Hamilton, Ontario has become the first city in the world to consider requiring all food-service outlets to have an epinephrine auto-injector on hand in case of an allergic emergency. “This issue has sparked a lot of conversation,” says Lloyd Ferguson, the councillor in the Canadian city who is spearheading the initiative.
The concept is to have auto-injectors available in public places, similar to automated external defibrillators, or AEDs. This would protect not just those with known food allergies who forget their auto-injectors, but also those who experience anaphylaxis for the first time without ever having been told they have an allergy.
A local Rotary Club branch actually came up with the idea, after a 12-year-old girl  from a nearby town experienced anaphylaxis in March and died after eating ice cream at a mall. She had no history of severe reactions and did not carry an auto-injector.
Ferguson, who is a member of the rotary club, got behind the idea, taking it to city council in the form of a motion . While it remains unclear who would be responsible for distributing and purchasing the devices, the text of the motion says that “the Rotary Club of Ancaster A.M. has set a goal to have an auto-injector in every food court, restaurant, snack bar and fast food facility in Hamilton”. Ferguson notes that this rotary club may end up helping to finance the project, but this has yet to be determined.
There are significant hurdles to overcome to see this become reality: including the costs associated with purchasing, distributing and replacing the auto-injectors (about $100 each with a one-year shelf life), as well as the training necessary for restaurant staff to use the devices.
But Hamilton is definitely considering the move: Dr. Elizabeth Richardson, Hamilton’s Medical Officer of Health, has been tasked with looking into the idea along with well-known allergist Dr. Susan Waserman, a professor of medicine at McMaster University. They are expected to release a report detailing the feasibility and costs surrounding the program, including how to get restaurant staff trained in using the lifesaving devices. This report will be released in October.
“I generally support the idea, but there will be challenges, and it will take some strategizing to see how best to execute it,” notes Dr. Waserman. “It’s best to start this as a small pilot project.”
Another question is whether individuals who administer an auto-injector will be legally protected. Ferguson believes this would fall under Ontario’s Good Samaritan Act, which protects individuals responding to an emergency from liability.
Also being considered is whether the program would be mandatory or voluntary. This is something that would be decided after running a pilot test version, says Ferguson.
While the report is being penned, at least one other Canadian jurisdiction has already expressed some interest in the idea. Nearby Peel Region has tabled a letter on the same topic from the Canadian Anaphylaxis Initiative, a food allergy advocacy group, for further discussion.