Community presentations of anaphylaxis in Tasmania: Who is administering the adrenaline?

Introduction: Anaphylaxis is a significant health concern within the community. The early administration of adrenaline to patients experiencing anaphylaxis has long been recognised as the cornerstone of treatment. Health care providers, including general practitioners, nurses and paramedics, are well equipped to manage anaphylaxis through the administration of adrenaline. Patients themselves also often have adrenaline auto-injectors, allowing early self-management. The objective of this study was to determine the rates of adrenaline administration and identify the administering persons for all anaphylaxis patients presenting to ambulance services in Tasmania over a four-year period by using a retrospective chart review.

Methods: Ambulance Tasmania electronic case reports (n = 226,421) from the period 1 January 2008 to 31 December 2011 were searched for all cases fitting the parameters of anaphylaxis, allergy or allergic reaction. Of these cases, 373 were given a final paramedic diagnosis of anaphylaxis and constituted the primary data for this report.

Results: During the study period, Ambulance Tasmania attended 373 patients that were given a final primary diagnosis of anaphylaxis. Of these, 59 (15.8%) were excluded, leaving 314 electronic records for analysis. Of the cases identified, 71.7% (n = 225) were administered adrenaline according to paramedic records. Adrenaline was administered by a range of health professionals, including general practitioners (n = 27), paramedics (n = 159), ambulance volunteers (n = 4), nurses (n = 1) and other health professionals (n = 3). Adrenaline was self-administered by 12.4% (n = 28) of patients, with an additional 11.6% (n = 26) receiving adrenaline from a non-health care worker (layperson). In 10.2% of cases (n = 23) adrenaline was administered by more than one provider. Administration of adrenaline prior to paramedic arrival was evident in fewer than 10% of cases treated with adrenaline (n = 22).

Conclusion: The early administration of adrenaline in anaphylaxis is often vital for patient recovery. This study shows that adrenaline is administered by a number of different providers, with early administration accounting for only 9.8% of presentations treated with adrenaline. These findings raise the question, is adrenaline being administered early enough and often enough to improve health outcomes?