The crew of Attack One has just completed a public safety demonstration on a hot summer afternoon when they are dispatched to another metropolitan park for a woman in respiratory distress. On arrival they find a lady in that condition, with a distressed park ranger holding her off to the side. Concerned family members in the picnic area can only watch as the woman labors to breathe. The crew quickly exits the vehicle and moves to her side.

   The patient is unable to speak, and it's immediately apparent that her swollen tongue is sticking out of her mouth in a very unusual manner. She is pale and diaphoretic. A male bystander and the park ranger explain that the woman, at a picnic with a large family group, took a drink from a cola can. She immediately reported she had swallowed something that stung her in the mouth, her tongue began to swell, and she developed tremendous distress. Family members report she is healthy and has no history of reactions to stings, and neither she nor her family members have a self-administration package of epinephrine.

   The crew members take immediate action, supporting the patient on her side and using a tongue depressor to keep her tongue from completely obstructing her mouth. The lady is close to completely losing consciousness and losing her airway. The Attack One crew leader had pulled all the epinephrine out of the drug box as soon as he heard that a sting had caused this severe reaction. As he prepares a dose for the patient, he asks the EMT to pull everything out of the supply bags that might be needed for an airway or a cardiac arrest. "Get out the needle cricothyrotomy kit, the nasal intubation airway, the IV supplies with all sizes of catheters, all the drugs, and a bunch of bags of IV fluids," he instructs. "Get the intraosseous kit out and open it. Have it all ready immediately!"

   The paramedic quickly prepares a syringe of the higher concentration of epinephrine, drawing up 0.3 cc of the 1:1,000 preparation, which is most common for treating allergic reactions. This is almost a reflex action for the crew, but as he pulls the cap off the subcutaneous needle, he and the paramedic holding the patient conduct a rapid discussion about giving the medicine.