An intramuscular injection of epinephrine combined with an oral antihistamine is the treatment of choice for life-threatening anaphylactic reactions that occur in remote settings. Legal issues aside, the purpose of this brief post is to review the options available to outdoor programs who wish to carry epinephrine into the field. There are currently four available. All have been used successfully. All have their advantages and disadvantages.

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1. Commercial auto-injectors.
2. Ampules and syringe.
3. Vials and syringe.
4. Pre-filled syringes.

The option you end up with will be influenced by your state laws, the personal bias of your physician adviser, your ability to provide effective and on-going training, and your budget. Regardless of which option you choose, we highly recommend quarterly training for all trip leaders and a brief pre-trip review of your administration protocols.

Research conducted in Thailand in 2010 concludes that pre-filled syringes of epinephrine remain stable and sterile for up to three months making pre-filled syringes a reasonable option for financially strapped outdoor programs wishing to carry epinephrine in the field. Download a brief article discussing the the pros and cons of the current options and to view a copy of the research article.