Anaphylaxis and EpiPen Knowledge for First Aiders at Work

Workplace first aiders can use this guide to recognise anaphylaxis, follow the NHS-recommended response and understand the legal position on emergency adrenaline use. An adrenaline auto-injector, such as an EpiPen, is a pre-filled device that injects a dose of adrenaline into the outer thigh.

Anaphylaxis can develop within minutes, leaving very little time to decide how to respond. First aiders need to prepare for this rapidly developing emergency before it happens.

The sections below cover the emergency response, employers’ first-aid duties in Great Britain and the UK rules on using an adrenaline auto-injector, including one prescribed for another person.

Anaphylaxis is a life-threatening allergic reaction that develops very quickly, usually within minutes of contact with a trigger such as food, a medicine or an insect sting (NHS, 2023).

Anaphylaxis develops quickly and can cause serious breathing problems or problems with blood circulation. Skin changes may also occur, but a rash is not always present (NHS, 2023). Warning signs include:

• swelling of the throat, lips or tongue
• difficulty breathing, or breathing very fast
• a hoarse voice or a feeling of tightness in the throat
• wheezing, coughing or noisy breathing
• confusion, dizziness or fainting
• skin that turns pale, grey or blue

Sudden throat or tongue swelling, difficulty breathing, collapse or fainting that does not resolve are emergency warning signs: act immediately. A raised, itchy rash may occur alongside them, but a rash alone does not necessarily mean anaphylaxis (NHS, 2023; Resuscitation Council UK, n.d.).

For suspected anaphylaxis, use an available adrenaline auto-injector promptly and call 999. Follow these five NHS-recommended steps without unnecessarily delaying adrenaline or emergency help (NHS, 2023):

1. Use an available adrenaline auto-injector, such as an EpiPen, following the instructions printed on the device.
2. Call 999 and say clearly that anaphylaxis is suspected.
3. Help the person lie down, raising their legs if possible. If breathing is difficult, raise their shoulders or help them sit up slowly. If the person is pregnant, help them lie on their left side.
4. If the person was stung by an insect and the sting is still in the skin, remove it.
5. If symptoms have not improved after five minutes and a second auto-injector is available, use it.

The person should not stand or walk at any point during this process, even if they start to feel better, because standing suddenly can make the reaction worse (NHS, 2023).

In Great Britain, the Health and Safety (First-Aid) Regulations 1981 require every employer to provide adequate and appropriate first-aid equipment, facilities and personnel for employees, regardless of the size of the business. The Health and Safety Executive (HSE) explains that what is needed depends on the workplace (HSE, n.d.-c). Northern Ireland has separate first-aid legislation.

What counts as adequate and appropriate is not fixed in the Regulations. Employers determine it through a first-aid needs assessment: a review of the nature of the work, the size and make-up of the workforce, and the specific hazards present, including whether any employees have a known severe allergy (HSE, n.d.-a).

UK medicines law does not prevent a first aider from using an adrenaline auto-injector prescribed to someone else where its use is for the purpose of saving life in an anaphylactic emergency (Department of Health and Social Care, 2025).

Ordinarily, giving medicines to treat illness is not part of first aid at work, but emergency adrenaline is a specific exception (HSE, n.d.-b). Regulation 238 of the Human Medicines Regulations 2012 permits the administration of medicines listed in Schedule 19, including the specified injectable adrenaline preparation, for the purpose of saving life in an emergency (Human Medicines Regulations, 2012; Human Medicines Regulations, 2012, sch. 19).

Some Resuscitation Council UK online guidance still states that a named person’s auto-injector can only be given to that person (Resuscitation Council UK, n.d.). However, the Department of Health and Social Care clarified on 1 December 2025 that the regulations do not prevent emergency use of an auto-injector prescribed to someone else; the legal explanation here follows that later government clarification (Department of Health and Social Care, 2025).

Schools have a separate arrangement introduced in 2017 allowing them to obtain spare adrenaline auto-injectors without individual prescriptions. Under the school-specific administration provision, a person carrying on the school’s business who is trained to administer the medicine may give it in an emergency to a pupil at that school who is known to be at risk of anaphylaxis (Human Medicines (Amendment) Regulations, 2017). This arrangement is separate from the general lifesaving emergency provision.

Permission to administer adrenaline in an emergency does not by itself authorise an employer to obtain prescription-only medicines, which normally require a prescription for their sale or supply. An employer considering emergency stock should obtain advice from an appropriate healthcare professional about a lawful supply route, clinical oversight, suitable devices, storage, expiry checks and staff training (Department of Health and Social Care, 2025; NHS Specialist Pharmacy Service, 2026). Workplace arrangements should not rely on employees’ personal auto-injectors as shared stock.

First aiders need to be able to recognise anaphylaxis and use the relevant device. Where a first-aid needs assessment identifies that emergency medication may be needed, HSE advises employers to consider additional training in its use (HSE, n.d.-b).

Ongoing first-aid training matters for anaphylaxis because first aiders need to recognise a suspected reaction and respond promptly using the appropriate device. Annual refresher training is not a legal requirement, but HSE strongly recommends it to help first aiders maintain their basic skills and keep up to date with changes in procedures (HSE, n.d.-b). Employers should select First Aid at Work (FAW), Emergency First Aid at Work (EFAW) or another appropriate level of training according to their first-aid needs assessment (HSE, n.d.-a).

Anaphylaxis requires prompt recognition and emergency action, even when there is no rash. The lifesaving emergency permission to use adrenaline is separate from the rules on obtaining workplace stock. Employers need first-aid arrangements and training suited to their workforce and risks.

If your team needs to review general workplace emergency procedures, Human Focus’s Basic First Aid at Work course provides online first-aid awareness training (Human Focus, n.d.). It does not replace the practical training and assessment required for the workplace first-aider role or instruction specific to anaphylaxis and auto-injector use.