Initially published 2013, updated January 2020
Carrying epinephrine on day and overnight trips has become common practice for outdoor programs with staff trained in Wilderness First Aid (WFA) or Wilderness First Responder (WFR), or who have participated in an epinephrine training. Due to the seriousness of anaphylaxis, schools and other front country organizations are also likely to have staff trained in epinephrine administration. Additionally, it is common for individuals with known allergies to carry a personal prescription of epinephrine. Over the past several years a variety of manufacturers have produced epinephrine auto-injectors. It is important for individuals trained and responsible for the use epinephrine to be familiar with the variety of epinephrine auto-injectors. In addition, prescriptions other than epinephrine are also beginning to be placed in similar auto-injecting devices. Prior to use of any medication; confirm the type of medication, who it is prescribed to, and that it is within the expiration date.
Most epinephrine auto-injectors are available in two dosages; 0.15 mg dose for individuals 33-66 pounds and 0.30mg for individuals above 66 pounds. The Auvi-Q has a third dosage size option that supports administration to infants and toddlers weighing 16.5-33 lbs.
See manufacturer websites, your doctor, or your program’s medical director for specific and detailed instructions for each of the auto-injectors listed below.
EpiPen and EpiPen Jr.
The EpiPen adult dose is in a device with a yellow label and the EpiPen Jr (child) has a green label. EpiPen works by removing the carrying case, removing the blue “safety” cap, pressing the application end of the device into the lateral (outer) aspect of the mid-thigh until the device clicks, hold in place for ten seconds, and dispose of device in an appropriate location. Both the EpiPen and EpiPen Jr. are designed to administer only one dose of epinephrine.
Watch the EpiPen training video (leaves the LWM website and opens a new webpage)
Adrenaclick is administered similarly to the EpiPen. The additional step of removing the cap on the injection end of the device is needed to prepare for administration. The child dose has a purple colored carrying case and the adult dose has a black carrying case. Both child and adult devices administer one dose of epinephrine.
Watch the Adrenaclick training video (leaves the LWM website and opens a new webpage)
Auvi-Q was recalled in 2015, but has since returned to the US market. Auvi-Q (Allerject in Canada) is a smaller pocket sized device. The device provides audio prompts to assist in administration of medication. The prompts work in the same way an AED provides direction for usage. The red packaged Auvi-Q is the adult dose, blue packaging indicates the dose for children weighing 33-66 lbs. and the purple package indicates a dose for infants and toddlers weighing 16.5-33 lbs.. The Auvi-Q is designed to administer a single dose of epinephrine.
Watch the Auvi-Q training video (leaves the LWM website and opens a new webpage)
TwinJect (Discontinued March 30, 2012)
The TwinJect injector holds two usable doses of epinephrine. The first dose is administered similarly to the Adrenaclick. The second dose is accessed by removing the red cap on the injection side of the auto-injector. After removal of the cap, a syringe (same needle as first dose) is accessible for the administration of the second dose. Due to the multiple components to the TwinJect, it is highly advisable for individuals who have exposure to the device receive training with TwinJect training tools.
Non-Epinephrine Auto Injectors
Due to the ease of use, other medication (i.e., Alsuma, acute migraine medication) has been placed in auto-injectors. The device looks similar to epinephrine injectors and care needs to be taken to ensure medications are not confused at the time of administration. It has been suggested by members of the medical community that programs label non-epinephrine injectors as “NOT EPI” to provide fast identification during emergencies. This practice may reduce the potential of confusion or misadministration of medication by program staff.
Outdoor travel and recreation does not often support epinephrine's 68-77 degree F storage temperature range. Students participating in the LWM medical elective tested a variety of options for protecting temperature sensitive medications in environmentally dynamic environments.
Gaudio F, Lemery J, Johnson D. Wilderness Medical Society roundtable report: recommendations on the use of epinephrine in outdoor education and wilderness settings. Wilderness & Environmental Medicine. 2010; 21:185-187.
EpiPen (2020). Patient Information. Retrieved from EpiPen. website http://epipen.com
Adrenaclick (2020). Patient Information. Retrieved from Adrenaclick. website https://www.adrenaclick.com/usage.php
TwinJect (2013). Learn More About TwinJect. Retrieved from TwinJect. website http://twinject.com/auto-injector/learn-more.html
Auvi-Q(2020). Patient Information. Retrieved from Auvi-Q. website http://www.auvi-q.com/media/pdf/Patient-Information.pdf
Hawkins S, Weil C, Fitzpatrick D. Epinephrine Autoinjector Warning. Wilderness & Environmental Medicine.2012; 23:371-372.
In order to safely spend time in remote locations, it is necessary for preparations to include appropriate medical training and the creation of a first aid kit with supplies to assist in the case of an emergency. It is important to know how to design a kit that meets the needs of each individual or group and to understand that there is not one perfect kit for all travel. In order to create a first aid kit that meets the needs of each trip you take, LWM encourages you to consider the following:
The practice of wilderness medicine teaches improvisation, but there are a few items that are hard to improvise effectively. Emergency response can place you in a situation where you come in contact with body substances such as blood, vomit, feces and urine. Body substance isolation (BSI) is the practice of protecting your exposure from these substances to limit the risk of disease transmission. Non-latex gloves and a CPR mask should be considered mandatory items for even the smallest first aid kit.
First aid kits are not “buy it and forget it” purchases. Items get used, wet, hot, cold, expire, and dirty due to all of the places that you take your kit. Ensure that you have the appropriate items available when you need them by periodically inventorying your first aid kit and restocking items that are used, worn out, or expired.
Acquiring a kit
The simplest way to get your first medical kit is to purchase a commercially made kit from an outdoor retailer. Commercially designed kits use names or numbers to indicated the kit’s intended use. Purchasing a pre-made commercial kit allows the purchaser to get most of the necessary items along with a carrying case without having to purchase full boxes of many of the items for the kit. As you look at which kit to purchase and maintain, ask yourself the following questions:
Who are you traveling with?
Do you travel with groups, adults, kids or solo? The more people you travel with the more opportunities present themselves to use the items in your kit. With group travel, consider adding additional reserves of commonly used items such as adhesive bandages and pain relievers. For expeditions with adults at risk for heart conditions, ensure that aspirin is in the kit. Additionally, you may consider adding a dental kit with temporary filling for adults with a history of tooth issues. If kids are on the trip, small items like bandages with cartoon characters or a small toy can go a long way to decrease their stress.
How long will you be out?
Ensure that you have an inventory that matches the length of your trip . For longer trips, increase the number of common use items such as bandages, athletic tape, non-latex gloves and over-the-counter medications. The number of these items can be decreased on short day trips. On day trips to remote environments, consider bringing an emergency blanket in the case that injury lengthens your trip resulting in an unexpected overnight.
What type of activity are you doing?
The items carried in a first aid kit should match the potential illnesses or injuries that are associated with the activity. Hikers commonly experience blisters and musculoskeletal injuries, making it beneficial to have kit including bandages, mole foam, an elastic wrap and pain relievers. A nail clipper in a first aid kit can also can reduce many potential foot issues when on trail runs, day hikes, or backpacking trips. Boaters can add a small container of high strength sunscreen and sunglasses to reduce the potential of sunburn from the reflection of the sun on the water if they run out of (or forget) sunscreen or loose their sunglasses.
What is your level of training?
It does not make sense to carry items in your first aid kit that you do not know how to use. If there is something in your kit you do not understand, take time to research what the item is used for and how to use it appropriately. In addition to your current understanding of medicine, consider adding knowledge to what you carry with your first aid kit.
Longleaf Wilderness Medicine courses address how to create first aid kits that will allow for response to minor and major emergencies. Check out a LWM course to develop your assessment and treatment skills for when the unexpected happens.