The following frequently asked questions may provide your organization with many of the answers you are looking for. If your specific question is not addressed below, please feel free to contact the Check & Inject NY team at anythime, either by email at checkinjectny@mlrems.org, or by phone at (585) 463-2900.

Do I need to continue to carry epi autoinjectors in addition to the syrine epinephrine kits?

• Our understanding of the approval of the Check & Inject NY program by the commisioner is that the presense of a sryinge epinephrine kit (SEK) is acceptable in place of and epinephrine auto injector.

What is the expiration date for the Syringe Epinephrine Kits?

• The actual expiration dates will vary, and can be located on the short edge of the syringe epinephrine kits.

Following the Check & Inject demonstration project, will I be able to continue using syringe epinephrine kits within my agency?

• The goal of the Check & Inject NY team is to present the findings of the demonstration project to the SEMAC for approval for continued use in New York State. Please understand that the Check & Inject NY team can neither guarantee SEMAC approval, nor the timetable for approval should that approval be granted.

What is the ordering process?

• Contact Bound Tree Medical Directly. Order by phone, fax or mail.

  **  Note: This product is not available to online ordering.

   Customer Service

  Monday – Friday 8:00 AM – 8:00 PM (EST)

   Toll Free 1-800-533-0523

  Order by fax 1-800-257-5713

How do I obtain a replacement kit after an kit is used? Is there any cost for the replacement?

• As part of the demonstration project, any used kit will be replaced at no cost to the participating agency. However, replacement kits are not shipped until the physician reporting has been completed by the agency following the kit use.

After the use of an SEK, can I place an EpiPen on my ambulance until I receive my replacement?

• No. One of the requirements of the SEK project is that your agency is ‘all in’ once you have committed to the project. Since the SEK is capable of administer either an adult OR pediatric dose, one SEK should be adequate to meet the needs of any patient you may encounter until a replacement SEK arrives.
• On the occasion where BOTH of your SEKs are administered from a single vehicle, you may move kits from other vehicles until your replacement SEKs arrive. If for any reason, you do not have enough SEKs to supply each certified vehicle with AT LEAST one SEK, contact an SEK project team member at (585) 463-2900. Arrangements can be made for expedited shipping or other delivery options.

If my agency is not able to download the training materials, can we still participate?

• If you are having any difficulty obtaining or presenting any of the SEK materials, please contact our office and speak with an SEK project team member at (585) 463-2900. We will make every reasonable attempt to provide you with alternatives.

Who needs to receive training for the SEK project?

• Every EMT-Basic must be trained, regardless of their background or outside experience.
• All advanced EMTs must be present for the video training, but may opt out of the skills sessions.

I have a member/employee who says they have completed the training with another registered Check & Inject NY agency. Do they have to repeat the training for additional agencies?

• There is no need to have providers repeat the training. It was designed to be self-contained, and identical regardless of time or place that it is offered.
• As for proof of completion, we would suggest only accepting the Check & Inject NY Training certificate that is included with all the training materials offered to enrolled agencies. If a provider does not have the certificate, I would refer them back to the agency with which it was originally taken, and have them request a certificate. If they are unable to provide you with that certificate, then I would suggest having them repeat the training with your agency.

Can I email copies of the pre-test and post-test, or do I have to send the originals?

• It is acceptable to scan and email back the pre-test and post-test from the training materials. It is important that the exams are scanned copies of actual handwritten exams, not a list of scores or copies of an electronic version of the exam. This may be especially helpful for larger agencies.
• Remember, it is the responsibility of the individual agencies to maintain a copy of the skills verification in their training records.

I have several EMRs (CFRs) in my agency. Can they participate?

• Only an EMT-Basic or higher can participate in the project. The SEK project does not authorize any EMR or CFR to administer epinephrine. However, anyone may attend the training sessions for the information provided, and to better understand how this project may affect the agency.

If I am unable to expose my injection site, can a SEK be delivered through clothing?

• It is recommended that the injection site be exposed and visible before delivering an injection. However, since epinephrine is known to be lifesaving in anaphylaxis, the SEK can be administered through a reasonable amount of clothing, much like EAIs are delivered currently.

The needle in the kits is much longer than the needle in an Epi-Pen. Should providers have any concern about striking the bone during an injection, especially in pediatric and elderly patients?

• Since the epinephrine is being given with an intramuscular injection (IM), and not a spring loaded auto-injector, there is no need to insert the entire needle into the injection site. As it is demonstrated in the training, a simple dart like motion where 1/3 to 1/2 of the needle length is all that is required to administer the injection correctly. This differs from the auto-injector, where pressure against the injection site is what triggers the injection to occur.

My agency is a BLS First Response agency, and no one in our agency is comfortable teaching the SEK training to my department. Can someone else do the training for us?

• If you have an affiliation with an agency within your region who would be willing to assist you in your training, that is acceptable. It will remain the responsibility of the Agency Check and Inject Coordinator for your agency to maintain those training records once they are completed. It will also remain the responsibility of the Agency Check and Inject Coordinator to ensure all new members/employees are trained moving forward. If you need further clarification, please contact a SEK project team member at wither mlrems@mlrems.org or (585) 463-2900.

Can I get multiple doses from a single vial?

• No. Similar to the Epinephrine Auto-Injector (EAI) delivering a single dose, the SEK project specifically uses one dose = one vial for the Syringe Epinephrine Kits (SEKs).

 In agencies that have BLS and ALS units/responses, does the QA form need to be completed for ALS responses as well?

• The QA form is to be completed for ALL responses (both BLS and ALS) where the provider identifies the chief complaint / primary problem as an allergic reaction or anaphylaxis. We have found that those responses are typically only about 2-3% of total call volume for most agencies.
• Additionally, the QA form does not need to be completed at the time of the call, and does not have an impact on the restocking of used SEKs. Please feel free to follow your normal QA flow, ensuring that it captures all the allergic/anaphylactic responses, and submit the RedCap response as you complete your standard reviews. 

Our protocol says to deliver a different dose of epinephrine to an anaphylactic patient. Should I try to draw up more epinephrine to match my protocol?

• The SEKs are intended to replace EpiPens and not appropriate for the use in ALS protocols. Any ALS provider using the SEK should only use the SEK as it was designed to be used. Any variation in protocol where a dose > 0.3 mg is suggested is likely linked to an ALS protocol. Some regions do have ALS protocols which indicate the administration of 0.5 mg epinephrine for anaphylaxis. If you have any questions, contact your agency or regional medical director.
• The Epi Safe syringe can only be used to administer 0.15 mL and 0.3 mL doses.

How can I figure out how many KGs my patient weighs?

• Any weight in pounds can be converted to kilograms using the following formula:

 weight in pounds / 2.2 = weight in kilograms

•  There is also a convenient chart located at www.mlrems.org for you to download.

Why doesn’t the training mention to pull back on the syringe before administering the dose of epinephrine? Isn’t that standard practice for an intramuscular (IM) injection?

• The SEK program is duplicating the procedure used in the administration of epinephrine auto injectors. The use of EAIs makes no provisions to ensure placement of the injection before delivery, other than by proper site selection. Epinephrine is the lifesaving treatment in the setting of an anaphylactic reaction and timely administration is crucial.
• The procedure to administer most medications is to draw back on the syringe and check for the presence of blood before administering the injection.

Updated March 31, 2016