Pt. stung multiple times by bees. Certainly she was symptomatic with a swollen tongue, difficulty breathing, etc. An IM shot of benadryl and then a SQ of epi 1/10 and she came around. Then a neb treatment that cleared up wheezing. By the time she was in the ambulance she was off o2 and feeling fine.
She asked me why do I have to go to the hospital? I kind of edged around saying well they have to check your lungs, it's serious we don't know what can happen etc.
It did get me thinking why does she need to go? The symptoms from the allergic reaction were gone. Vitals, pulse ox etc. were fine. Why does she need to go to the hospital? Diabetics after D 50 need to eat and be stable and they can avoid transport....why not this pt.?
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There are cases of secondary reaction or biphasic reaction. Here is a link to the EpiPen site and some information on that.
The Benadryl does not really do anything, so epi should not be delayed to give it. Epi can be given IM also - and EpiPen injection is an IM injection.
A patient can refuse transport after receiving epinephrine. You do not have permission to abduct a competent adult making an informed decision to refuse transport, no matter what your medical director says. You should persuade them to go to the hospital for follow up.
Unless the patient is clearly not able to understand, you can be charged with a crime for transporting the patient against the patient's wishes. The medical director will probably avoid charges by claiming that you misunderstood the protocols.
If the patient does not agree to go AND I think the patient should go to the hospital, I put the patient on the phone with the medical command physician. They usually agree as soon as they hear the voice of a doctor. A few do not. If the medical command physician refuses to talk to the patient, I document that they refused to do anything to assist in convincing the patient to go to the hospital and have anyone present, especially police, also sign as a witness. Police may not mind the possibility of court time (usually on overtime).
Unlike hypoglycemia, this should be extremely rare for the person. Not that EMS treated hypoglycemia should be common.
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