There is no free market
Michael Kelly

Hey Michael,

First, let me say that I respect your experience as a cowboy learning to draw and inject cows. (And my sympathies, #18s are a bitch to accidentally stab yourself with!) I can certainly see how that leads you to ask why people who need Epi-Pens can’t just inject from a syringe.

I just wanted to share my opinion, as someone who does weekly medicine injections and who also carries an Epi-Pen. My normal meds process is take my vial, use an #18 1.5" needle to draw up a mL of med, push out the air, switch to a #23 1" needle, find a patch on my thigh that doesn’t have any visible artery/veins, insert needle, pull up to aspirate to make sure I haven’t hit blood, and then inject intramuscular. I’ve been doing this for 9 months so I think I’m getting good at it, but it still takes me about 7 minutes on a fast day. I’m trying to get it down to 5.

I’ve also experienced anaphylaxis. I know the sudden sense of distress, of not being able to breathe, of that Sense Of Impending Doom descending. I thought it was BS when my allergist told me some people could feel it coming on by a sensation of dying, till I felt it the first time. It’s a sensation of crushing pain in the chest and an overwhelming panicking feeling, like being caught in a ripcurrent and being sure you’re going to drown. I can tell you that if I had a full kit on me of syringe and vial, I would not be able to go through the proper steps of “Draw right amount, tap out air bubble, find thigh safe spot, inject” in a short enough amount of time to save myself before I slip unconscious. If I had a pre-loaded syringe with the needle on and capped, I could probably make a self-inject work, but I know the mental effects of not being able to breathe right are going to make it a lot more likely that I either draw the wrong amount of meds (potentially over or underdosing myself, thus causing death in a different way), or accidentally injecting into a blood vessel.

The Epi-Pen autoinjector is so awesome because it’s a preloaded dose of the right amount and it’s pull off cap, apply to thigh — I’ve gotten it down to 10 seconds from bag to thigh with the trainer. It can go through most kind of pants, unlike my #23 needle. Also, if I have gone unconscious, a passerby could apply it without the more detailed knowledge that a vial/syringe setup would need.

For those reasons, I disagree that just switching to a vial/syringe setup would save everyone. Would it be cheaper? Sure! I’ve heard that some EMTs are going to switch to vial/syringes in response kits, rather than Epis, and I think that’s great because they have the medical training to dose and inject correctly. For end users who have never self-injected, or whose anaphylaxis is such rapid onset that they’re not going to have the time to make it through the multi-step process, the auto-injectors provide a level of automation that saves lives.

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