These posts are not in any order of importance. They are more based on available time to post. Just something to keep in mind.
I'd like to emphasize first that EMR and EMT-B are the most restricted scopes. This is typically defined at the state level involving drug administration and procedures allowed. National standards are considered and of course the regional medical director calls the shots--literally and figuratively.
What else would I add for patient consideration? Aside from scope and experience, medics come from a wide variety of backgrounds. We are trained to rapidly assess mechanism of injury or nature of illness (among a host of other things) to determine if we must treat disease, injury (trauma), or combo. The biggest gains in prehospital transport has been trauma care. There are medics who are battlefield trauma gods. If I were hit during a mass casualty incident you bet I'd want that sort of experienced medic. For anaphylaxis, perhaps not. Depends.
Medics can get stuck in tunnel vision where calls get categorized. I would say despite the best of intentions, and these are not only good people but they really are determined to render the best care to each and every patient, they may just not be able to sync up with what allergists would do under the same circumstances. There are so many different types of trauma and disease signs and symptoms to treat, and each call has its own challenges (physical obstacles, gathering information, # of patients on scene, danger, etc.).
FARE, Allergic Living, and the community can and should do more to address the communication gap. I'm using this thread as a platform to log some thoughts and communicate with other stakeholders. An ideal outcome for me (and I hope some of you) is a targeted business communication with our concerns clearly outlined.
When I can do so properly I will address asthma and anaphylaxis. I think those remain riskier prehospital treatment. In my EMT course, which used very industry standard textbooks, not one portion of instruction for drugs or treatment mentioned comorbid asthma and anaphylaxis. The only association presented to us was aspirin 'sensitivity' correlated with asthma and peanut 'sensitivity' as a contraindication for albuterol administration.