New Jersey Assembly Bill A1206: “Requires restaurants to maintain supply of epinephrine and permit trained employees to administer epinephrine on-site to persons suffering from anaphylaxis” was introduced in 2018. It is sponsored by the Democrat Representatives Arthur Barclay and Benjie Wimberly. The bill aims to ensure that restaurants maintain a supply of epinephrine to be administered in case allergic patients suffer from anaphylaxis. This research paper will examine the bill, the ethical and advocacy issues related to the policy, perform a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis on it, and finally, suggest ways in which it can be improved.
Summary
The bill explains that restaurants carry a high risk of causing life-threatening anaphylactic attacks. Since a variety of allergens can be present in the food offered, whether due to a chosen dish’s ingredients themselves, or cross-contamination due to a large number of things being cooked in the kitchen, a customer might unknowingly ingest something to which they are allergic (NJ A1206). This is a life-threatening situation that can be easily resolved by an injection of epinephrine, commonly available in the form of auto-injection devices. Therefore, it posits that keeping a supply of this medicine and providing employees with training in its use is prudent.
Examination
A1206 aims to serve people with food allergies, particularly mentioning those who are unaware of said allergies. A survey by Gupta et al. (2019) claims that 10.8% of the US adult population suffer from such conditions. Furthermore, a study by Baloh, Winger, Shankar, Fajt, and Green (2016) points to only 62% of adults and 86% of children with food allergies carrying epinephrine. Radke et al. point out that “nearly half of reported fatal food allergy reactions over a 13-year period were caused by food from a restaurant or other food service establishment” (2017, p.1).
Finally, according to statistics, “the estimated incidence of fatal food anaphylaxis for an individual with [a] food allergy is low and adds little to overall mortality risk” (Turner et al., 2017, p. 1172). Nonetheless, when discussing possibilities to avoid fatalities, even low chances are not to be ignored. Therefore, there is a significant likelihood that one might not have the medicine available, and a supply maintained by the restaurant can resolve the emergency situation.
Another benefit is relieving emergency services workload, since the restaurant’s authorized employees can administer epinephrine before an ambulance arrives. However, since emergency procedures for anaphylaxis still require the patient to be delivered to an emergency room, this will not necessarily cause a significant reduction in the number of calls. Overall, A1206’s benefits are obvious, but they can prove to be minor and inefficient when considering the cost of implementation.
The bill is weakened by the fact that, in its current form, it does not clarify the source of funding for restaurants’ policies. Therefore, one can assume that it will incur additional expenses on the business owners, and may cause a reduction in employees’ salaries, an increase in prices, and be poorly received in general. A common perception that an epinephrine auto-injector is a common enough device to be available without specific provisions may lead to such requirements to be viewed as excessive.
Finally, as restaurants are a common business type, and maintaining oversight of another policy over all of them can be difficult. Overall, A1206’s proposition, while it has the potential of reducing fatalities, in its current form, is unclear, can be difficult to implement, and seen as excessive and wasteful. These factors posit the bill’s major weakness — it may not be cost-efficient, and the funding it would require would be better used elsewhere.
Ethics and Advocacy Issues
Ethically, the bill is straightforward: it aims to provide a potentially life-saving medicine in a setting where a particular life-threatening condition is common. Therefore, it readily falls within the principle of beneficence, ensuring patients’ well-being. However, the core principle of justice is also involved, as the bill seeks to make resources more readily available. Still, in its current state, it shifts the burden of implementation mainly onto business owners. Furthermore, considering the overall availability of epinephrine auto-injectors, their relatively short shelf life, and incidence of (not necessarily fatal) cases of anaphylaxis at restaurants, the likelihood of the devices’ expiration should be assessed. It is possible that this manner of distribution of resources would be wasteful, and, therefore, unfair.
Since the bill does not involve medical or nursing personnel directly, its relation to nursing advocacy issues is limited. However, there is a potential effect on the matter of safe staffing of emergency services, as it aims to redistribute the workload and allow some emergencies to be resolved by non-medical personnel present on site. This effect, while potentially beneficial, is, ultimately, minor, because an ambulance must still be called in case of an anaphylactic reaction. Another possible implication is that since large numbers of personnel need to be trained in the use of epinephrine auto-injector devices, this can detract from the funding that would otherwise be used for educating nurses.
SWOT Analysis
Summarizing the bill’s strengths, discussed above, one can conclude that the effects of requiring restaurants to carry a supply of epinephrine auto-injectors for emergency use would be beneficial. However, the bill’s weaknesses lie in its potential costs, which may outweigh its usefulness. It is, ultimately, targeting an unlikely cause of death, and although non-fatal cases of anaphylaxis are common, the probability of a restaurant’s supply expiring needs to be assessed. Therefore, further discussion should focus on a cost-benefit analysis, as well as clarifications to the sourcing and distribution of its funding.
Suggestions for Improvement
As stated previously, the bill suggests simple, straightforward, and obvious measures with limited opportunity for abuse. However, there is still room for improvement in organization and implementation. For instance, conditions may need to be provided for the amount of auto-injection devices to be stored at each restaurant. A similar bill, S2321, which is further in its progress, can be used to borrow concrete suggestions.
It aims to ensure that public libraries maintain a supply of opioid antidotes to be administered in case of an opioid overdose. It clarifies from what sources the funding of its suggested policies can be obtained, and suggests a grant program to distribute these funds between public libraries (NJ S2321). Similar clarifications and expansions would greatly benefit A1206 by ensuring that it offers specific measures.
Conclusion
A1206 is a straightforward suggestion whose implementation may is likely to save the lives of people suffering an anaphylactic reaction while at a restaurant. It may also reduce workload and work-related stress among emergency response personnel. However, the bill’s implementation would face difficulties caused by its broad area of application and the potential to be viewed as excessive and wasteful. In its current state, the bill is missing several key elements, such as funding considerations, regarding both the source of funds and the method of their distribution. Addressing these issues and performing a cost-benefit analysis of the proposed policies should, therefore, be the priority in further discussion of the bill.
References
Baloh, C. H., Winger, D., Shankar, T., Fajt, M. L., & Green, T. D. (2016). Likelihood of having self-injectable epinephrine in adult and pediatric patients presenting for evaluation of food allergy. Journal of Allergy and Clinical Immunology, 137(2), AB53. Web.
Gupta, R. S., Warren, C. M., Smith, B. M., Jiang, J., Blumenstock, J. A., Davis, M. M., … Nadeau, K. C. (2019). Prevalence and Severity of Food Allergies Among US Adults. JAMA Network Open, 2(1), e185630. Web.
NJ A1206: Requires restaurants to maintain supply of epinephrine and permit trained employees to administer epinephrine on-site to persons suffering from anaphylaxis, 218th Leg. (2018)
NJ S2321: Authorizes public libraries to maintain supply of opioid antidotes and permits emergency administration of opioid antidote by librarian or other trained library employee, 218th Leg. (2019)
Radke, T. J., Brown, L. G., Faw, B., Hedeen, N., Matis, M., Perez, P. … Ripley, D. (2016). Restaurant food allergy practices — Six selected sites, United States, 2014. Morbidity and Mortality Weekly Report, 66(15), 404–407. Web.
Turner, P. J., Jerschow, E., Umasunthar, T., Lin, R., Campbell, D. E., & Boyle, R. J. (2017). Fatal anaphylaxis: mortality rate and risk factors. The Journal of Allergy and Clinical Immunology: In Practice, 5(5), 1169-1178.