Retrieval of Additional Epinephrine From Auto-Injectors

EpiPens contain more that a single dose of medicine.  

I want to scream this from the mountains. This is a headline I want to get into the minds of as many people that travel outdoors in groups or know someone that needs to carry an EpiPen.  It might save a life.

I came across the idea that a single use Epinephrine Auto-Injector, or EpiPen, actually contained more than one dose in Seth C. Hawkins book entitled Vertical Aid.  Vertical Aid is an outstanding Wilderness First Aid (WFA) book with a focus on rock climbing and mountaineering.  I highly recommend it for anyone interested in WFA.

Tools used to remove the carpule, the carpule itself after removal, and the opened auto-injector shell of a post-2010 EpiPen. Photograph courtesy F. Baty.

In the book, Hawkins cites an article he wrote for the Wilderness & Environmental Medicine Journal entitled Retrieval of Additional Epinephrine From Auto-Injectors   In the article, he states “for wilderness applications, a single dose of epinephrine is frequently not enough to manage even a single episode of anaphylaxis, as many episodes are biphasic or protracted.” Furthermore, access to multiple injectors is often unfeasible in the wilderness setting because of cost, size, or lack of preplanning. EpiPens are typically sold in 2-packs to address the frequency of biphasic or protracted patterns of anaphylaxis, however, they are separated for convenience or storage in multiple locations.

As a Whitewater Raft Guide, I am often required to carry EpiPens for our guests. I can attest that I am typically only given one EpiPen. If someone were to go into anaphylaxis and one does was not enough to stop the episode, we may not have enough time to get the victim out of the gorge to additional doses.  

What if you were on a 5-day backpacking trip and you needed to use your only EpiPen on day 2 and needed it again on day 4?

Armed with the information from Hawkins, we can use that single EpiPen to administer multiple doses. Each EpiPen contains up to 4 additional doses.
Hawkins’ article goes over several methods for accessing the additional Epinephrine. I highly recommend reading through the whole article and watching the supplemental videos.  The Roane State method is found on YouTube.

Being familiar with these methods could save a life.

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