen in the last few days:
Epinephrine for children
Whilst the dosage for children is listed, what would be the appropriate way to manage a call whereby only an adult dose was available, and the child was having a serious reaction? Would we treat this as “not prescribed for them” or do something different given that it would be known that the adult dose is higher than recommended?
Removing a helmet (motorcyclist)
I have had a lengthy concern regarding this so again I wonder if you can please point us in the direction of any further learning or advise if this should be flagged anywhere?
AOC Quality Assurance and Education Manager
East of England Ambulance Service
Hope all is good with you. Please can you assist with Donna’s email below.
UK & European Regional Manager
Lovely to hear from you.
Both of these questions have been considered by the Academy’s Council of Standards in the past, and the unanimous advice has been life-over-limb.
On the adult dose injector issue, you are exactly right. If a child is having an anaphylactic reaction and the available injector is not theirs, treat the case just as you would any other using the Medicine Not Prescribed for Patient panel of Protocol P. This will advise the EMD to hold off and look for the listed “clear symptoms of severe allergic reaction” and use the injector if any present, or if any doubt exists. The minimal risk of the higher dose pales in comparison to inaction in these cases.
Regarding helmet removal, treat as we do for all trauma cases in the DLS Links. If unconscious with effective breathing, use the BVDxT and monitor with the helmet on. If at any point breathing becomes ineffective, remove the helmet, open the airway, and start CPR if needed. Removing the helmet in this situation is really no different than opening the airway when it comes to risk of exacerbating a neck injury; the minimal risk involved is secondary to the necessary intervention.
Hope all is well.
Brett A. Patterson
Academics & Standards Associate Chair, Medical Council of Standards
International Academies of Emergency Dispatch®
Thank you, Brett,
This is really helpful.