State Bill Would Allow Schools to Stock Vials of Epinephrine to be Administered by Syringe


HB 1608, a bill introduced Thursday by Washington State Rep Dan Bronoske (D-Lakewood) is intended to increase access to epinephrine in schools and reduce costs.

Epinephrine is the only drug that can halt and reverse the progression of anaphylaxis, a life-threatening allergic reaction to a food, drug, insect venom, or environmental substance.

The drug is most often administered via auto-injector, a hand-held device that automatically inserts a needle and injects a premeasured dose when jabbed into the outer thigh. But the drug can also be administered via a syringe by trained medical professionals.

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Said Bronoskie:

The idea for this bill came from a call that I went on in my other job as a firefighter. We were called to a local high school to monitor a student who was stung by a bee and may have had a severe allergic reaction. We were required on the scene because the school did not have an auto-injector available as they are cost-prohibitive to always have on stock. With the skyrocketing costs of auto-injectors, it is time that we allow registered nurses to administer epinephrine from a vial. This will deliver considerable cost savings to schools and ensure that school nurses can save the life of a student with a severe allergic reaction.

Washington schools are currently allowed to have stock epinephrine auto-injectors on hand for anaphylactic emergencies. Still, the devices are expensive costing up to $700 per two-pack and expire within a year. A vial of epinephrine costs $20-$30 with a similar time to expiration.

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Said Bronoskie:

When someone needs an auto-injector, calling emergency services might not be quick enough. Schools need to have epinephrine readily available to protect their students, but high prices for auto-injectors combined with tight budgets have prevented some schools from keeping it on hand. This commonsense measure will allow a registered nurse to dispense epinephrine from a vial, saving schools hundreds, possibly thousands of dollars and ensuring that students have quick access in an emergency. This is especially important in rural areas where emergency services can take longer to arrive.

We at see this legislation as an important but suboptimal solution.

We would prefer stock epinephrine auto-injectors be made available at every school together with training on how to recognize the symptoms of anaphylaxis and administer the devices. Such training is relatively simple as there are few steps to using an auto-injector.

If vials and syringes are introduced, more schools may be able to keep epinephrine on hand but fewer individuals on staff would be permitted to administer the drug due to the added complexity of preparing a syringe for use. School nurses are in short supply and are not available all day at every school.

What do you think? Let us know in the comments section below.

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  1. Do not support. Here is why. If a School District cannot afford a full time nurse (with back up staff when nurse is out of building) then this is not a viable solution. It is time to stop putting minimal measures in place for students with life threatening food allergies. It is time to develop across the board FEDERALLY funded protocols for Public School Districts to follow. 1. Epi pens will follow the child – either self carried or with trained staff. 2. NO epi pens will be locked up. The excuse they could be used as a “weapon” is ridiculous. Scissors can be used as a weapon and you’ll find pairs of them all over school buildings. 3. ALL staff, regardless of their position in the building, will be trained on how to administer. (IF a teacher/other staff opts out of training, which they can do in some states, a designated trained staff in close proximity to the classroom that does not have trained staff will be assigned to cover that classroom. This is not Rocket Science. These are life saving measures. NO child should ever be without access to their life saving medication. Ever!!!

  2. It should be federally mandated that every school building have an Epi-Pen. Some schools have separate buildings and each building should be equipped. Epi-Pens should also follow each child. The auto injector remains the easiest, quickest and most efficient way of addressing an allergy. It is challenging enough getting everyone on board and trained with an Epi-Pen. I would like schools and individuals to have the right to carry vials and syringes as a back up. In some ways a syringe and vial is easier than the auto injector.

  3. I am a registered nurse who also has food allergies. I autoinjector epi in the event that I would be unable to draw up and inject myself.
    That being said, why not stock both vial/syringe and autoinjectors. If a RN is on site, he/she could draw up and inject the person having the reaction. If no RN is available, trained personnel can use the autoinjector. The amount of time to injection would not be significant- it would likely take longer if the event were occurring in a hospital. The cost of epi could potentially be lowered.

  4. Stock both. If a RN is on site, vial/syringe can be used. If no RN available, use the autoinjector. If there are multiple allergic incidents, you may very well save money. The time difference for a RN using vial method would minimal- if the reaction took place in a hospital, it would likely take a greater amount of time for the dose to be delivered to the patient.

  5. Having gone through the process of fighting school principals and teachers, I continue to feel that a 504 with an individualized healthcare plan in place is the only way to protect your child. Specific instructions are needed for school personnel to adhere to and unfortunately sometimes that can only be achieved with a legal document.
    Everything needs to be spelled out for them including having a nurse in the building during school hours, on field trips, etc. regardless. Nurses were trained (at one point during their studies) to deal with emergencies and secondary “trained” staff may not be able to handle an actual emergency when faced with it, no matter how good their intension is. In addition, having seen generic autoinjectors, I feel certain ones are substandard to the brand named Epi pen version and may actually have a greater potential to fail given the poor design. I personally wouldn’t care how the epinephrine is administered as long as it is readily available, the proper dose is administered by a profession and most importantly, saves my child from a tragedy!


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