Epipens, anaphylaxis and the untrained bystander


As our trainers travel around the UK visiting schools one topic seems to generate more discussion than others. Can an untrained bystander administer an Epipen?

Can an untrained bystander administer an Epipen?

Anaphylaxis is a relatively rare, life threatening condition caused as a result of a severe and acute allergic reaction. Huge amounts of histamine are released into the casualties system which causes the airway to swell restricting oxygen supply to the lungs; secondly it acts as a vasodilator, opening up the blood vessels within the circulatory system. Consequently the casualties’ blood pressure drops quickly and dramatically, the pulse increases to compensate for this sudden drop in BP and if left untreated can lead to a cardiac arrest. The emergency treatment for a casualty going into Anaphylactic shock is an Epipen.

An Epipen contains a metered dose of adrenaline, when injected this acts in the opposite way to histamine, it dilates the airway and constricts the blood vessels, so restoring some form of blood pressure. It is regarded by the Medicines Act as a life saving medication.

As to the answer, in an emergency can an untrained bystander administer an Epipen to an unconscious casualty? (a conscious one would of course self administer) the answer is YES. A lay responder must satisfy 2 criteria

  1. They have legitimately obtained the Epipen (it is a Prescription Only Medicine as defined by the medicines Act)
  2. They are adminitering the Epipen for the purposes of saving life

Under the Prescriptions Only Medicines (Human Use) (Order) 1997 there exists a list of what are described as life saving medications; metered doses of Adrenaline appear on that list. Whilst training is certainly desirable it is not absolutely essential and even if you are wrong the benefits far outweigh the potential for harm where adrenaline is concerned.

We have visited many clients who asked for confirmation of this advice therefore in 2006 we requested clarification from the HSE (their website appeared a little ambiguous), the following is an excerpt from their reply:

“One of the roles of the medicines legislation was to enable non-medical staff to administer basic medicines and undertake simple medical procedures to free up medical staff’s time for more complex procedures. You are quite right in your interpretation of the legislation that it does not require training to administer epipens. The legislation – Prescriptions Only Medicines (Human Use) (Order) 1997 permits a non trained person to administer some medicines, including epipens.

We have plans to update our first aid website later in the year and will revise the guidance on this particular matter. Nevertheless we would still advocate that the ideal situation is that the person who administers epipens, or other similar medicines, has suitable training to do so. We would consider this as good practice. Clearly if there was an emergency then anyone should be able to administer it.”

Health and Safety Executive

Specific Hazards and Leisure section