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First Aid - Using an Epinephrine Auto-injector

What is an epinephrine auto-injector?

During an allergic reaction, the immune system can react very severely. With a severe allergy, a potentially life-threatening reaction called anaphylaxis can occur. Anaphylaxis can cause shock, a drop in blood pressure, and trouble breathing. In some cases, death may occur.

Epinephrine, also known as adrenaline, is a drug that can slow down or stop an anaphylactic reaction.

An epinephrine auto-injector is a device that has a syringe and needle that can inject a single dose of epinephrine. Commercial brand names include EpiPen®, Auvi-Q® or Allerject®, and others.


What are the signs and symptoms of anaphylaxis?

Symptoms usually occur within minutes of exposure, but there can also be a delay of 30 minutes or more. There can be an equally serious second reaction one to eight hours after the initial reaction. A range of signs and symptoms may occur, including:

  • Flushed or pale skin
  • Other skin changes, such as hives, itching, or rash
  • Swelling of the eyelids, and itchy, watery eyes
  • Itchy or swollen tongue or throat
  • The feeling of a lump forming in the throat
  • Constriction (a blocking) of the airways, causing wheezing or trouble breathing
  • Rapid or weak pulse
  • Rapid heart rate
  • Dizziness or fainting
  • Nausea, vomiting, or diarrhea
  • A feeling of impending doom

Triggers commonly include:

  • Certain medications
  • Certain foods
  • Insect bites or stings (venom)
  • Certain chemicals, materials, or products

When can anaphylaxis or allergic reactions be a workplace issue?

Some people may react to products in the workplace. Examples of workplace allergens include latex, bee stings, and certain chemicals (e.g., diisocyanates). In the situation where the allergic agent is known, workplaces can take steps to control exposure (e.g., elimination, substitution).

Or, for example, if a person who is allergic to insect stings is stung while working outdoors, there is need to have help from a co-worker and to have an epinephrine auto-injector close by. This situation could have other hazards that contribute to the severity of the situation such as working alone, or working at heights (e.g., the person reacts so severely that they cannot inject him/her self, or a person faints from a reaction and falls from a ladder).


What can the workplace do?

Because of the ease of use, some organizations have decided to include an epinephrine auto-injector as part of their first aid supplies, or to be available to assist the public.

  • Workplaces should have trained first aid personnel, including cardio pulmonary resuscitation (CPR).
  • People who are aware that they may experience anaphylaxis should inform their workplace that they have been prescribed an epinephrine auto-injector by their doctor. They should also wear a medic alert bracelet or necklace that states their allergies and the location of their injector.
  • If an employee has the potential of having a severe reaction, permission should be obtained to provide first aid personnel with information about the person, the allergy, and the locations of the auto-injectors.
  • Employees should be educated about the dangers of anaphylaxis, how to recognize and respond to the signs of anaphylaxis, and how best to avoid known allergens.
  • Basic principles of allergen control including handwashing, cleaning and disinfecting work surfaces, and properly handling and/or preparing food should be promoted.
  • Employees should be taught how to recognize the signs and symptoms of an allergic reaction and how to use an epinephrine auto-injector properly.
  • The allergic person should carry an auto-injector with them at all times. If not possible, or in addition to, have a second or third auto-injector available in a safe but quickly accessible place (e.g., can be in a drawer, but not in a locked drawer with limited keys).
  • Epinephrine should not be stored in extreme temperatures (not too cold or too hot).
  • Epinephrine is light sensitive and should be stored in the container provided
  • Epinephrine auto-injectors expire (about 18 months). Check the expiry date and be sure there is always a current injector available.
  • The epinephrine auto-injector should be replaced immediately after use.

During a reaction, it may not be possible for the person to inject the drug themselves. Make sure immediate co-workers know how to recognize signs of a reaction, where the auto-injector is located, and how to use it. Co-workers should also know how to call for first aid personnel or for outside emergency responders.

In some cases where exposure to an allergen is possible, it may be necessary to assign that person to other duties. For example, if the person has a severe allergy to bee or wasp stings, consider assigning that individual to other duties, away from the area with a hive or nest (especially if the work involves disturbing the hive or nest). Or, if the workplace serves food (or has a social “pot luck” event), be sure to inform participants that there is a food allergy in advance, avoid cross contamination, and label all foods regarding their ingredients.


When would you use an epinephrine auto-injector?

If the person indicates they are having a severe allergic reaction, or if you suspect a person is having a severe reaction, using an epinephrine auto-injector would be appropriate. No harm will be caused to a person by providing a single injection if it turns out they are not having an allergic reaction.


What first aid steps are appropriate for anaphylaxis?

  • Act fast. Give the person the epinephrine injection right away, before symptoms worsen.
  • Follow the manufacturer’s instructions for safe use. The drug is usually injected by pressing the auto-injector to the person’s thigh. It may take about 10 seconds for the injection to complete.
  • Call for emergency medical assistance. Symptoms may return, and a medical professional should monitor the individual’s recovery.
  • Monitor the individual’s condition while waiting for emergency assistance.
  • If the person’s breathing or heart stops, perform CPR if you are trained to do so.
  • Have the person lie down to prevent injury if they faint and fall.
  • Loosen tight clothing and cover the person with a blanket. Do not give them anything to drink.
  • Watch for vomiting or bleeding. Turning a person to their side may help to prevent choking.
  • Put the used injector back into the storage tube and close the cap of the tube. Give the injector to the emergency responders or bring it with you to the hospital.
  • Make a note of what time you gave the injection.

When using an injection method, be aware of the hazards and risks associated with needlestick injury and the transmission of infections.

In most cases, the person will feel the epinephrine working right away. They may also feel a rapid heartbeat and nervousness. Always call for first aid or medical assistance. Symptoms can return or get worse after giving the injection. Only administer a second injection if specifically told to do so by a doctor.

Document last updated on April 7, 2017

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Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.