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The Triton


Medical training means crew don’t need EpiPens to treat anaphylaxis


By Rebecca Castellano

Dominating the news last month was a significant price increase of the EpiPen, an auto-injector device that delivers a pre-measured amount of epinephrine, also known as adrenaline, to individuals who suffer from severe allergic reaction.

What the news stories have neglected to note is that there are several brands of adrenaline auto-injector pens on the market that are affordable and available. Many of these are only available and affordable outside of the United States.

Epinephrine itself is an inexpensive drug; it’s the auto-injector delivery method that is expensive. The information here is important to understand the medical need, reduce unnecessary expenditure and improve medical outcomes.

Anaphylaxis is a life-threatening allergic reaction to a chemical that one may encounter in everyday life that then becomes an allergen. The allergen can be many things, but typically is a food such as shellfish or nuts, insect venom from bees or wasps, or a toxin from jellyfish, molds or algae.

For those allergic to a substance, their immune system overreacts to the allergen by releasing chemicals that cause allergy symptoms. Typically, these symptoms may be mild on a first exposure and may occur in only one location of the body.

However, many people may not recall a first exposure if it was mild or they were young. On a repeated exposure, some people may react in a severe way, called an anaphylactic reaction. This reaction typically affects more than one part of the body.

Anaphylaxis requires immediate medical treatment, including but not limited to an injection of epinephrine and a trip to an emergency medical facility. If it isn’t treated properly, anaphylaxis can be fatal.

The first signs of an anaphylactic reaction may look like typical allergy symptoms, a runny nose or a skin rash. But within seconds or minutes, more serious symptoms appear.

One out of 5 people may have a second anaphylactic reaction within 12 hours of the first. This is called a biphasic anaphylaxis. Close medical monitoring is essential after an initial reaction.

Epinephrine is the most effective treatment for anaphylaxis, and the shot should be given quickly, at the onset of symptoms. Quality medical kits will include boxes of epinephrine/adrenaline in ampuls or prefilled syringes, and the dose is double of that provided in an auto injector. This adrenaline can be easily pulled into a needle and syringe, also supplied in the medical kit, and is administered by intramuscular injection to a victim. This requires some skill, but is easily learned by anyone with some proper medical training. Most yacht captains and senior crew have had advanced medical training and all crew should look to add these skills to their resume.

The auto-injector pen was designed to be self-carried and self-administered by persons with known anaphylactic allergies. The epinephrine dose in the auto-injector buys a victim about 10 minutes until additional dose and other medical intervention is needed. Having an auto-injector inside a yacht’s medical kit defeats the purpose of its design for quick use.

Yachts and yacht crew need not incur the great cost of buying EpiPens. Having a needle, syringe and ampul of adrenaline in the main medical kit, a tender kit or in a small box on your person is equally effective.

The yacht’s medical kit will also contain additional medicines and diagnostic equipment necessary to ensure adequate response to most medical emergencies. Having the full medical kit at hand and telemedicine support to an “on call” doctor during an anaphylactic episode is strongly advised. The on-call doctor will guide someone administering aid through the proper treatment until a victim can be transported to a medical facility.

“At risk” guests or crew members should take steps to keep themselves safe. Having a lot of auto-injectors scattered about does not improve the outcome of an anaphylactic episode. Education, training and the proper use of adequate medical tools does.

Anyone with asthma or a family history of anaphylaxis is at higher risk of an episode. Anyone who has had an anaphylaxis reaction before should wear an alert tag and carry at least two doses of epinephrine with them at all times.

Rebecca Castellano is a registered nurse and sales executive with Medical Support Offshore ( Comments are welcome at

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