I recently received a credible email account of a person with WFR training accidently discharging an auto-injector of epinephrine into their thumb.  Thankfully, the thumb, and the patient who really needed the epinephrine are fine.  The anecdote is a reminder that these devices are not foolproof.  We need to learn how to use them properly, periodically refresh our knowledge and have the presence of mind to use them correctly.

A recent issue of the Journal of Allergy and Clinical Immunology has a paper describing self-reported unintentional injections from auto-injectors.   They found 15,190 reports from 94-07 and a trend of increasing reports paralleling the increasing popularity of these devices.  This number caught my attention.

The study is unable to tell us whether these injections harmed the patient; we do know that very few of these incidents sought medical care.   We don't know how they happened, although errors during injection, during disposal of a fired device, training mishaps and reaching into a bag or purse to get the auto-injector are mentioned.  

There are also reports in the medical literature that a disturbing number of people leave the doctor’s office and the pharmacy with inadequate instruction, unable to properly use their auto-injector.  (BMJ 2003,  J Allergy Clin Immunol 2000.)

There are at least three models of auto-injectors available; the Twinject and the classic and the newer version of the EpiPen.   If you carry one of these for personal use, or might have to assist someone to use their personal auto-injector, it’s a good idea to make sure you know how and when to use the device.

Take care

Tod Schimelpfenig

Curriculum Director

Wilderness Medicine Institute of NOLS

Voluntarily reported unintentional injections from epinephrine auto-injectors.  J Allergy Clin Immunol 2010;125:419-23.)