EMT Administration of IM Epinephrine via Syringe

Connecticut, following the leads of states such as New York, has just expanded the scope of practice for EMTs to include injecting medications. This means instead of carrying two $600 Epi-pens, EMTs can now draw up 0.3 mg of epi from a $5 vial and administer it to a patient suffering a severe allergic or anaphylactic reaction.  Services who wish to provide this alternative need authorization from their sponsor hospital, but all EMTs in the state will be taught the skill as part of their regular training.

Here’s a link to Connecticut’s training program:

EMT Administration of IM Epinephrine via Syringe


Unfortunately, the rising cost of the injectors and their short expiration periods create a significant financial burden on the EMS agencies. King County Washington EMS system, which uses the “Check and Inject” program, estimates they have saved $335,000 annually by switching to a syringe method. According to a recent survey, 13 states have training programs to allow BLS to inject epinephrine and 7 others are considering it. 

Basic Life Support Access to Injectable Epinephrine across the United States

Evidence/Value of Safety of BLS Syringe Injection

“EMTs successfully implemented the manual “Check and Inject” program for severe allergic reactions and anaphylaxis in a manner that typically agreed with physician review and without any overt identified safety issues..”

TECHNICIANS FOR ANAPHYLAXIS.” Prehospital Emergency Care; January 15, 2018, Published Online (1-7)

Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis

“Based on the results of a State Emergency Medical Advisory Committee (SEMAC) demonstration project, the New York State Emergency Medical Service Advisory Council (SEMSCO) approved Syringe Epinephrine for Emergency Medical Technicians (Check & Inject NY) at the September 14, 2016 meeting. The project established that EMTs, with the appropriate training may administer the proper dose of epinephrine for a patient experiencing a severe anaphylactic reaction using a specific 1cc syringe. Additionally, the project realized a significant cost saving over maintaining epinephrine auto-injectors.

– Bureau of Emergency Medical Services and Trauma Systems POLICY STATEMENT 17-06, May 24, 2017

I am all for this program.  Some have argued that this is a skill that should be reserved for paramedics, but to me, it is a skill easily taught.  EMTs can administer this drug safely in life-threatening situations and the cost savings can be used to improve other aspects of the EMS system.