Necessity of Epinephrine in Pre-Hospital Stage: In the Early Management of Anaphylaxis Following a Bee Sting

Park, Sang Wook; Lee, Byung Kook; Yun, Seong Woo

Abstract

PURPOSE
Anaphylaxis is a serious allergic reaction of rapid onset that may lead to death. The primary treatment for anaphylaxis is epinephrine. However, use of epinephrine in pre-hospital stage is unavailable, because epinephrine is not permitted to be equipped in the 119 rescue ambulance and use of epinephrine by emergency medical technicians (EMT) is not authorized by law in Korea. The aim of this study is to identify the necessity of using epinephrine in prehospital stage from the perspective of early management of anaphylaxis following a bee sting.
METHODS
Patients suffering from a bee sting who used the 119 rescue in Jeollanamdo between 2008 to 2011 were included. Age, sex, month of injury, time factors, distance factors, presence of cardiac arrest, AVPU triage by EMT, presenting symptoms, and signs were extracted. The severity of bee sting injury was divided into mild, moderate, and severe according to the presenting symptoms and signs.
RESULTS
A total of 1,647 patients were included: 917 (55.7%) patients were classified as mild; 480(29.1%) patients were classified as moderate; and 250(15.2%) patients were classified as severe. The median of total transport time and distance was 32 minutes and 21.3 kilometers, respectively. Nine patients collapsed at the scene. Bee sting injuries occurred primarily from June to October.
CONCLUSION
The incidence of anaphylaxis following a bee sting was not low. The transport time was relatively long, since bee stings occur primarily in rural areas. Therefore, for early management of anaphylaxis, equipment of epinephrine in the 119 rescue ambulance and use of epinephrine by EMTs should be considered.