[retSava]

Probably because that is not what matters. With the epipen, I can just jam it into my daughters thigh, straight through thick winter clothing and all. I don't need to ensure she gets the dosage right, nor that the syringe doesn't break.

[JshWright]

My point is that with a very slight increase in the complexity of the process, you could have a _dramatic_ reduction in cost.

New York State is actually in the process of transitioning EMTs from EpiPens to vial/syringe kits.

[retSava]

EMTs are not the target customer of epipens. They work with life-threatening situations day after day. To a kindergarten teacher, if a child if having an anaphylactic chock, this is very far from a "very slight increase in complexity".

Just to ground the situation, the kindergarten teachers at my daughters place are already freaked out from the thought of having to administer an epipen. I can't even start to imagine how they would handle a syringe and a bottle.

[JshWright]

There are thousands of people out there who carry IM Glucagon kits, an similarly time sensitive medication, intended to be administered by untrained bystanders. If it works for Glucagon, I see no reason it can't work for Epinephrine. In reality, there's no need for a vial, the syringe can be prefilled with the correct dose.