Epinephrine Access and Emergency Treatment Act
Anaphylaxis is an acute, life-threatening condition that is mostly caused by systemic allergic reactions. It starts suddenly upon trigger by several things, including food ingestion, and can escalate to a fatal state. In emergency cases, the most effective first-line treatment for anaphylaxis is administration of intermuscular epinephrine using an auto-injector (Cooke & Meize-Grochowski, 2019). The problem is that some of the extreme cases of the allergic reactions happen while patients are in institutions such as schools, and churches. People who have had similar attacks in the past can help in such situation if they are licensed. The New Jersey A190 bill is a revision to the Epinephrine Access and Emergency Treatment Act.
The passing of this Act into bill will demonstrate an endeavor to prevent fatalities from anaphylaxis, a fatal condition that is effectively curable using epinephrine. Moreover, it will increase the use of epinephrine in schools and other institutions as it removes some restrictions in its administration. The federal government has made provision for the correct use of epinephrine but the challenge is that its adoption at the state level continuous to have differ in its implementation. A comprehensive review by Volerman et al. (2022) reveals that all the 50 states and Washington DC permits undesignated epinephrine in learning institutions. However, the main problem is that majority of the states only allow the medication in school without mandating its stock. Moreover, there are differences in epinephrine procumbent procedures, choice of stakeholders, training, administration, and liability. Thus, a person who has relocated from one state to the next should seek to understand the law requirements to avoid legal implications
The bill is an extension of an existing law with several stakeholders, including the lawmakers, pharmaceutical companies, people with allergies, schools, and healthcare workers. The bill will be officially introduced on November 1, 2022 (NJ, 2022). It will make it possible for any individual with an epinephrine auto-injector device including a valid prescription for the adult or a minor under their guardianship to administer the medication in good faith to a person with anaphylaxis (New Jersey A190, 2022). Consequently, there will be no civil liability to the person who administers the epinephrine for free. Noteworthy, there is already a law in place which demands that for a person to get permission on obtaining, administering, maintain, and disposing of the medication, they must complete an educational program with approval from the health commissioner. Upon passing the bill, the people will not only be allowed to self-inject the drug and administer to another person during emergency cases.
The bill will allow competent healthcare professionals with license to prescribe and dispense epinephrine auto-injector devices, directly or through a standing order, to an authorized person. Further, an entity that employs a person for administering the medication will adhere to the standards and protocol established through the commissioner’s regulation (New Jersey A190, 2022). The policy environment for administering the medication must be during emergency cases where the patient is displaying signs and symptoms of anaphylaxis.
Anaphylaxis is a national concern and is bound to increase, given the escalating appearance of food allergies. All people are at risk of developing the condition, implying that any barrier to its treatment affects many individuals, especially children who already have a history of allergies. The diagnosis of anaphylaxis is likely to be positive when there is a fast progression of symptoms, primarily within 30 minutes of exposure to an allergen of body systems such as central nervous, gastrointestinal, and respiratory symptoms (Cooke & Maize-Grochowski, 2019). The reaction may involve the mucosa, skin, or both and at least on compromise the respiratory system or low blood pressure. Inability to correctly identify anaphylaxis causes under treatment. Yet, to date, there is no diagnostic test to affirm the condition.
Unfortunately, there have been many barriers to the administration of the drug due to many factors. One study involving preschool children with a prevalence of anaphylaxis established that only 30% of those who need epinephrine shots get them when needed (Prince et al., 2015). One of the reasons is the rising cost of the medication making it hard for some families to afford. In 2016, the cost of 2 EpiPens was more than $700, representing a 545% increase since 2001 (Prince et al., 2018). The high cost causes schools, camps, and individuals not to have the drug readily during emergency cases. Moreover, the public does not appear to be supporting the bill because of misconceptions that deter patients and their caregivers from using epinephrine even when it is available. Some of the beliefs that people have include perceived high risk for individuals with an history of cardiovascular disease and infants (Prince et al., 2018). Furthermore, there are people who believe that the drug has adverse effects such that immediately after use, a person should be taken to the emergency department.
The passing of the bill into law will benefit many people with allergic reactions and those with a history of anaphylaxis. Particularly, the people who cannot afford to buy the medicine will experience some relief because it can be administered to them by those with the same issue in good faith. The Act will provide guidance to school regulations and practices regarding storage and administration of the medication. In addition, it will benefit the licensed healthcare workers to avoid legal implications when they authorized the administration of epinephrine. The implication is that the incidences of sudden deaths from anaphylaxis will significantly reduce. The family members of patients will not have to worry about the dangers of any food that they give their significant others with the same disease. Therefore, the Act has a nationwide positive effect given that all people, including the ones that have no history of allergic reactions to food, can still develop the condition.
There have been related laws on the use of epinephrine for emergency anaphylaxis in the past. Particularly, President Barack Obama signed the Emergency Epinephrine Act on November 13, 2013 (Shaker, 2020). The law was an amendment to the Public 3 Health Service Act, which gave license for increasing preferences on some asthma related grants across schools that permitted stock and administration of epinephrine. The past challenge regarding the law is that Epinephrine Access and Emergency Treatment Act had some restrictions that limit saving the lives of patients when in severe danger of death following an allergic reaction. Upon being signed, the Act will be operational immediately and the cost will be covered by the government, patients, and institutions such as schools. Non-governmental, and private organizations are welcome to support people with anaphylaxis.
The legislators must make several assumptions when discussing and passing this Act into a bill. For instance, they have to assume that the people who have successfully completed an educational program with the health commissioner on the administration, maintenance, and disposal of the epinephrine can identify when a person’s symptoms show they have anaphylaxis. Furthermore, they assume that because a patient or guarding has experience in self-injecting or giving the medication to those they are guardians over, they can apply the same skill to others. In addition, they must believe that even though the drug is expensive, those who offer it in emergency cases will not charge the patients but do so in good faith.
Policy Argument
Information: People who suffer from anaphylaxis have severe symptoms that can escalate within 30 minutes to a fatal level when there is no proper and immediate intervention.
Therefore
Claim: The legislators should discuss and approve the NJ A190 Extends “Epinephrine Access and Emergency Treatment Act into a bill in the Senate.
Warrant: The bill give authority to people who have successfully completed and been awarded a certificate to administer the epinephrine auto-injector device to any person presenting with symptoms and signs of anaphylaxis in good faith and without charging money. The person will not be liable should there be other dangers because their intention was to help (New Jersey A190, 2022). The other warrant is that licensed healthcare professionals will have the authority to give an order to such persons to administer the epinephrine, whether in person or virtually. The final warrant is that entities with an employee authorized to maintain, administer and dispose of the medicine will follow the standards and protocols provided by the commissioner.
Backing: Epinephrine is the most effective drug when correctly administered to save the lives of people suffering from an emergency Anaphylaxis (Cooke & Meize-Grochowski, 2019). Yet, it is expensive and not readily available to the people who need it the most.
Rebuttal: Allowing patients to administer the epinephrine drug based on their experience with Anaphylaxis to identify and correctly diagnose the signs and symptoms of others may result in high false positives. As a result, there is a high chance that there will be increased abuse of the drugs. Moreover, issues of consent and liability in the case where the client is injured may result in conflict between parties involved.
References
Cooke, A. T., & Meize-Grochowski, R. (2019). Epinephrine auto-injectors for anaphylaxis treatment in the school setting: A Discussion Paper. SAGE Open Nursing, 5(1), 237796081984524. Web.
New Jersey A190 | 2022-2023 | Regular Session Introduced. (2022). LegiScan. Web.
NJ – A190. (2022). BillTrack50. Web.
Prince, B. T., Mikhail, I., & Stukus, D. R. (2018). Underuse of Epinephrine for the Treatment of Anaphylaxis: Missed Opportunities. Journal of Asthma and Allergy, 11(1), 143-151. Web.
Shaker, M. (2020). The stock epinephrine law: Five years later and counting. Annals of Allergy, Asthma & Immunology, 124(5), 447-448.
Volerman, A., Brindley, C., Amerson, N., Pressley, T., & Woolverton, N. (2021). A national review of state laws for stock epinephrine in schools. Journal of School Health, 92(2), 209-222. Web.