Anaphylaxis knowledge among paramedics: Results of a national survey

Background. Very little is known about prehospital providers' knowledge regarding anaphylaxis care. Objectives. The purpose of this study was to evaluate how well nationally registered paramedics in the United States recognize classic and atypical presentations of anaphylaxis. We also assessed knowledge regarding treatment with epinephrine, including dosing, route of administration, and perceived contraindications to epinephrine use. Methods. This was a blinded, cross-sectional online survey of a random sample of paramedics registered by the National Registry of Emergency Medical Technicians that was distributed via e-mail. The survey contained two main sections: demographic data/self-assessment of confidence with anaphylaxis care and a cognitive assessment. Results. A total of 3,537 paramedics completed the survey, for a 36.6 response rate. Among the respondents, 98.9 correctly recognized a case of classic anaphylaxis, whereas only 2.9 correctly identified the atypical presentation. Regarding treatment, 46.2 identified epinephrine as the initial drug of choice; 38.9 chose the intramuscular (IM) route of administration, and 60.5 identified the deltoid as the preferred location (11.6 thigh). Of the respondents, 98.0 were confident they could recognize anaphylaxis; 97.1 were confident they could manage anaphylaxis; 39.5 carry epinephrine autoinjectors (EAIs) on response vehicles; 95.4 were confident they could use an EAI; and 36.2 stated that there were contraindications to epinephrine administration in anaphylactic shock. Conclusions. Whereas a large percentage of the paramedics recognized classic anaphylaxis, a very small percentage recognized atypical anaphylaxis. Less than half chose epinephrine as the initial drug of choice, and most respondents were unable to identify the correct route/location of administration. This survey identifies a number of areas for improved education.