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The cost of epipens really is hitting some ambulance services hard. In my state, advanced EMTs and Paramedics can draw up and administer Epi from ampules like this, but basic EMTs only have epipens. There's some rumors floating around that our state protocols may change to let basics do it, mostly because an amp of Epi + an IM needle is ludicrously cheaper than an epipen. I'm a basic and I'll welcome it if it goes through, but it's sad to see our protocols change based on med prices and not research.