Training Program Outline for EMT-B Personnel to Administer Atropine by Auto-Injector in Life-Threatening Situations

PURPOSE:

To provide basic life support personnel with the basic knowledge and skills to administer atropine by auto injector in a life-threatening situation. (For the purpose of this outline, "basic life support personnel" is defined as individuals who have certification as a NYS Emergency Medical Technician - Basic, (EMT-B) that allows them to assist patients with certain prescribed medications.)

INSTRUCTOR:

The Physician (Emergency Health Care Provider) or his/her designee should teach this program.

OBJECTIVES:

Upon completion of the training the participants will be able to demonstrate the following competencies:

  1. Identify common causes of nerve agent poisonings;
  2. Identify the signs and symptoms of a severe allergic reaction (anaphylaxis), and how they differ from other medical conditions;
  3. List the steps for administering atropine by an auto injector;
  4. Describe the methods for safely storing and handling atropine and appropriately disposing of the auto-injector after use;
  5. List the steps for providing for on-going care of the patient until turned over to definitive care;
  6. Understand the state regulations that allow an agency to possess and use an atropine auto-injector in a life threatening situation.

What are the signs and symptoms of nerve agent poisoning?

MILD SYMPTOMS of nerve agent or insecticide exposure include the following:

  • Blurred vision, miosis
  • Excessive unexplained teary eyes
  • Excessive unexplained runny nose
  • Increased salivation such as sudden unexplained excessive drooling
  • Chest tightness or difficulty breathing
  • Tremors throughout the body or muscular twitching
  • Nausea and/or vomiting
  • Unexplained wheezing or coughing
  • Acute onset of stomach cramps
  • Tachycardia or bradycardia

SEVERE SYMPTOMS of exposure to nerve agent or insecticides include the following:

  • Strange or confused behavior
  • Severe difficulty breathing or severe secretions from your lungs/airway
  • Severe muscular twitching and general weakness
  • Involuntary urination and defecation (feces)
  • Convulsions
  • Unconsciousness

Does the atropine come in more than one size or dose?

Yes, the atropine auto-injector comes in both an adult dose and a pediatric dose. However, agencies in this program will only be carrying and administering the adult dosage Atropen.

How do I administer the atropine with the auto-injector?

Sit the patient down and try to calm and reassure him/her. If the patient is confused, disoriented, or unconscious (altered mental state) and signs of a weak, rapid pulse, cool clammy skin (hypoperfusion), lay him/her down and slightly elevate his/her feet. If oxygen is available, administer a high concentration of oxygen. If the patient is having difficulty breathing, administer the atropine as follows:

Step One:

  • Remove the safety cap from the auto-injector. Check to see if the fluid is clear and colorless. Never put your fingers over the green tip when removing the yellow safety cap or after the safety cap has been removed!

Step Two:

  • Place the tip of the injector against the patient's bare outer thigh. (Halfway between their waist and the knee)

Step Three:

  • With a quick motion, push the auto-injector firmly against the thigh until the spring-loaded needle is activated. Hold the auto-injector in place for ten (10) seconds.

Step Four:

  • Remove the auto-injector from the thigh and record the time of the injection.

Step Five:

  • Carefully re-insert the unit (without replacing the safety cap) -NEEDLE FIRST- into the carrying tube and re-cap the carrying tube. Never put your fingers over the green tip after the yellow safety cap has been removed! Dispose of properly using blood borne pathogenic guidelines.

Step Six:

  • Watch the patient carefully, and keep them calm. Note if the patient gets any better or worse.

What will the patient feel when I use the auto-injector?

The injection itself is relatively painless and the patient may not feel the medication being injected. Soon after the injection the patient should begin to feel the beneficial effects of the drug. The most common changes the patient may feel are secretions drying up and easing of dyspnea.

What information do I need to give the ALS personnel or the receiving hospital?

If the atropine auto-injector is used, make sure the following information is accurately and concisely conveyed to the ALS Provider and/or physician:

  1. The substance (nerve agent) the patient was exposed to
  2. How long ago the exposure occurred
  3. The signs and symptoms the patient experienced (difficulty breathing, any secretions, any pinpoint pupils, etc.) before the atropine was administered
  4. The time and dose of the atropine administered
  5. Did you notice any change(s) in the patient after the atropine was administered
  6. Other specific information about the patient such as name, age, guardian, physician, medical history, etc.

Where should I keep the atropine auto injector?

You will need to keep the atropine auto-injector where you can have quick and easy access to it in an emergency. Keep it away from children. Keep it in the plastic carrying tube it comes in. It is important to remember that the atropine needs to be kept at room temperature. It should not be refrigerated, nor should you allow it to be exposed to extreme heat, such as the glove compartment of the ambulance during the summer. Do not expose the atropine auto-injector to direct sunlight; light and heat can cause atropine to degrade.

Does the Atropine Auto-Injector have an expiration date or need to be replaced?

As with any medication, the atropine auto-injector will have an expiration date, which is printed directly on the unit. It is important to periodically check the expiration date and replace the unit before it expires. When checking the expiration date also check to make sure the fluid is clear and colorless. Replace the unit if the fluid is discolored.

Can I be injured by the auto-injector unit?

The auto-injector unit is generally very safe and easy to use. It is important to remember that the unit does have a sharp needle in it. Do not remove the safety cap until you are ready to use the auto-injector. Never put your fingers over the green tip when removing the yellow safety cap or after the safety cap has been removed. Do not replace the safety cap once it has been removed. After use carefully re-insert the unit -NEEDLE FIRST - into the carrying tube, and then re-cap the carrying tube.

Who can use an atropine auto injector?

For many years physicians have prescribed the atropine auto-injector to patients with known nerve agent poisoning.

To be authorized to possess and use the atropine auto-injector an individual or organization (as noted above) must have a written collaborative agreement with a physician "emergency health care provider" which is filed with the local Regional Emergency Medical Services Council and the Department of Health. All participating individuals must complete this or an equivalent training program.

How is the atropine auto injector obtained?

The Atropine Auto-Injector will be distributed to the agencies throughout NYS with the approval of the regional medical directors. All agency personnel participating in the program must attend an approved atropine auto injector training program and documentation of such should be on file at the agency and the local REMSCO.

For more information:

Bureau of Emergency Medical Services:
New York State Department of Health
Bureau of Emergency Medical Services
433 River Street, Suite 303
Troy, New York 12180
(518) 402-0996