If epinephrine is not available on scene and EMS protocols do not allow carrying it, which course of action is recommended?

• 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)

When a life-threatening allergic reaction is suspected but epinephrine isn’t available on scene and protocols don’t allow carrying it, the priority is to support the patient’s breathing and get them to definitive care quickly. Providing oxygen helps stabilize oxygenation during bronchospasm and airway swelling, and transporting at once gets the patient to a facility where epinephrine can be given and advanced care started. Calling for a paramedic intercept brings in providers with the necessary medications and skills to manage the reaction promptly, improving outcomes by reducing time to treatment.

Waiting for bystanders to provide epinephrine is not reliable within many EMS protocols and can delay care. Diphenhydramine alone is not enough to treat anaphylaxis and can delay the use of epinephrine. Staying on scene without transport postpones life-saving therapy and risks deterioration.