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January 31, 2018

Beyond auto-injectors: New kit expands BLS treatment options for severe allergic reactions

Sponsored by Bound Tree Medical

By EMS1 BrandFocus Staff

Roughly 40 million Americans have severe allergies, and anaphylaxis can be deadly. Of the millions of severe allergic reactions occurring in the U.S. annually, several hundred end in the death of the patient.

Epinephrine is the only treatment, and most EMS providers rely on auto-injectors like the EpiPen. But the spiraling cost of these devices, combined with the short shelf life of epinephrine (it expires after 18 months), has put many EMS agencies in a fiscal bind. This is especially true for those required by local or state law to carry the means of administering epinephrine in every ambulance.

A number of effective new tools and protocols for treating severe allergic reactions have emerged in recent years, including Curaplex Epi-Safe Kits, developed by researchers at the University of Rochester in New York and available through Bound Tree Medical.


New York state requires all ambulances to carry epinephrine. After the price of EpiPens spiked in 2016, it was estimated that New York’s EMS agencies were spending as much as $10 million each year on the devices – which often expired without being used.

“That’s really good patient care, but when you’re paying $900 for two auto-injectors, that becomes fiscally challenging, particularly for many volunteer companies,” said Dr. Jeremy Cushman, an associate professor of emergency medicine at the University of Rochester and a certified paramedic. “Let’s face it – we don’t use epinephrine every day, thank goodness, so for some of these agencies, although it was life-saving, they may use it once a year.”

Most BLS providers are limited to use of auto-injectors to treat anaphylaxis, but Cushman and his team drew inspiration from a program in King County, Washington, that had enabled EMTs to draw up and administer epinephrine using a syringe and vial.

“Their model was very straightforward – it was a syringe, a vial of epinephrine and everything else you needed in a small kit,” Cushman said. “We took their lead and identified a way to create a syringe that at least theoretically decreased the medication error related to dosing by only providing two graduations on the syringe for the adult and pediatric dosages.”


The team found a syringe manufacturer to produce a custom-designed safety syringe marked only with the pediatric and adult doses for epinephrine. They then partnered with Bound Tree to provide the kits for the pilot program needed to demonstrate that both ALS and BLS providers could safely administer epi with this method.

Nearly 650 agencies participated in the New York Check & Inject pilot program, which used the prototype Epi-Safe kits to establish that EMTs could safely and successfully administer the proper dose of epinephrine with the proper training and supplies. The project also demonstrated a significant opportunity for cost savings, significantly reducing the price tag of epi use by EMS while expanding providers’ ability to treat patients.

The kits developed for the Check & Inject pilot program are now available for purchase through Bound Tree. The Curaplex Epi-Safe Kits offer a clinically appropriate alternative to using an epi auto-injector. They are available in single-dose, double-dose and training kits. The single-dose kit contains:

  • 1 1mL vial of epinephrine.
  • 1 Epi-Safe syringe.
  • 1 safety needle, 23ga x 1”.
  • 2 alcohol prep pads.
  • 1 adhesive bandage, 1” x 3”.
  • 1 flex-top case.


In May 2017, the Check & Inject protocol using the Curaplex Epi-Safe Kits was added to the scope of practice of EMTs in the state of New York. With this change, New York has joined other states (notably IllinoisOhio and South Carolina) in allowing EMTs and emergency medical responders to administer epinephrine by drawing up the medication from an ampule or vial for injection.

The effort is projected to slash the price tag of epi use by EMS almost tenfold while expanding providers’ ability to treat patients.

“We were able to identify a safe and cost-effective solution that is likely saving our EMS agencies literally millions of dollars,” said Cushman. “That allows us to perhaps get more epinephrine out there or support our agencies in other ways, particularly in the diminishing reimbursement environment of ambulance services.”

Further, Cushman says, expanding the number of providers who can administer epi means better patient care, especially in remote areas where ALS may not be immediately available.

“The more that we can facilitate the treatment for anaphylaxis out in the field, the better off we’ll be,” he said.