To the Editor-in-Chief:
Karatzanis et al.1 propose the storage of epinephrine in restaurants, bars, and beaches, and its administration by trained lifeguards in Crete, Greece. Epinephrine is life saving in the management of anaphylaxis,2 and we would not want to delay its administration; however, the following should be considered:
- 1Many conditions can mimic anaphylaxis, and may occur on the beach. Making the correct diagnosis is essential as epinephrine, even intramuscular, given outside the context of life-threatening anaphylaxis is not appropriate and not without risk.2
- 2Even among medical doctors, confusion arises regarding the dose and route of administration of epinephrine for anaphylaxis.3
- 3The auto-injector has a shelf-life of approximately 20 months, and should be stored at a temperature of 25°C , not be refrigerated and must be protected from light.4 The cost effectiveness of storing epinephrine at these locations could be debated.
In our opinion, from the UK perspective, training lifeguards on a 2-month course to correctly recognize life-threatening anaphylaxis, administer the epinephrine, and be able to manage complications associated with its use is not appropriate. Immediate attention from trained medical/paramedical personnel with appropriate equipment and monitoring should be sought. Lifeguards could be trained to assist patients who carry an auto-injector, who have been trained in its use, and have a documented history of anaphylactic reactions.
Ricardo J. José * and Huw S. Jenkins ‡