he previous issue of the Boatman’s Quarterly Review included an article about the administration of epinephrine to treat severe allergic reactions, possible legislation, and what that might mean for river guides. The article also indicated that State Representative Doug Quelland was personally committed to addressing this life and death issue through legislation, and momentum was building. Indeed it has. Arizona Bill #2110 is currently moving through the House of Representatives and reads as follows:

Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 21.1, article 1, Arizona Revised Statutes, is amended by adding section 36-2226, to read: 36-2226. Emergency administration of epinephrine by good Samaritans; exemption from civil liability.
A. Notwithstanding any law to the contrary, a person may administer epinephrine to another person who is suffering from a severe allergic reaction if the person acts in good faith and without compensation for the act of administering the epinephrine and a health professional who is qualified to administer epinephrine is not immediately available.
B. A person who administers epinephrine pursuant to Subsection A is not subject to civil liability for any personal injury that results from that act.

This bill has since been amended by the House Judiciary Committee to add the following stipulation: “This exemption does not apply if the person is negligent in the administration of epinephrine.”
Of course, the scope and effectiveness of any law are a function of the language used and the possible interpretation of that language. An initial draft of this legislation included the qualifier, “without compensation,” similar to the Good Samaritan statute. After consultation with Dr. Michelle Grua, the wording was later changed to “without compensation for the act of administering the epinephrine” in order to broaden the applicability to include people like river guides and camp counselors who are paid to do their jobs and shoulder the responsibility for their clients’ health and well being. The revised language dispels civil liability because there would be no direct billing of the victim for the administration of the epinephrine.
We concluded our previous article on this subject with a request for thoughts from our members regarding the efficacy of legalizing the administration of epinephrine. Our article also acknowledged that divergent opinions on the issue exist within the river community, and ironically the responses we received by email reflect those opposing viewpoints:

Email #1:
Forget the law—it’ll come with a whole bunch of regulations. It seems to me less likely that a guide will be sued if she/he uses epinephrine when it is not specifically allowed, than if she doesn’t use it after they pass a law with the expectation for her to use it. Said another way, guides are better off in a legal fog than if they draw attention to it with a law. Who’s going to prosecute someone for using epi anyway? The AMA? The State of Arizona? C’mon man. Guides are more likely to get sued by the family of a victim—so, is it more likely they died from too much epi or the lack of it? Odds are it’s the lack that kills them, and guides are more likely to get sued for not using it. The litigious relatives are more likely to win against us if there is a legal expectation that we should use it. It’s better to be breaking the law in an extraordinary circumstance with good intentions, than defending against pre-set expectations that may not match the circumstances. With a law, you’re likely to have to explain to the jury why you ran out.

Email #2:
I believe that if any opponent to the idea of guides being authorized to administer epinephrine on the river were to consider for only a moment their feelings if a loved one needed the shot and were denied it because of legal concerns they would realize how stupid blocking the idea to permit guides to use this life-saving remedy is. I have a grandson allergic to bee stings and I bless the availability of the epi-pen. If there is anything I can offer to help get this authorization established, please let me know.

Hopefully, the simplicity of the proposed bill may serve to quell the concerns of those individuals who would prefer that that the epi conundrum remains a grey area. The gist is essentially this: if a person administers epinephrine in an emergency situation because they feel it’s warranted, and there is no other medical authority on site, they can do so without being subject to liability concerns as long as they act in good faith and without negligence. There are no attendant regulations or required training, nor is there any expectation that people should carry or use epinephrine.
Quite a number of states have enacted epinephrine legislation, and Arizona was bound to travel down this road eventually. However, it took the personal initiative and commitment shown by both Representative Quelland and Dr. Grua to move this issue beyond the theoretical, clearly demonstrating the power of the individual to enact change. As an organization, Grand Canyon River Guides’ role is to keep our members informed by presenting a balanced view of both sides of this issue. River guides have a responsibility as well—to question, and to carefully weigh this information against their value systems and the realities of the guiding profession in Grand Canyon.

Lynn Hamilton
Executive Director

Editorial Note

The introduction to the article, The Administration of Epinephrine—To Legalize Or Not in the last issue of the bqr (page 12, Volume 18:4) has raised some important questions about the difference between toxic reactions and anaphylaxis, and the necessity of differentiating between the two. Wilderness First Responder classes are currently the proper venue for gaining this important information. The point remains however, that river guides must actquickly in medical emergencies based on their best knowledge and expertise (and without the assistance of an authorizing physician). This underscores the main thrust of our article—a law regarding the administration of epinephrine could conceivably provide very necessary clarification at a time when it’s most needed: a life and death situation.