Can First Aiders administer an adrenaline auto-injector (epipenŽ) to a casualty in anaphylaxis?

Essentially, as long as they have been appropriately trained, First Aiders can and should administer a casualty's adrenalin if they are displaying signs of an allergic reaction.

The Medicines Law in the UK means that a lay person cannot administer any prescription medication or encourage someone to take another persons prescribed medication. The exception to this is using adrenalin via auto-injection for the purpose of saving a life in an emergency.

Read what the HSE and the Resuscitation Council (UK) say on the subject:

[Ref: http://www.resus.org.uk/pages/faqana.htm Questions 8]
I am a first aider at work. If I come across a person having an anaphylactic reaction, am I allowed to use their adrenaline auto-injector to give them IM adrenaline?  

Answer: There is no legal problem in any person administering adrenaline that is either prescribed for a specific person or administering adrenaline to an unknown person in such a life saving situation (through specific exemptions in the medicines act). However the first aider involved must be competent in being able to recognise the anaphylactic reaction and administer adrenaline using an auto-injector. First aiders must ensure that they work within the guidelines of the first aid training organisation that issued their qualification and their employer.

The Health & Safety Executive also provides guidance on its website www.hse.gov.uk/firstaid/faqs.htm As at 25 January 2008 this stated: “Medicines legislation restricts the administration of injectable medicines. Unless self administered, they may only be administered by or in accordance with the instructions of a doctor (e.g., by a nurse). However, in the case of adrenaline there is an exemption to this restriction which means in an emergency, a suitably trained lay person is permitted to administer it by injection for the purpose of saving life. The use of an Epipen to treat anaphylactic shock falls into this category. Therefore, first aiders may administer an Epipen if they are dealing with a life threatening emergency in a casualty who has been prescribed and is in possession of an Epipen and where the first aider is trained to use it.”

So who can train a lay person to administer an adrenalin auto-injector?

All React First trainers are skilled in the delivery of anaphylaxis training. Our Anaphylaxis Awareness course covers all of the below requirements from the Resuscitation Council (UK).

The React First Anaphylaxis and Adrenalin Auto-injector (epipen) training course covers:

  • recognition and treatment of severe allergic reactions
  • communication and casualty care
  • dealing with an unconscious casualty
  • different types of auto-injector –  EpiPen®, Anapen®, Jext® pen
  • correct use of an adrenalin auto-injector
  • CPR resuscitation – adult and child

This training is part of our First Aid for Schools course. It can also be delivered as a standalone course which lasts 3 hours or, with additional time it can be added to any other first aid course.

The Resuscitation Council (UK) gives the following information on anaphylaxis training courses:

"Individuals who require training to use an auto-injector include those who have to carry an auto-injector for self-use and those who may have to treat a person with anaphylaxis using an auto-injector, e.g., parents, carers and teachers.

There is no statutory legal requirement in the UK deeming who is suitably trained to train others. However any trainer has an obligation under common law to ensure they are competent to train others. The Resuscitation Council (UK) recommends that those who train others in treating anaphylaxis and the use of adrenaline auto-injectors should be appropriately qualified.

Trainers should be skilled in teaching others, and be able to demonstrate competency in teaching others how to recognise and treat anaphylaxis including the use of an adrenaline auto-injector. The following groups are suggested as trainers: doctors, nurses, resuscitation officers, registered paramedics, statutory ambulance service trainers, voluntary aid society and voluntary rescue organisation trainers, and other individuals such as accredited first aid trainers. This list is not exhaustive.

Whilst there is no prescriptive course programme, training for trainers should be based on current Resuscitation Council (UK) recommendations. Trainers should also be familiar with the current legislation which applies to their client group.
All those who prescribe adrenaline auto-injectors must ensure that individuals who carry an auto-injector receive training in its use. There is more than one available brand of auto-injector so training will need to be tailored accordingly.

Adrenaline auto-injectors are not intuitive and everyone who attends training needs to be shown how to use the device and also be given an opportunity to practise using a training device. Anaphylaxis training should also include avoidance of allergens, the early recognition of symptoms and crisis management which would include when to administer emergency treatment, and how to care for the patient whilst waiting for emergency services to arrive."

[Source: Question 21 of Frequently asked questions on "Emergency treatment of anaphylactic reactions Guidelines for healthcare providers" Resuscitation Council (UK).] Click here to see the original of this document.

What is an adrenalin auto-injector?

Once someone has suffered from a server allergic reaction once then they are commonly prescribed an adrenalin auto-injector pen to carry with them should the same thing happen again.  People often refer to these injectors generically as "Epipens®", however Epipen® is a brand of injector and there are two other common brands in use in the UK; Anapen® and Jext®.

Learn the differences between each of these devices by reading our article on How to use an adrenalin auto-injector.