A 37-year-old male experiences a severe allergic reaction to penicillin. He does not have an epinephrine auto-injector and your protocols do not allow you to carry epinephrine on the ambulance. How should you proceed with the treatment?

• A. Administer oxygen, transport at once, and request a paramedic intercept.
• B. Quickly determine if there are any bystanders who may carry epinephrine.
• C. Ask the patient if he has any diphenhydramine tablets that you can administer.
• D. Remain at the scene with the patient and request a paramedic ambulance.

Answer: (A)

In anaphylaxis, the immediate priority is to support breathing and get the patient to definitive care quickly when you don’t have epinephrine on scene. Administering high-flow oxygen helps improve oxygenation during bronchospasm and shock. Since your protocols don’t allow carrying epinephrine and you can’t reliably obtain it from bystanders, the best move is to transport the patient at once and arrange for a paramedic intercept to bring and administer epinephrine if available. This approach prioritizes life-saving treatment and rapid definitive care.

Other options would either introduce delays or rely on ineffective substitutes: waiting for bystanders to provide medication can slow down critical care, and antihistamines like diphenhydramine do not treat the airway swelling or circulatory collapse seen in anaphylaxis. Staying on scene without transport delays care; rapid transport with advanced support is the safer, more effective choice.