Epi Pens

[Toddy]

Thanks Adi, I might well try that

Pict, I really hope neither of us have to use the pens, but thank you for adding your experiences; I admit I have wondered just what it might feel like to both need and have administered the epipen.

Have you looked at the research results from the American military testing of 'out of date' pharmaceuticals ?
Makes for very interesting reading. Apart from nitroglycerine heart medicines, insulin, liquid anti biotics and certain water purification tablets, virtually all pharmaceuticals are thoroughly effective beyond their supposed 'expiry' dates. Apparantly dispensing chemists routinely put the date at a year from date they re-packaged or sold the drugs, regardless of the manufacturer's own expiry dates.
The research has literally saved the American military millions of dollars with no loss of efficacy of the medicines.

cheers,
Toddy

[santaman2000]

True Toddy but as epinephrine and insulin are both hormones, I suspect they might expire on a similar schedule to one another. Just a guess though. At any rate since epinephrine is used for emergencies would you really want to depend on it? At at the same time, if all you had was an expired one, what are your choices?

[Toddy]

Much my point tbh, especially if they aren't available in Brazil. Tbh if experience showed my reaction to be so dire I think I'd try to source and import if necessary.

Storage can be critical with them though; high temperatures in particular seem to be very detrimental to the contents of the pen.

cheers,
M

[santaman2000]

Yeah, temperature is the problem for my diabetic meds also. Not on insulin but I was injecting Byetta for years until last week when I was switched to Victoza (also injected) Supposedly no need to refrigerate but the listed temp range (40ish up to 86F) isn't realistic in the outdoors here in Summer. An insulated lunch bag with a cold pack works for a day trip but after that I'm S.O.L.

[rik_uk3]

"Have you looked at the research results from the American military testing of 'out of date' pharmaceuticals ?"

Interesting point. There were thousands of morphine ampoules recovered from a WW2 ship wreck and the drug was still perfect, some of the morphine issued to troops in the Falklands was packed in WW2 as well. I cleared out an old first aid kit last year, one I'd taken to the 2006 bushmoot and there was a Ventolin inhaler dated 2007 and my lad used it when he ran out/lost his one weekend...worked and did the job. I'm not advocating relying on out of date drugs but it makes you think how many are wasted. Don't know if it still happens but the NHS used to send out of date antibiotics to third world countries.

[TeeDee]

Have you looked at the research results from the American military testing of 'out of date' pharmaceuticals ?
Makes for very interesting reading. Apart from nitroglycerine heart medicines, insulin, liquid anti biotics and certain water purification tablets, virtually all pharmaceuticals are thoroughly effective beyond their supposed 'expiry' dates. Apparantly dispensing chemists routinely put the date at a year from date they re-packaged or sold the drugs, regardless of the manufacturer's own expiry dates.
The research has literally saved the American military millions of dollars with no loss of efficacy of the medicines.

cheers,
Toddy

Can anyone provide a link for this please? I've heard of the report but I think its been pulled down from most websites due to pharma-Industrial pressure. I 'd be interested in reading it if anyone can stick an active link up.

thanks

[Pict]

I do need to get a new pair of Epi-pens. I still have the expired one. As noted they are not cheap, I do need a prescription, and they are only available to me in the US. So for me all the planets have to align. Most of the time I go back the US it is for six months to a year and I keep telling myself that I'll get a new pair of epi's at the end of my stay so they won't expire so soon after I get back home.

[dwardo]

"Have you looked at the research results from the American military testing of 'out of date' pharmaceuticals ?"

Interesting point. There were thousands of morphine ampoules recovered from a WW2 ship wreck and the drug was still perfect, some of the morphine issued to troops in the Falklands was packed in WW2 as well. I cleared out an old first aid kit last year, one I'd taken to the 2006 bushmoot and there was a Ventolin inhaler dated 2007 and my lad used it when he ran out/lost his one weekend...worked and did the job. I'm not advocating relying on out of date drugs but it makes you think how many are wasted. Don't know if it still happens but the NHS used to send out of date antibiotics to third world countries.

Just been to the docs to have my inhalers renewed, both were 18 months out of date and if it wasnt for the missus spotting the date i would still be using them

[Adi.]

On your 2nd point; I'm not so sure. Here it's regulated by the individual states and I know of no state that has a separate standard of care for foreigners. However I suppose expeds here might be limited to less remote sites where the issue wouldn't come up.

The definition of expedition medicine is more than 4 hours from professional medical care.

[santaman2000]

The definition of expedition medicine is more than 4 hours from professional medical care.

Difficult to imagine. I can certainly imagine many places (even here) that are more than 4 hours from professional medical care BUT...If a group were truly called an "expedition" then one would think that a foray to such a place would include a properly equipped medical "professional."

[nigeltm]

More than 4 hrs to medical care can cover many areas in the UK. Even in well travelled areas such as the Brecon Beacons it can take a MR team many hours to reach a casualty.

Once you take into account delays in altering the MR incident controller (sometimes a surprisingly long time, you've got to love Police PolSARs!), paging the team, mobilising and driving to the roadhead/RV just getting to the area can take a couple of hours. Then even if you know the casualty location it may take a few hours to walk in with medical equipment, especially if the weather is bad and an Air Ambulance or RAF heli isn't an option. If it is a search before rescue then in a worst case scenario you could be talking tens of hours before a drugs pack is on site. With that sort of delay an Epi pen very well may be pointless by the time help gets there.

I'd say carrying an Epi pen is an expensive and often pointless exercise in the UK for the "non-professional". The chances of someone developing a reaction without prior indicators (eg. family history) is pretty low. Most people will never have a severe reaction so why carry one. Using the "just in case" argument you can justify carrying lots of shiney kit you'll never use. It may be fun also pointless.

[santaman2000]

Agreed, there are definitely places where medical care is beyond 4 hours (especially if you factor in the search time) I suppose what I was/am struggling with here is the definition of an expedition; it just seems to me that, as stated, a qualified and equipped medical professional would be a member of such a group. If you do have such a member then obviously you're carrying your professional medical care along with you and therefore cain't be 4 hours from it.

All that said, when I take my family into the deep woods (or sometimes not so deep) my preferred choice of meds are OTC anti-histamines and anti-itch creams. Granted, none of us have any known allergies; none that anything I could carry would help anyway (I don't count my daughter's Celiac condition nor her Crohn's Disease as allergies) I suspect the best thing I could carry for her on deep trips (and need to get one) is a personal EPRB.

[Adi.]

Agreed, there are definitely places where medical care is beyond 4 hours (especially if you factor in the search time) I suppose what I was/am struggling with here is the definition of an expedition; it just seems to me that, as stated, a qualified and equipped medical professional would be a member of such a group. If you do have such a member then obviously you're carrying your professional medical care along with you and therefore cannot be 4 hours from it.

All that said, when I take my family into the deep woods (or sometimes not so deep) my preferred choice of meds are OTC anti-histamines and anti-itch creams. Granted, none of us have any known allergies; none that anything I could carry would help anyway (I don't count my daughter's Celiac condition nor her Crohn's Disease as allergies) I suspect the best thing I could carry for her on deep trips (and need to get one) is a personal EPRB.

I believe it is called Wilderness First Aid in the States. Laws are different world wide so courses from one county might be different to those in another country but most are recognised worldwide. Expedition medicine in the UK is more like advanced first aid really although the courses go up in complexity. The first two courses are aimed at UK trips into the hills and just touch on some advanced skills to provide a slightly higher level of life support. The second two courses are aimed at foreign travellers and goes into a higher level of life support, some drug use and IV therapy (although IV has to be taught by a medical health professional with the relevant qualification). Then there is a 5th course for Health professionals. You can also go on to do PHTLS and ATLS if you are really that way inclined although doing these courses it is still advisable to do the 5th course.

If you are on a large money trip that can afford a doctor they will still want Expedition medics/first aiders on the team because the doctor often needs help or stays back at base camp.

Why would you do one of these courses? Well if you work with and take kids into the wilds then you need the qualification. But most people that do courses do them because they want a slightly higher knowledge for when they go on holidays or on trips into the hills for their friends and family, many people who take part in adventure sports also come on the courses.

I made the point earlier, epi pens are really there to give time during normal day to day life and don't have much use in remote locations unless you carry POM strength antihistamines but if you have been proscribed Epipen the POM drugs should not be an issue as you would normally be on a script for them too I believe. And if not if you were to speak to your GP I would have thought they would happy to prescribe you a suitable script if you were doing something out of the ordinary.

Nigel Am I hear what you are saying about PolSAR but I think it is important for any SAR team to build a good relationship with its PolSAR officers. Once they have the respect for the team the team will be deployed a lot faster and more often, especially as the teams improve their standards.

[Pict]

So by definition standing in line at the government medicine clinic here is considered expedition medicine... learn something new every day.

[Adi.]

So by definition standing in line at the government medicine clinic here is considered expedition medicine... learn something new every day.

LOL yeap. That is why its time and not distance. If over 4 hours from definitive care then you can start treating people. lol

[nigeltm]

Nigel Am I hear what you are saying about PolSAR but I think it is important for any SAR team to build a good relationship with its PolSAR officers. Once they have the respect for the team the team will be deployed a lot faster and more often, especially as the teams improve their standards.

We have a couple of PolSARs in the team. Joking aside they're not that bad :-) It's not their fault that at times the communication within the Police service and with other agencies can be a bit confused. Something for us to all work on and improve.

[santaman2000]

I believe it is called Wilderness First Aid in the States...

If you are on a large money trip that can afford a doctor they will still want Expedition medics/first aiders on the team...

Why would you do one of these courses? Well if you work with and take kids into the wilds then you need the qualification...

...if you have been proscribed Epipen the POM drugs should not be an issue as you would normally be on a script for them too I believe. And if not if you were to speak to your GP I would have thought they would happy to prescribe you a suitable script if you were doing something out of the ordinary...

On your 1st point, We only have one level of 1st aid here. It's the general course taught by either the Red Cross or a commercial company teaching industrial 1st aid to satisfy OSHA requirements. Either of them are based on the premise of, "stabilize and call 911." Additional courses are for 1st responders (cops, firemen, EMTs, etc. that might be responding to an emergency) They are progressively more advanced but they too are based on stabilize for transport. There are some courses taught for wilderness type situations but generally they're not certified or accredited in any way.

On your 2nd point I expect you're right about a Dr. remaining in base camp but I suppose I was vague about what I was considering to be a medical "professional." I was including EMTs (Emergency Medical Technicians) and Paramedics in my estimation of "professional."

On your 3rd point, the only requirement here for taking kids (medical requirement) is the same as for caring for them in an urban day care center. Namely basic 1st aid & CPR certification; although I expect for liability purposes you'd want something more (preferably a good evac plan) I suppose I'm being presumptuous in this statement as I don't know the law in every state but I believe it's generally consistent.

On your 4th point I agree completely.

[Adi.]

On your 1st point, We only have one level of 1st aid here.

Really? What are these courses then? http://www.remotemedical.com/wildern...ducation-Group

[Adi.]

Really? What are these courses then? http://www.remotemedical.com/wildern...ducation-Group

I meant to add this Quote... "is recognized world-wide by groups such as the American Mountain Guides Association, the Association of Canadian Mountain Guides, the US Government, as well as major outdoor programs."

[santaman2000]

Adi those courses are nothing more than a commercial organization teaching for profit. I haven't taken them so I have no idea if they are actually any good or not. The fact that they are recognized by such organizations as The American Mountain Guides Assn, The Assn of Canadian Mountain Guides, etc. means nothing because none of these organizations are recognized either. The statement that they are recognized by the US government is equally meaningless as medical certification here is done by the individual states and the federal government has no authority beyond approving drugs (the FDA) and whatever medicine is practiced in the military (even that must fall within state guidelines)

In short, that ad is a misleading commercial solicitation bordering on an outright falsehood.