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The main questions we are asked with anaphylaxis are the rules for giving medications out of work or where a first aid responder or nurse is wondering if they can use the patients auto injector to give medication. 

The UK Resuscitation Council have covered both these points recently and also the HSE has given advice. The advice given was as follows:  If a first aid responder at work came across a person having an anaphylactic reaction, are they allowed to use their adrenaline auto-injector to give them adrenaline? The answer is that there is no legal problem in anyone administering adrenaline regardless if it is prescribed for a certain person or not. The important thing is to help someone as much one can in a life or death situation. 

This is possible through specific exemptions in the medicines act.  However, the first aid responder involved must be competent in being able to recognise the anaphylactic reaction and administer adrenaline using an auto-injector. First aid responders must ensure that they work within the guidelines of both their employer and the first aid training organisation that issued their qualification.

The Health & Safety Executive also provides guidance on their website; they issued a statement to clarify the use of auto injectors in the workplace. They stated that “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. 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 a life.

The use of an auto injector to treat anaphylactic shock falls into this category. Therefore, first aid responders may administer an auto injector 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 aid responder is trained to use it.”

When we look at what a nurse can do, the answer is slightly different. The question asked of the UK Resuscitation Council was if a nurse iworking in an acute hospital came across a person outside the hospital having an anaphylactic reaction, are they allowed to use their adrenaline auto-injector to give them IM adrenaline?

The answer by the UK Resuscitation Council was that there is no legal problem in any person administering adrenaline that is either prescribed for a specific person or in administering adrenaline to an unknown person in such a life saving situation (through specific exemptions in the medicines act). However the nurse involved must work within the Nursing & Midwifery Council (NMC) standards, and must therefore be competent in being able to recognise the anaphylactic reaction and administer adrenaline using an auto-injector.

Therefore, it would be sensible for trusts/employers to ensure that such a provision is included in their first aid or anaphylaxis guidelines. If in doubt, ask your manager now before it becomes an issue.