The Second Dose Question

Anaphylaxis is one of the emergencies first aiders most fear getting wrong — it can escalate quickly, and the treatment involves a piece of medical equipment (an adrenaline auto-injector) that many people have never actually held, let alone used. The 2025 guidelines bring welcome clarity to one of the most common points of confusion: what to do if the first dose doesn't seem to be working.

The core treatment hasn't changed

To be clear from the outset: the fundamentals of responding to anaphylaxis remain the same. Recognise the signs — difficulty breathing, swelling, a rapid drop in the ability to function normally, sometimes a rash — call 999 immediately, and use an adrenaline auto-injector (such as an EpiPen or Jext) without delay if one is available and the person is trained or being guided to use it.

What's new: the second dose

Where the guidance has been sharpened is around what happens next. It's now confirmed that a second dose of adrenaline may be given approximately five minutes after the first, if the person's symptoms haven't improved, or have got worse. This brings first aid and workplace teaching in line with current clinical anaphylaxis guidance, and closes a gap that previously left many first aiders unsure whether a second dose was appropriate, or whether they should simply keep waiting for the ambulance.

This is a meaningful clarification. Anaphylaxis can be unpredictable, and a single dose of adrenaline doesn't always fully resolve the reaction. Knowing that a second dose is not just permissible but expected in that scenario removes a moment of costly hesitation at exactly the point where a casualty may be deteriorating. The current guidance also specifies that, where possible, the second dose should be given in the opposite leg to the first — a small but practical detail worth building into training.

Why this matters beyond healthcare settings

This update has particular relevance for schools. There's been a growing push — including government-level requirements in some settings — for schools to stock adrenaline auto-injectors as part of their emergency provision, given how many pupils live with severe allergies. That makes it increasingly likely that non-clinical staff, including teachers, will be the ones administering an auto-injector in a real emergency, potentially more than once.

For anyone responsible for training staff in these environments, this isn't an obscure clinical detail — it's a practical, high-stakes piece of knowledge that could genuinely change the outcome of an emergency in a classroom or on a school trip.

Teaching it well

A few things worth building into anaphylaxis training this year:

• Practise with trainer pens. Auto-injector trainer devices (non-medicating practice pens) let learners physically rehearse the action under pressure, which builds far more confidence than simply describing the steps.

• Be explicit about timing. Teach the five-minute window clearly, and discuss how to judge "symptoms haven't improved" in practical terms, rather than leaving it as an abstract concept.

• Cover both single and multiple auto-injector scenarios. Some individuals carry two pre-prescribed auto-injectors specifically for this reason — learners should understand why, and how to use a second device if one is available.

Anaphylaxis moves fast, and hesitation is often the biggest risk factor in a bad outcome. This update exists to give first aiders — and increasingly, teachers and school staff — the confidence to act decisively if a first dose isn't enough.

Build real confidence with auto-injectors

Practising with a trainer pen before you ever need the real thing makes all the difference. Basecamp First Aid courses include hands-on adrenaline auto-injector practice as standard.

Book a course at basecampfirstaid.com or email info@basecampfirstaid.com — particularly relevant for schools and childcare settings.

Disclaimer: This article is for general information and educational purposes only and does not constitute medical advice. It reflects a summary of the Resuscitation Council UK 2025 Guidelines as understood at the time of writing; guidance may be updated, and implementation timelines can vary between awarding bodies and training providers. Always follow the specific instructions of your first aid course provider and the current guidance of the Resuscitation Council UK (resus.org.uk). In a real emergency, always call 999 (or your local emergency number) immediately.

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