What would you have done !

Submitted: Monday, Jan 28, 2019 at 13:20
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So we are camping over christmas with a large group of friends by the river at the busy but isolated Talbotville camping area.

Starting to head off to bed when someone comes running past all the campers yelling out "EPI-PEN EPI-PEN".

I know nothing about medical stuff but will describe the situation as best I can !

EPI-PEN is a self medicated injection used in emergencies to buy time to get to hospital, usually used for allergic reactions to bites allergies peanuts etc.


So this guy was pretty agitated , believing his wife was having an allergic reaction to spider bite and she had discovered that she had left her
medication including her EPI-PEN at home.

She had taken anti-histimenes (apparently this relieves some mild reactions).
They did nothing, I think she had already got something stronger from another camper and it also wasn't working.

Realizing it would take 2-3 hours to get to a hospital panic set in.


It turns out my friend always carried an EPI-PEN and has occasionaly used it himself or for kids in an emergency.

Question is , do you give someone else your medication , espically something as severe as this injection ?

What if you or kids needed it in an emergency - which is why you carried it when hours from help.

There could also be ethical/legal implications.

Net effect is you don't give it out lightly !

With some reluctance the EPI-PEN was handed over and used , it was now about 11pm and patient was driven off to nearset town (Dargo) which has a clinic.

Apon arrival in Dargo around midnight, everything was closed and so patient made an emergency call.
As soon as operator realized an Epi-Pen was used an ambulance was dispatched and a helicopter was also dispatched from nearset city to Dargo.

The ambulance arrived first and patient was stabilized and taken to hospital and recovered over a couple of days.

P.S.
The patient did the right thing and ensured the expensive EPI-PEN was promtly replaced and delivered to my friends campsite.
Robin Miller

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Reply By: Member - Stephen L (Clare SA) - Monday, Jan 28, 2019 at 13:25

Monday, Jan 28, 2019 at 13:25
Hi Robin

In a situation like that and it looked serious, it would have been out with the sat phone and dialed 000 or even trigger the PLB.

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Follow Up By: Keith B2 - Monday, Jan 28, 2019 at 13:30

Monday, Jan 28, 2019 at 13:30
My daughter works in a pharmacy and says you can get an EPI PEN without a prescription. Might be a good addition to the first aid kit for remote travel.
Keith
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Follow Up By: Member - Stephen L (Clare SA) - Monday, Jan 28, 2019 at 13:55

Monday, Jan 28, 2019 at 13:55
Hi Keith

My wife also works in a Pharmacy here in South Australia and you can not buy them over the counter and must have a prescription from your doctor and according to their web site, once administrated, dial 000

The only other issue, is that they have a very short shelf life of around 6 months and are expensive if you are not going to use it.


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Follow Up By: Member - Boobook - Monday, Jan 28, 2019 at 14:30

Monday, Jan 28, 2019 at 14:30
Unless something has changed recently. Stephen, I have bought Epipens with and without Prescriptions.

Without a prescription, they are about $50 each, with a prescription they are $30 for 2. My chemist lets me take the second one when the first one expires.

Also as you say their shelf life can be very short. As short as a day if left in a hot car. It can't be treated as a normal first aid item that you carry in case of use. It can't be kept in a fridge either.

They are a pain in the arse for storage ...so to speak.
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Follow Up By: Member - Stephen L (Clare SA) - Monday, Jan 28, 2019 at 14:44

Monday, Jan 28, 2019 at 14:44
Hi Tony

Fiona is going to find out first thing tomorrow morning what is the latest for South Australia.


Cheers


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Follow Up By: Robin Miller - Monday, Jan 28, 2019 at 16:06

Monday, Jan 28, 2019 at 16:06
Hi Stephen

I don't know why there was a reluctance to call for help , normal mobile service was only available to those with a good setup and perhaps not to the guy looking for epi-pen.
I suspect it was all a panic and not all options were fully considered as a helicopter could have landed near us, but I think some of these things start out small and escalate.
In this case the hour to drive to clinic seemed reasonable but then you find its closed !
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Follow Up By: Member - Racey - Monday, Jan 28, 2019 at 16:26

Monday, Jan 28, 2019 at 16:26
I have a reaction to bee stings. My Dr informed me he could NOT prescribe an Epi-pen.
They can only be prescribed by an Allergy specialist.
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Follow Up By: Member - Boobook - Tuesday, Jan 29, 2019 at 18:03

Tuesday, Jan 29, 2019 at 18:03
I'd check that information Racey. They are allowed to be sold from Pharmacies over the conter without prescription.

Schedule C - Available over the counter.
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Follow Up By: Member - Stephen L (Clare SA) - Tuesday, Jan 29, 2019 at 19:12

Tuesday, Jan 29, 2019 at 19:12
Hi Team

Fiona checked today at her work.

Yes you can come in and buy them over the counter without a Doctors Prescription, but you will pay full price .


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Reply By: Malcom M - Monday, Jan 28, 2019 at 13:34

Monday, Jan 28, 2019 at 13:34
As a first aider you are not legally responsible if it 'goes wrong'. The courts look at it as "at least you tried".
However that does not mean you blindly hand over your dangerous drugs without good reason.

In this case I would have handed over my Epi pen having satisfied myself that the guy had some idea of what he was talking about.
Up to him if he used it or not.

000 is fine but the patient could have died from anaphylactic shock or something by the time any medical people got there.
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Follow Up By: Robin Miller - Monday, Jan 28, 2019 at 16:11

Monday, Jan 28, 2019 at 16:11
I think that both the user and the donor were familiar with epi-pens and this was main consideration in giving it as you suggest Malcom.
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Reply By: Baz - The Landy - Monday, Jan 28, 2019 at 13:56

Monday, Jan 28, 2019 at 13:56
“One problem at a time Sarge”...

In the situation you’ve described, we’d deal with the emergency at hand and offer it to the person immediately without further thought.

We always carry two in our medical kit, working on the basis if you need one, Murphy’s Law says you’ll need another.

Mind you we’d still hand our last one over to someone in need...

They also have an expiry date and thankfully we have disposed off more than one without use.

Cheers, Baz - The Landy

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Follow Up By: Robin Miller - Monday, Jan 28, 2019 at 16:19

Monday, Jan 28, 2019 at 16:19
"One problem at a time" sounds simplistic but most of the time I suspect its right move.

I and the EPI-PEN donor have unfortunately seen situations in which the legal eagles and lawyers can second guess your actions with perfect hindsight Baz.
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Follow Up By: Baz - The Landy - Monday, Jan 28, 2019 at 17:40

Monday, Jan 28, 2019 at 17:40
Simplistic, yes!

It is a favourite quote of mine that I often remind myself of when things start going pear-shaped. It was attributed to an American Army Sergeant involved in “Operation Eagle Claw’ in 1980 to rescue the American hostages in Tehran that went badly for the Americans

The soldier was sitting on an aircraft, totally fatigued and exhausted, barely awake he noticed the front of the aircraft was on fire and people being burnt to death; the plane was going to crash he thought and that meant certain death for him.

He ran to the back and jumped out of the burning aircraft and adopted a sky diving position - he landed in the sand face down immediately; the aircraft was in fact still on the ground...

Relaying the story to his Superior later on he was quizzed - you jumped out of the burning aircraft whilst thinking you were in the air and without a parachute.

What were you thinking and what were you going to do next he was asked...?

He replied - “One problem at a time Sir...”

Sometimes it is as simplistic as that...

But on the “legal eagles” and the legal implications of supplying a potentially life saving device and being held to account for that action if it goes wrong...

“One problem at a time Sir, one problem at a time...”

All good for thought,

Cheers, Baz
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Reply By: Guy G - Monday, Jan 28, 2019 at 15:01

Monday, Jan 28, 2019 at 15:01
In WA you can buy Epi-Pens 'over the counter' at a Chemist but you need a prescription to get one at the reduced PBS price. I don't see any ethical or legal issues. If the guy says his Wife needs it & she left her's at home, presumably she has a known medical condition & knows when she needs the measured dose of adrenaline the Epi-Pen provides to alleviate her symptoms & possibly save her life. My Wife is allergic to bee stings & just one sting will put her in to anaphylactic shock & she stops breathing. If you give them the medication, provided they administer it themselves, my understanding is that you wouldn't have any legal liability. The same principle applies if someone needs a 'heart pill' to put under their tongue, or an asthmatic needs a puffer or a low blood sugar diabetic needs a sugary soft drink or food. As you said, this ended well & they had the courtesy to replace the Epi-Pen promptly (with an obligatory carton I hope) If anyone did take legal action I am sure the remoteness of the location, the fact that they were desperate & there were independent witnesses who heard the guy running around shouting for the medication & your actions were the only viable alternative to possibly saving a fellow persons life, would all be taken into account & looked favourably upon in a court
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Follow Up By: Robin Miller - Tuesday, Jan 29, 2019 at 14:28

Tuesday, Jan 29, 2019 at 14:28
I think you got it right Guy - essentially my mate was reacting to a request - not making a diagnosis.
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Reply By: Hoyks - Monday, Jan 28, 2019 at 15:32

Monday, Jan 28, 2019 at 15:32
"Question is , do you give someone else your medication , espically something as severe as this injection ?"

Well, yeah!

Do you need it right now?
Would you rather see someone slowly suffocate as their airway closes over, but have a warm fuzzy feeling that you have an epi-pen 'just in case'?

Is it worth watching someone die just so you aren't inconvenienced with an unscheduled drive to town in slow time to restock?

Using it on someone that doesn't need it is unlikely to kill them. although it probably won't be pleasant. Not using it on someone that does, well that's another matter entirely.
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Follow Up By: Robin Miller - Monday, Jan 28, 2019 at 15:55

Monday, Jan 28, 2019 at 15:55
Apparently an epi-pen can aggravate a heart condition and so should not be used lightly.
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Follow Up By: Hoyks - Monday, Jan 28, 2019 at 16:19

Monday, Jan 28, 2019 at 16:19
It can, and diabities.

Its a massive dose of adrenaline, so imagine something several times worse than the heart pounding reaction you'd get from flicking down the sunvisor and finding a funnel web falling into your wedding tackle while missing getting run over by a truck.

That's why it isn't good for those with heart conditions.

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Reply By: Kenell - Monday, Jan 28, 2019 at 16:38

Monday, Jan 28, 2019 at 16:38
Robin,

I would and have responded as you did. As one human to another it is what one does. Good Samaritan laws operate throughout Oz to varying degrees to protect people from liability in such circumstances. A medical professional is not protected by this legislation as I understand it but I think he/she also has a duty in cases such as this. The laws were introduced to ensure people didn't stand back when urgent assistance was required for fear of legal recourse.

A case I was involved in was a chap having what seemed to me to be a heart attack and all people were saying was put him in the coma position ie on his side. I checked his pulse and couldn't find one so I didn't think the coma position was going to help him much. I started CPR and provided entertainment to about a dozen or so with cameras until someone who was better trained than me turned up to take over - around 10 minutes after I started. He was alive when the ambulance turned up a little while later but after that I don't know. I have never been so frustrated - nobody was prepared to even touch the guy but they could find their phones.

Good on you for doing as you did. I doubt the patient will leave home without her kit in future.

Ken
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Follow Up By: Robin Miller - Tuesday, Jan 29, 2019 at 14:24

Tuesday, Jan 29, 2019 at 14:24
Yes I get your point on bystanders Ken, it can be hard to think clearly sometimes just when you need to most.

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Follow Up By: Batt's - Thursday, Jan 31, 2019 at 11:23

Thursday, Jan 31, 2019 at 11:23
Good to see you acted but I personally wouldn't react very well If I knew people were standing around using their cameras when some one else was performing cpr.
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Follow Up By: Kenell - Thursday, Jan 31, 2019 at 11:52

Thursday, Jan 31, 2019 at 11:52
Yes Batt's you share my position. It happened in Venice and I discovered that there is a word used frequently in the Australian vernacular that is universal. Using that word loudly certainly gets attention. The poor chap was American and his wife was very distressed but she gathered some composure when I did my melon. One of the standers by raced off to a pharmacy apparently as the pharmacist returned with oxygen and some pills (anginine I guessed). The ambulance was water borne obviously and arrived with a Police escort. They were very short with the crowd.
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Reply By: Allan B (Sunshine Coast) - Monday, Jan 28, 2019 at 18:21

Monday, Jan 28, 2019 at 18:21
.
Without hesitation Robin, I would use the satphone to contact RFDS where I can speak directly to a doctor and obtain guidance. Then follow it.

I would not phone 000 where an operator would waste time asking for my address and "the nearest intersecting street".
000 is appropriate for a house fire, suburban vehicle collision etc. but if you are somewhat remote it is of very limited help in an urgent critical situation. There have been numerous published incidents which have demonstrated this.
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Follow Up By: Bob Y. - Qld - Monday, Jan 28, 2019 at 19:26

Monday, Jan 28, 2019 at 19:26
I’d endorse Allan’s suggestion, to call RFDS rather than 000, when in a remote situation. Okay, they mightn’t drop a KingAir in to assist you but speaking to a doctor will assist & reassure the callers.

As for any legal repercussions from anyone treating a patient, we were always told during First Aid courses, by the instructing ambulance officer, that we would be exempt as we would be treating the patient at the best of our ability.

Bob



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Follow Up By: Gustle - Tuesday, Jan 29, 2019 at 13:24

Tuesday, Jan 29, 2019 at 13:24
During a recent visit to the Broken Hill RFDS, I asked at the front counter if they could give me a business card that I could leave in the glove box in case I needed to call them for an emergency. Well, this caused quite an internal stir and became a discussion point at the office. Apparently the new rule is that everyone needs to dial 000 as they discourage taking direct calls from the public. After I left, I was however not convinced that they knew exactly what the procedure is and as a grey nomad on the road I still carry their various state phone numbers in my glove box. Incidentally, their website states both 000 and the phone number of the state the RFDS is located at. I know which number I would rather ring...
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Follow Up By: Allan B (Sunshine Coast) - Tuesday, Jan 29, 2019 at 14:19

Tuesday, Jan 29, 2019 at 14:19
.
Hi Gustle,
Here is a screen shot from the RFDS website.
Clearly it is OK to phone direct. Of course they do not want calls from suburban locations.
I think that often the people in tourist places such as RFDS are casual or volunteers who are not fully acquainted with operational facts.
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Follow Up By: Allan B (Sunshine Coast) - Tuesday, Jan 29, 2019 at 15:00

Tuesday, Jan 29, 2019 at 15:00
.
Followup to "RFDS contacts" above:

I am an RFDS subscribing member and the postie just this minute delivered a letter from them containing a Medical Emergency Card. It says....

"To contact the RFDS call the emergency operator on '000'. They are trained to decide which emergency service is most appropriate for your situation and location".

Maybe so for some people but I believe that I am capable of making that judgement without a series of questions and answers from an '000' operator, "trained" or otherwise. I guess that RFDS are fielding calls from people who have little idea who should respond so have adopted "000" to interface for them and sort the chaff.

I will still contact RFDS directly in the case of a remote medical emergency. If this access was removed I would be having "interesting discussions" with them.
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Follow Up By: Hoyks - Tuesday, Jan 29, 2019 at 16:19

Tuesday, Jan 29, 2019 at 16:19
Or if you download the EMERGENCY+ app it will give you your grid and street location to relay to the 000 operator.

When they ask 'What City or town' simply say I'm XXkm and direction out of whatever town at grid XXXXX and they will adapt.
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Reply By: rumpig - Monday, Jan 28, 2019 at 18:42

Monday, Jan 28, 2019 at 18:42
If i had an EPI-PEN (which we don't) and someone is running around camps in a panick asking for one, I'd give it to them....thinking some lawyer will make a meal of me if i do is much less of a thought to me, then knowing someone died and I had an item sitting in my camp thier partner or whoever was screaming for that could have saved thier lives, but I was to scared to give it to them incase something might happen to me.
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Follow Up By: Shaker - Tuesday, Jan 29, 2019 at 21:23

Tuesday, Jan 29, 2019 at 21:23
I would do the same at Talbotville, I’m embarrassed to say that I’m not so sure if I would halfway along the Cannng Stock Route, particularly if the EPI-pen was for my child.

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Follow Up By: Batt's - Thursday, Jan 31, 2019 at 11:39

Thursday, Jan 31, 2019 at 11:39
Hope you have had the courtesy to tell or discuss this with others who travel with you Shaker because the day may happen the favour isn't returned either. I have cut short a couple of small trips over the yrs due to helping others it's pretty easy to turn around and go back home it's not the end of the world.
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Follow Up By: nickb - Thursday, Jan 31, 2019 at 18:10

Thursday, Jan 31, 2019 at 18:10
Surely on a remote trip like that you would carry at least 3 of them if one of your crew required it??
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Follow Up By: RobynR4 - Friday, Feb 01, 2019 at 23:04

Friday, Feb 01, 2019 at 23:04
Absolutely!
I just did my compulsory annual CPR and first aid update.
Considering an epi-pen is administered and should be re-administered should no change be observed in 5 minutes, no-one in their right mind would travel remotely with just one if they were at risk of anaphylaxis.

Just administer the darn thing.
Don't be afraid.

My husband had an accident 21 years ago and if his mates had not performed CPR in the back of the ute as it was being driven into town, I would either be married to a brain damaged man or I would be a widow.
Even when they met up with the ambulance it took 3 zaps with the defibrillator to get him going again.

Each year when I redo my CPR and first aid certification I am reminded of these 2 men who kept my husband's vitals going. Their actions still reduce me to tears when I think of what could have been.

If people went to film me I would be absolutely furious. The times I've had to go to the rescue I was lucky to have helpful people around. As I've been taught the S in DRSABCD stands for "send", as well as "send for help" I'd also consider it to mean "set someone in charge of dismissing the phones because I'm not a darn sideshow!" (I don't think I'd be that polite!)

:)



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Reply By: Ron A - Tuesday, Jan 29, 2019 at 07:43

Tuesday, Jan 29, 2019 at 07:43
No doubt about it Robin, if someone was asking specifically for an EPI PEN and I had one it would be made available.
It also concerns me that someone would drive from Talbotville to Dargo at around 11 pm seeking medical assistance. For that matter any remote community at that time of night. Dargo is a Bush Nursing Service that operates limited hours and has limited facilities. I am not even sure if the Bush Nurse lives onsite any more.
Talbotville is easily accessible by Air Ambulance and a call from Talbotville initially rather than waiting until Dargo would have been a much better idea in an emergency situation.
Your situation certainly highlighted the importance of being prepared when you go remote. If you need medication...make sure you pack it.
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Follow Up By: Robin Miller - Tuesday, Jan 29, 2019 at 14:09

Tuesday, Jan 29, 2019 at 14:09
Yeh , the road was in worse condition than normal - even having 50m long water filled ruts when we first drove in.

I'd couldn't find out why heli took so long either, so while no players had any control over the response it looks like going to town turned out to be the best option.
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Follow Up By: Ron N - Tuesday, Jan 29, 2019 at 16:56

Tuesday, Jan 29, 2019 at 16:56
Robin, the cost of running helicopters is huge, and it's a judgement call on the heli dispatcher as to whether a heli is warranted.

Late at night, the heli could have been on another "more important" job - or grounded for the night - in which case, it takes time to get the pilot out, and get the heli airborne.

A flight plan has to be filed, and a weather report acquired (METAR/SPECI) and pored over, to determine if weather is going to be a deciding factor in the task.

It's not uncommon for heavy fog to roll in, in many areas during the night, increasing the risks - and often, even meaning the task has to be abandoned.

Cheers, Ron.
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Reply By: Banjo (WA) - Tuesday, Jan 29, 2019 at 09:14

Tuesday, Jan 29, 2019 at 09:14
Robin Miller writes, 'Apparently an epi-pen can aggravate a heart condition and so should not be used lightly.'

However if one cannot breathe and is likely to die then consideration of the consequences of administering an antidote would be put aside.

Adrenaline is not likely to cause harm in normal circumstances.

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Follow Up By: Robin Miller - Tuesday, Jan 29, 2019 at 14:20

Tuesday, Jan 29, 2019 at 14:20
Yep I agree Banjo , but sometimes its no so black and white.

I remember once trying to get a woman out of an upside down car , she was hanging from seat belt - I was as scared as hell of realising the belt as she would fall straight down onto her head.
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Reply By: Dean K3 - Tuesday, Jan 29, 2019 at 19:25

Tuesday, Jan 29, 2019 at 19:25
Didn't figure out if comms was reliable or not ie normal mobile phone coverage or back up redundancy required ie sat phone HF PLB.

RFDS call be my first and safest option, let them assess and they can then provide instructions on what to do etc

2ndly and I do have to question this and discussed this with my GP, who concurred with me.

first aid is simply that now it seems to becoming a case or providing paramedical assessment and administering a variety of drugs to either prevent reaction or subdue a reaction dependent on situation.

Carrying of a defib unit is also deemed mandatory by a certain sector of medical world, my gp said once your flat lining or in fibrillation chances of survival unless your inside a coronary care hospital is minimal

Personally I would ensure I carried all medication that I required for myself, including a repeat of any prescription medications I use.
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Reply By: Alloy c/t - Thursday, Jan 31, 2019 at 14:52

Thursday, Jan 31, 2019 at 14:52
Given the circumstance , yes definitely , give them the Epic-Pen , thing to remember though is that a 'single' pen may not be enough , the dosage is fairly small , that why you do not need a prescription for purchase in most Australian states ,
When we travel any considerable distance from home we carry for my allergy [ seafood , prawns ect ] vials of adrenalin and the means to inject same , it is just 'to easy' to be unwittingly 'poisoned' even by having dinner at a Chinese restaurant for example where even asking for a fried rice without 'prawns' can and has had dire consequences .....if stored correctly the vials have usable life of 12mth and are a much cheaper alternative than the 'Epic-Pen' .....
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