Anaphylaxis Cases Treated By out-of-Hospital EMS in Western Quebec

Marissa A. Love, MD, Madison Breeden, BS, Kyle Dack, BA, Alyssa Milner, BA, Andrew C. Rorie, MD, Selina A. Gierer, DO; University of Kansas Medical Center, Kansas City, KS. RATIONALE: We sought to identify geographic disparities and existing barriers to receiving life-saving epinephrine in Kansas schools. METHODS: A survey of school nurses was conducted at the 2015 Kansas School Nurse Association conference. Excel was used to analyze the descriptive data, which was compared to demographics published by the U.S. federal government. RESULTS: In 2009, the Kansas legislature authorized accredited schools to stock emergency epinephrine, pre-dating federal legislation in 2013. Unfortunately, stock epinephrine remains limited to only a few Kansas communities. Our survey revealed significant disparities in implementing stock epinephrine, with 59 of 105 counties reporting. Only 20 counties stocked epinephrine in at least 1 school. When stratifying by household income, 60% of schools that stocked epinephrine were in the top 10% of wealthy counties, whereas 41% that did not were in the bottom 50%. Of schools stocking epinephrine, 35% were in the wealthiest county. Further, 70% of schools with stock epinephrine were associated with the largest urban cores in Kansas. Nurses cited cost, legal liability, having a prescribing physician, lack of staff knowledge or training, and lack of administrator support as reasons why injectable epinephrine was not stocked in their schools. CONCLUSIONS: Our study reveals unequal access to life-saving epinephrine across Kansas, despite state and federal legislation. Further investigation is necessary to resolve this inequality, which disproportionately affects Kansas communities.