A severe allergic reaction nearly cost the life of an 82-year-old woman at a seniors’ residence in Saint-Bruno-de-Montarville last June. The facility did not have an epinephrine injector, known by the brand name EpiPen, in its first aid kits, due to conflicting directives between the CISSS de la Montérégie-Centre and the Ministry of Health.
On June 19, after taking an antibiotic in the dining room of the Jazz St-Bruno residence, Françoise Schwartz went into anaphylactic shock, a severe allergic reaction. “After five minutes, my hands were red and tingling,” she says. Since she is allergic to several other antibiotics, she rushed to the nursing room. “I told the nurse that I was allergic to the medication and I lost consciousness,” she recalls.
PHOTO MARTIN CHAMBERLAND, THE PRESS
Françoise Schwartz, 82 years old, a resident of the Résidence Jazz St-Bruno
Within minutes, she went into respiratory arrest. In her first aid kit, the nursing assistant did not have an EpiPen, a medical device designed to counter the effects of a serious allergic reaction, because the integrated health and social services centre (CISSS) of Montérégie-Centre prohibits it. So she began cardiac massage while waiting for first responders to arrive, about thirty minutes later.
The CISSS de la Montérégie-Centre had informed the residence that staff are not authorized to administer a non-prescribed EpiPen to a resident, in accordance with Quebec government rules.
In response to the request of The Press to know why the EpiPen is prohibited, the CISSS responded that it applies the regulation on the certification of private residences for seniors.
These rules indicate in particular that a retirement home (RPA) cannot provide medication to a resident, even if it is over-the-counter medication, such as acetaminophen (Tylenol) or cough syrup.
The Jazz St-Bruno residence therefore complied with the CISSS rules.
“It’s part of the regulations to obtain our certification as a private residence for seniors. Unfortunately, we can’t do anything. Our hands are tied,” says the assistant director of Jazz St-Bruno, Chantal Galarneau.
The regulations are very strict. We have residences that are being given notices of non-compliance because they have kept what could be interpreted as a medication.
Hans Brouillette, Director of Government and Public Affairs of the Quebec Association of Seniors’ Residences (RQRA)
“It doesn’t make any sense. They watched me die and there was nothing they could do. I find it illogical to let someone die when there are two pharmacies within a minute’s walk. It’s easy to go and get one,” says M.me Schwartz. Although it is usually prescribed by a doctor, the EpiPen can be obtained without a prescription. Paramedics eventually gave him several injections of epinephrine when they arrived at the residence.
Diverging directives
However, the directives of the Ministry of Health and Social Services (MSSS) diverge from those of the CISSS.
We can say straight away that there are no restrictions on the use of an EpiPen by staff in a private seniors’ residence.
Marie-Pierre Blier, Media Relations, Ministry of Health and Social Services
Anyone can, in the absence of a paramedic or first responder, administer adrenaline during a severe allergic reaction of the anaphylactic type using an auto-injector device, she said. The presence of an epinephrine auto-injector in the first aid kit is also not prohibited.
“Epinephrine helps reduce the effects of the allergic reaction and allows you to survive,” explains Jérémy Ménard, assistant general manager of the Coopérative des techniciens ambulanciers de la Montérégie (CETAM). Whether or not you have access to the medication, emergency services must be called in the event of anaphylactic shock.
The EpiPen can cause some side effects, including increased heart rate. “The risk is still low,” says Ménard. Paramedics can also administer the medication to patients of all ages.
Making the EpiPen accessible
Françoise Schwartz, who is now doing much better, wishes that there were EpiPens in all residences in case of need and that the guidelines for RPAs were clearer, in order to eliminate any ambiguity. “If there are EpiPens in restaurants, there should be EpiPens in the residences’ dining rooms. Someone might die one day.” Since the incident, she now carries an EpiPen with her at all times.
Dominique Seigneur, director of communications and development at Allergies Québec, also believes that it would be useful to have auto-injectors in residences, just as they are already found in many restaurants, schools and sports centres.
“It’s the responsibility of the allergic person to have it in their possession. But sometimes, one dose is not enough, or the person may have forgotten it, it may be expired,” she says. “There are all kinds of situations where it’s a very good idea to have it.”