MinervaBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2697 (Published 08 July 2009) Cite this as: BMJ 2009;339:b2697
All rapid responses
We agree that the Epipen remains an imperfect design. We have seen
several accidental thumb injections over the years. However, the risks can
be substantially modified with high quality training. Specifically, the
advice of 'never put your thumb over either end, in any circumstance' is
very useful. This prevents accidental thumb injections and allows
parents/children a 'second chance' to get the pen orientation correct.
The correct hand position is shown clearly on the Epipen training
devices but not on the actual Epipens.
Competing interests: S Bricknall carries an Epipen.
The problem is with the counter-intuitive design of the pen. The
user is instructed to remove the grey protective cap before use, and then
apply the OPPOSITE end of the pen to the thigh and press it hard. Any
normal person, unfamiliar with the pen and under stress from a medical
emergency, would naturally apply the end from which they have removed the
The manufacturers should change the design.
EpiPen carrier for son.
Competing interests: No competing interests