Saving lives with stock epinephrine: An interview with nurse practitioner Kelly Dunfield

Kelly Dunfield

In 2015, we wrote about a new stock epinephrine pilot project launched in Sussex, New Brunswick by nurse practitioner Kelly Dunfield, Robert Dunfield, and allergist Dr. Andrea Canty. The project was funded by the Sussex and Area Community Foundation. Food Allergy Canada supplied training materials and information, and Sanofi Canada provided an 18-month supply of auto-injectors.

The project, which ended December 31, 2016, established wall-mounted cabinets similar to automated external defibrillators (AED) stations, containing epinephrine auto-injectors for the emergency treatment of anaphylaxis in 28 locations, including restaurants, schools, the Fire Department, churches, healthcare facilities, and recreation centres.

Food Allergy Canada: What led you and Dr. Andrea Canty to launch the stock epinephrine program in Sussex?

Kelly Dunfield: Well, I’m a nurse practitioner and I was at a conference around 2012 where an allergist was speaking, and she was talking about a young girl with asthma who died from anaphylaxis. AEDs were popping up all over the place in shopping malls and airports and I thought “I don’t know why we’re not doing this with epinephrine auto-injectors.” I spoke to the allergist after the conference and then caught up with her a few months later and ran the idea by her again and she liked it. So I decided to do research on publicly available epinephrine auto-injectors. All the research said that there should be plans in place, that people should receive it immediately, and that the sooner you get the epinephrine, the better. Yet I couldn’t find anyone anywhere actually making epinephrine publicly available in central locations. After doing the research, I thought I’d do a pilot. I submitted many applications to get funding, and looked at how we could do this. I designed a metal box, similar to an AED, with a different colour and epinephrine in it. You’ll see it on our website.

FAC: How did you implement it?

KD: I had to order them from the United States. Then, I put in applications to raise money to develop them. Next, me, my son, Dr. Canty, and our head person here for St. John Ambulance, did some extra training through Food Allergy Canada. This was very good, and I thought about how we could provide the education and the box, and then see how we might come up with getting epinephrine auto-injectors. We went ahead, received the funding for the project, and we were able to place an alarmed cabinet with a set of epinephrine auto-injectors, one adult dose and one junior dose in each site. We established 28 sites, and 32 sets. For example, our local fire station just wanted a set for each truck, so we got a little case to put them in; they didn’t need an alarmed cabinet. Then our local university wanted two, so there were some places that had two sets in different places. Our golf course has one in their clubhouse, and they also have one out on the course, kept at room temperature in a hut.

FAC: And then what happened?

KD: Well, we went through that process, which started in May, 2014. And we held education programs at all the sites ourselves. On September 14th of that year, it saved a man’s life. His name is Wellington McLean. [For more information about this story, about a man stung by yellow jackets, please click here.]

FAC: Did that have an impact?

KD: Prior to that event happening, I’d been getting all these phone calls because there was a lot of press out there about the program, and after it saved this man’s life, I was getting calls from all over. I remember receiving a call from Ireland, and calls from all over Canada and the United States. But at that point I didn’t have any more money [for the program], so I talked to a lawyer, and he said I really just needed to start a business, let other people figure out how to get the funding, and focus on providing the service, the cabinet and education. I also direct them to the education on the Food Allergy Canada web site.

FAC: What was your next step?

KD: Well, I wasn’t overly happy with the alarmed cabinets, so I started working on how we could make them better. Basically, we came up with a new design and created a new alarmed cabinet that’s more efficient, but can still be seen easily. It’s a little more compact, making it easier for people to take the epinephrine to the person having the anaphylactic reaction. So, that’s how it all got started. We did start a company called Be Ready Healthcare, and I receive calls every week from people. We have our cabinets installed at over 150 sites in New Brunswick and Nova Scotia. They can be installed any place that has restaurants or serves food, or has the potential for insect stings. Really any public setting where there are people.

FAC: You mentioned that you had a lot of cooperation. What was the acceptance like from the community? Was there any resistance?

KD: It was absolutely unbelievable. I presented to our local town, the Town of Sussex, and they were very supportive. They said they would do whatever they could do for us. They actually helped me to find a way to transport the cabinets to the U.S. They were also able to help us save a little money on taxes in the pilot project. Every place that we presented to, there was nothing but support, and comments like “Why haven’t we done this sooner and why aren’t we doing this everywhere?” and “This is such an important life-saving initiative.”

FAC: In the Allergic Living article that covered your project, it says that your son Robert became involved and helped as well. What led to his involvement?

KD: My son is in his second year of medical school at Dalhousie University, and he had to decide on a research project, which needs to be finished before they graduate. There’s a community about 20 minutes away from us, so these cabinets are now in over 20 communities to differing degrees. But the one that’s 20 minutes away from us, they purchased 25 of the cabinets similar to the ones we used in the pilot, because we hadn’t redesigned the new one yet. And my son offered to do all their education for free, if they would allow him to do his research project. He’s working with a couple of emergency physicians at the Saint John Regional Hospital, and they designed the research. This isn’t directly related to the pilot project, but what they’re looking at is the best way for us to help people remember how to give an epinephrine auto-injection correctly.

FAC: You mentioned that you had received calls from overseas. Have you had calls from people wanting information on how to implement this type of program in other locations around the world?

KD: Well, my closest contacts have been from across Canada. I’m actually going to Kelowna, B.C. soon to speak with a couple of the communities there. The call from Ireland was from a reporter who talked to me about the case I’m sure you’re aware of where a young girl and her mom were at a Chinese restaurant, and she asked a pharmacist for epinephrine. [N.B. The request was refused, and 14-year-old Emma Sloan died. For more information, please click here.]

FAC: Yes.

KD: I’ve also had calls from the States. The difficulty, I’ve found, is the fear of injecting epinephrine. And in the States, I haven’t really pinned down yet which States have it behind the counter, but it seems to be more relaxing for people when they know it’s available there. Cross-Canada it’s available behind the counter, so it’s not an issue here. Any of the sites that we work with can easily go and get the epinephrine at the pharmacy, and they can replace it easily. We have a disclaimer for the pilot project that says that if you have this on your site, you’re going to look after it and replace it if it’s used or expired. We want to make sure that people are looking after them. When I started the pilot project, I knew I didn’t want it to be only 18 months, followed by everybody taking the cabinets down. I want sites that are committed to maintaining this over time, just like they are committed to the AEDs.

FAC: You’ve educated so many people through this project, and you’ve said that one of your main goals is for people not to be fearful. You want people to be comfortable administering the epinephrine. Do think that the pilot project has had an impact in Sussex, around the level of comfort people have around giving the epinephrine?

KD: Absolutely. I mean, we’ve really educated hundreds of people. And it’s spread. Right away, the community 20 minutes away from us put 25 of these up. And then another community about an hour and 15 minutes away, in Grand Bay, just on the other side of Saint John New Brunswick, purchased 20 to place around their community. And they’ve all had very positive responses. When I start an education session with people, that’s what I say to them – that the goal is that, by the end of the training, for them not to be fearful to give the epinephrine and to learn how to do it properly.

FAC: That’s a very common concern. It’s important that you’re addressing it.

KD: Yes, and I always say to them “I’m more afraid for the person to die than to give them a needle.” I just had one of my school pilot sites call me. They asked me to come in on a professional development day. There were some new teachers there, and some of the teachers just wanted a little refresher. Again, it was all very positive and they said things like “We need this everywhere.” I replied that that’s the goal eventually!

FAC: What are some of the challenges you’ve seen with respect to epinephrine auto-injector access for all who need it?

KD: You know, there are so many situations where I write a prescription for an auto-injector for my patients, and they don’t get them filled because they’re too expensive. They don’t have a drug plan. So as a result, they don’t have it when they need it. I have patients who fill it and then walk out of the house without it. All kinds of people do that. And then there are the people who don’t even know that they have an allergy, and they could be in a restaurant and have an anaphylactic reaction. And their chances of doing well decreases without access to epinephrine? Once, I had an out-of-town mom come up to me at a conference, and she said “I was just at a mud run in Sussex, and I got to the ski hill and realized that I’d forgotten my daughter’s auto-injectors. When I walked into that lodge and saw that box with the epinephrine, I can’t tell you how relieved I was.” Those are the kinds of things that give me the energy to continue pushing this forward. It’s kind of a daily work thing on top of my full-time work. We’ve really done no marketing with our new cabinets, it just comes to us through word of mouth, because my husband and I are both so busy in our own full time jobs. We haven’t had a chance to go out and show it and encourage people to get it installed in their establishments.

FAC: So, it’s basically word of mouth at this point?

KD: It really has been. The only thing that we have is a Facebook page and a Twitter account. But I have a primary care practice of over 1,000 patients and that’s obviously my priority. It’s been an interesting journey.

Visit www.bereadyhealthcare.com for more information on Kelly’s company, Be Ready Health Care.

For more information about the Hamilton, Ontario stock epinephrine program visit our December, 2016 Advocacy and Research page.