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By Scott Hamilton, MD
October 28, 2022
Hamilton Blog Headshot Updated 12.21.21

Airline pilots practice emergencies that rarely happen. But if they do, pilots are ready to act quickly and save lives. The problem with emergencies is they require what the military calls “perishable skills,” a.k.a. “use it or lose it.” Every year, pilots have simulator training to drill emergency procedures. They get a hairy problem thrown at them, like if both engines quit. Often, their first attempt ends up “crashing” the simulator. The pilot gets the shakes: “What if this was real life?” Then they try it again and again until they get it right.

The EpiPen, an emergency device to save children from life-threatening allergic reactions, also requires practice. Though they're designed to be easily used, when kids are seriously sick and adrenaline is flowing, parents can freeze up. Thus, they should drill on when to use the pen and how to use it.

Deciding when isn't easy. Studies show that parents don't use EpiPens as often as they should. These are the reasons to memorize and periodically review: If children have two organ systems (like respiratory, gastrointestinal, skin or airway) affected, use it. For example, if the child has hives AND vomiting (skin and GI) or wheezing AND tongue swelling (respiratory and airway).

If a single system is going bad in a life-threatening way, use it. Like if a child’s throat is so tight they're making squeaky noises when they breathe or if their circulation is so affected that they're pale and lethargic.

Finally, when in doubt, use it! Epinephrine (the “Epi” in EpiPen) isn't harmful. Even if kids really don’t need it, it might save a life. Again, parents don't use pens enough. Don't be that parent - practice your decision making so that when your child needs you to act, you're ready.

Back to our airline pilots from above. Pilots have a few seconds to decide if there’s an emergency and get to it! In the movie Sully, about the real-life water landing of an airliner, time ticks by while Captain Sully and his copilot decide that their engines are dead and are not going to restart. When they decide to act, their actions to save the day are automatic - they march through the checklist like professionals.

Drilling how to use an EpiPen when your child is having a life-threatening allergic reaction is as important as deciding to use it. Besides practicing making the decision, practice using the thing. Some EpiPen kits come with a “dummy” practice pen. If yours doesn't, practice with a regular pen. After reading the directions and watching the video, take the steps.

First, always know where the EpiPen is. Don't be searching for it like your car keys while your child's life ebbs away. Second, clutch it in a fist grip. This prevents the most common mistake - injecting your own thumb (I've seen this happen more than once!).

Next, pull the cap off. Some models come with caps at both ends. Remove them both (watch those thumbs!). Step four: hold the child, lying down or sitting in your lap - no moving targets! Five: Press the pen into the outer thigh. There is no need to remove pants because pens are designed to punch through jeans. Six: Press the button and hold it down! You'll hear a click, meaning it's triggered and injecting. Continue pressing for ten seconds by counting to ten Mississippi.

Finally, call 911. If kids are sick enough to need injections, they'll need other medicines to keep the allergic reaction at bay. Get them to the ER right away. Parents, babysitters, grandparents, school personnel: practice the steps of these “perishable skills,” so when your child needs you, you're ready.