Washington State House of Representatives Office of Program Research	BILL ANALYSIS
Health Care Committee

ESB 5835

Brief Description:  Regarding administration of epinephrine.

Sponsors:  By Senators Finkbeiner, Thibaudeau, Winsley, McAuliffe, Costa, Honeyford, McCaslin, Kohl‑Welles, Prentice, Kline, Benton and Oke.

Brief Summary of Engrossed Bill

$Emergency Medical Technicians are allowed to carry and administer epinephrine indefinitely.

$Public school employees are allowed to administer epinephrine to students according to rules established by the state Nursing Care Quality Assurance Commission.

Hearing Date:  3/29/01

Staff:  Antonio Sanchez (786‑7383).

Background: 

Anaphylaxis (severe allergic reactions) is an allergic hypersensitivity reaction of the body to a foreign protein or drug.  Anaphylaxis can be caused by drugs, insect stings, foods, and inhalants.  In some cases it can result in convulsions, unconsciousness, and even death. Epinephrine is used to treat anaphylactic reactions. Those with severe allergies that could result in an anaphylactic reaction may receive a prescription to administer a dose of epinephrine through the use of an autoinjector device called the "Epi-Pen".

In 1999 the Washington State Legislature passed the "Kristine Kastner Act" requiring that all ambulance and aid services make epinephrine available to Emergency Medical Technicians (EMTs) in their supplies.  EMTs are now authorized to administer epinephrine to patients of any age with evidence of a prescription.  They are also authorized to administer epinephrine to patients under the age of 18 upon the request of a parent or guardian or upon the request of a person who presents written authorization from the patient, parent, or guardian.  The Department of Health was required to develop and distribute protocols and guidelines for medical training, establish the procurement process for the Epi-Pens, notify the over 500 licensed emergency medical services providers of the new requirements, and report to the Legislature on the statewide incidence of anaphylaxis and the training and care necessary to allow EMTs to carry and administer epinephrine.

The report by the Department of Health indicated that in 13 different counties across the state there were 26 different cases involving the use of Epi Pens by EMTs.  Of those cases, 50 percent showed improvement of their allergic condition, 42 percent  showed a reversal of the allergic reaction, and one patient was in cardiac arrest when the emergency medical services personnel arrived and the condition was considered irreversible.  Their recommendation was to authorize that EMTs continue to be allowed to carry and administer epinephrine.

The legislative authorization for allowing EMTs to continue to carry and administer epinephrine is scheduled to end on December 31, 2001.

In addition, under current law, public school employees other than registered nurses are not allowed to administer injections, including epinephrine.  Public school districts may use a variety of employees to provide health care services, and are not required to have registered nurses on staff.

Summary of Bill: 

The scheduled expiration date for the legislative authorization allowing Emergency Medical Technicians (EMTs) to continue to carry and administer epinephrine is removed. Emergency Medical Technicians will be allowed to carry and administer epinephrine indefinitely.

The state Nursing Care Quality Assurance Commission is directed to adopt rules and policies to allow public school districts to provide for the administration of epinephrine to students by school employees under certain circumstances.  Immunity is provided to employees who administer epinephrine to students in compliance with these rules, and employees are protected against employer reprisal when an employee refuses to agree to administer epinephrine.

Appropriation:  None.

Fiscal Note:  Available.

Effective Date:  Ninety days after adjournment of session in which bill is passed.