The use of EpiPens® by First Aiders

Can a first aider can administer adrenaline to a casualty who is experiencing an anaphylactic reaction?

Essentially, yes.   But it is important to know why because the laws that exist to allow people to administer adrenaline (typically using an EpiPen® or Anapen®) are specific to adrenaline and do not translate to other drugs or other medical problems.

Throughout this article, the term 'epi-pen' is used colloquially to refer to any prescribed, automated injection pen of Adrenaline for the treatment of Anaphylaxis.  Other brand devices are available.

Regulations

Laws on medicines are very strict:  No one should administer any prescription medication or encourage someone to take another persons medication: 

Section 58(2)(b) of the Medicines Act 1968 specifies that, for Prescription Only Medicines (POMs) no person shall administer (otherwise to himself) any such medicinal product unless he is an appropriate practitioner, or a person acting in accordance with the directions of an appropriate practitioner. (An appropriate practitioner is a doctor, a dentist, a supplementary prescriber and, within the terms of the legislation covering their prescribing, independent nurse practitioners).

In the case of Adrenalin by 'auto-injection', Article 7 of the Prescription Only Medicines (Human Use) Order 1997 provides an exemption to the requirements of Section 58(2)(b), to enable the parenteral administration (i.e. in a manner other than through the digestive system) of specified medicines where the administration is for the purpose of saving life in an emergency.  

Because of the seriousness of the situation, a casualty who has become exposed to an allergen and is displaying signs of reaction a lay-person  can and should administer a casualty's adrenaline if the casualty has it with them.

This situation is accepted and reinforced by the Health & Safety Executive in their statement here and by the United Kingdom Resuscitation Council's statement here.

Furthermore, clarification from the Medicines and Healthcare Products Regulatory Authority reveals that the a lay-person can indeed administer Adrenalin by auto-injection regardless of whether the casualty is prescribed it or not.  In other words, if a casualty is experiencing an anaphylactic reaction, any person can administer adrenaline if it is available.

Does the same apply to Asthma Inhalers or GTN spray?

No.  Whilst these, and other drugs, are also included in Article 7, the permission of a lay person to administer Adrenaline to a casualty in the interest of saving life is only extended to Adrenaline.

Using an Auto-Injector pen

Should I carry an EpiPen® just in case?

No.  Article 7, gives permission for a lay-person to administer Adrenaline for the purpose of saving life if it is available.  To carry Adrenaline around with you, with the intention of treating a casualty you may encounter is effectively prescribing the drug, which is illegal.

The use of auto-injector pens is covered on all of our first aid courses. The Practice Nurse at your GP’s surgery will also be able to train you in the use of these pens.

As with all common medical conditions (such as asthma, epilepsy and diabetes etc.) the experts are those who live with the conditions; get to know the people you work with and ask them what they would do and how they manage their condition.  Work with them to develop a simple procedure should an emergency occur.