Anaphylaxis First Aid in the Community: Recognise It and Act Fast

Anaphylaxis First Aid in the Community: Recognise It and Act Fast

By Garry Perkins, former Paramedic and Founder of Sussex First Aid Courses Ltd

Anaphylaxis is one of those medical emergencies where recognising what is happening and taking prompt action really can save a life.

During more than 35 years working in emergency care as a paramedic, I have seen how quickly a person's condition can change. For parents, carers, grandparents, teachers, colleagues and members of the public, the thought of dealing with a severe allergic reaction can understandably feel frightening.

The important thing is to know what to look for and what to do.

My message is simple:

Recognise it. Give adrenaline. Call 999. Position safely.

Anaphylaxis is a severe and potentially life-threatening allergic reaction. It can develop very rapidly and affect a person's airway, breathing or circulation.

Common triggers include foods such as nuts, milk, eggs, fish and sesame, medicines, bee or wasp stings and latex. Sometimes the trigger may not immediately be obvious.

How do you recognise anaphylaxis?

One of the simplest ways of remembering the serious signs is to think:

A – Airway

Look for:

• Swelling of the tongue or throat

• Tightness in the throat

• Difficulty swallowing

• A change in the person's voice or a hoarse voice

• Noisy breathing

B – Breathing

Look for:

• Difficulty breathing

• Wheezing

• Persistent coughing

• Very fast breathing

• A feeling of tightness in the chest

• The person appearing to be struggling for breath

C – Circulation

Look for:

• Feeling faint or dizzy

• Pale, cold or clammy skin

• Confusion or becoming unusually tired

• Collapse

• Reduced level of consciousness

• Becoming unresponsive

There may also be swelling of the lips or face, an itchy raised rash, flushing, abdominal pain, vomiting or diarrhoea.

However, there is an important point that everyone should know:

A person does not have to have a rash to be experiencing anaphylaxis.

Serious airway, breathing or circulation problems can occur without the obvious red, blotchy skin or hives that many people associate with an allergic reaction.

That is why recognising the overall condition of the casualty is so important.

Anaphylaxis can happen quickly

Some reactions develop over several minutes while others can progress extremely rapidly.

A person may tell you that they suddenly feel very unwell, frightened or that something is seriously wrong.

If anaphylaxis is suspected, do not wait to see if the person gets worse.

Act.

Adrenaline is the first-line emergency treatment

People known to be at risk of anaphylaxis may have been prescribed an adrenaline auto-injector, such as an EpiPen or Jext.

If anaphylaxis is suspected and the person's prescribed adrenaline auto-injector is available, it should be used without delay, following the instructions for that particular device.

Different brands of auto-injector can operate differently, so people who have been prescribed one — and their family members, carers or colleagues — should know how their particular device works.

Remember:

Adrenaline first – do not delay.

Antihistamines may have a role in treating some allergic symptoms, but they are not a substitute for adrenaline when someone is experiencing anaphylaxis.

Do not delay giving adrenaline while searching for antihistamines.

Top Tip – Using an EpiPen®

One of the things we regularly practise during our first aid and anaphylaxis training is becoming familiar with the auto-injector before an emergency happens.

For an EpiPen®, remember the simple phrase:

Blue to the sky – orange to the thigh

Remove the blue safety cap.

Keep your fingers and thumb well away from the orange end, as this is where the needle will emerge.

Hold the EpiPen® with the orange tip pointing towards the outer mid-thigh and push it firmly into the thigh at a 90-degree angle until it activates.

Then:

Hold it firmly in place for 3 long seconds.

In a real emergency, human factors play an enormous part. People become frightened, adrenaline levels rise and there is a natural tendency to rush.

My advice during training is therefore simple:

Slow yourself down. Keep the injector firmly against the thigh and deliberately count three long seconds.

One… two… three.

The recommended administration time for an EpiPen® is three seconds. The important thing is not to panic and snatch the device away too quickly.

Take control of those few seconds and make each one count.

After removing the EpiPen®, the orange needle cover will extend over the needle.

And remember: different adrenaline auto-injector brands may have different operating instructions, so always become familiar with the device that has actually been prescribed.

Call 999

After using the adrenaline auto-injector, call 999 immediately and tell the ambulance service:

“I think this person is having anaphylaxis.”

Even if the casualty starts to feel better after receiving adrenaline, they still require emergency medical assessment.

If somebody else is with you, they can call 999 while you concentrate on helping the casualty.

Stay with the person and continue to monitor their airway and breathing.

Position matters

This is an area of anaphylaxis first aid that is sometimes overlooked.

If someone is feeling faint, dizzy or showing signs of circulatory collapse, lie them flat. Their legs can be raised.

Do not suddenly sit them up or allow them to stand or walk around, even if they tell you they are feeling better.

If the casualty is having significant difficulty breathing, they may find it easier to sit up with their shoulders raised.

The important point is:

Do not allow someone with suspected anaphylaxis to suddenly stand or walk.

If the casualty is pregnant, lying on their left side is recommended.

What if the first adrenaline auto-injector doesn't work?

People at risk of anaphylaxis are advised to carry two adrenaline auto-injectors.

If the casualty's symptoms have not improved after five minutes, use the second prescribed auto-injector if one is available.

Make sure the ambulance service has been called.

Continue monitoring the casualty until professional help arrives.

What if they become unresponsive?

If the casualty becomes unresponsive, check their breathing.

If they are not breathing normally, call 999 if this has not already been done and begin CPR immediately. Use an AED as soon as one becomes available.

The ambulance call handler can also provide instructions while emergency help is on its way.

If you have been prescribed an adrenaline auto-injector

There are a few simple things that can make a huge difference in an emergency:

• Carry two adrenaline auto-injectors with you.

• Regularly check their expiry dates.

• Know how your particular device works.

• Practise with a trainer device.

• Make sure family, friends, teachers, carers or colleagues know where your auto-injectors are kept.

• Make sure those around you recognise the signs of anaphylaxis.

• Have an allergy or emergency action plan where appropriate.

An adrenaline auto-injector is only useful in an emergency if it is available and people have the confidence to use it.

Anaphylaxis in children

For parents, grandparents and carers, a severe allergic reaction in a child can be particularly frightening.

Children may not always be able to explain what they are experiencing.

A younger child might suddenly become distressed, unusually quiet, floppy or less responsive. They may cough, wheeze, have difficulty breathing or develop swelling around the lips, tongue or throat.

If a child has a known serious allergy, those responsible for them should be familiar with their emergency plan and know where their adrenaline auto-injectors are kept.

Schools, childcare settings, clubs and other organisations caring for children should also have appropriate allergy procedures in place and ensure relevant staff understand them.

Confidence comes from preparation

During our first aid courses at Sussex First Aid Courses, we don't simply want people to remember facts.

We want them to have the confidence to recognise when somebody is becoming seriously unwell and to act.

In an anaphylaxis emergency, remember:

RECOGNISE

Look for sudden Airway, Breathing or Circulation problems.

ADRENALINE

Use the casualty's prescribed adrenaline auto-injector without delay.

999

Call an ambulance and say “anaphylaxis.”

POSITION

Lie the casualty down. If breathing is very difficult, allow them to sit up. Do not let them stand or walk.

5 MINUTES

If there is no improvement after five minutes, give the second prescribed adrenaline auto-injector if available.

What about an asthma or reliever inhaler?

Some children and adults who are at risk of anaphylaxis may also have asthma and carry a prescribed reliever inhaler.

If the person is experiencing wheezing, chest tightness or breathing difficulties, their prescribed reliever inhaler may also be used in the way they would normally use it or in accordance with their personal asthma plan.

However, there is an extremely important distinction:

An inhaler does not replace adrenaline in anaphylaxis.

If anaphylaxis is suspected, give the person's prescribed adrenaline without delay and call 999.

A reliever inhaler can be used in addition to adrenaline where appropriate for wheezing or bronchospasm, but it should never delay the administration of adrenaline.

This is particularly important because severe asthma and anaphylaxis can sometimes look very similar.

If someone with known allergies develops sudden breathing difficulties following possible exposure to an allergen, think anaphylaxis, not simply asthma.

Learning first aid can make a difference

Most of us hope that we will never have to manage an emergency such as anaphylaxis.

But emergencies don't always happen when a healthcare professional is standing beside us.

They happen in homes, restaurants, schools, workplaces, parks, sports clubs and community settings.

first aid training matters.

You don't need to be a doctor, nurse or paramedic to make a difference.

You need to recognise that something is seriously wrong, know what to do and have the confidence to act.

Sometimes those first few minutes are the most important.

About the author

Garry Perkins is a former paramedic with more than 35 years' experience in emergency care and is the Director and Founder of Sussex First Aid Courses Ltd.

Sussex First Aid Courses provides practical, engaging first aid and medical emergency training for individuals, businesses, schools, carers, healthcare and dental teams across Sussex, Surrey, Kent and surrounding areas.

Sussex First Aid Courses Ltd 0800 069 9931 info@sussexfirstaidcourses.co.uk www.sussexfirstaidcourses.co.uk

This article is intended to promote first aid awareness and does not replace individual medical advice, the manufacturer's instructions for a prescribed adrenaline auto-injector, or practical first aid training.