Staff Administration of Non-Student Specific Epinephrine
First published on 09 February 2017 Posted in Health
Chilton Public School District
Anaphylaxis is a severe allergic reaction which can be life threatening. It may occur within minutes after a triggering event or up to hours later. Chilton Public School District will plan for the management of pupils attending school whom have life threatening allergies as well as plan for first-time anaphylaxis emergencies. The school district will also maintain an emergency action plan for the management of pupils attending the school who have known life-threatening allergies.
The following procedure for emergency use of stock epinephrine is to be used only by appropriately trained staff to administer epinephrine to a person (pupil, staff member, volunteer, or other) with or without previously diagnosed anaphylaxis. Stock epinephrine may be administered to a pupil or other person who the school nurse or designated school personnel believes is experiencing anaphylaxis in accordance with the following procedure which has been reviewed and approved by the District’s Medical Advisor. The person administering the epinephrine auto-injector must, as soon as practicable, dial “911” or in an area where “911” is not available, the telephone number for an emergency medical service provider.
Students with known life threatening allergies and/or anaphylaxis should provide their own prescribed epinephrine auto-injector in accordance with that pupil’s prescription consent. This anaphylaxis policy is not intended to replace student specific orders or parent provided individual medications.
Any district employee may be authorized to administer epinephrine who:
- is willing to assume that responsibility,
- is authorized by the school principal or his/her designee,
- has received Department of Public Instruction approved training, within four years, for the administration of epinephrine
- Has been sufficiently instructed by the District Nurse:
- In recognizing the signs and symptoms of anaphylaxis,
- On the proper administration of epinephrine auto-injector,
- On proper follow up procedures following administration of epinephrine auto-injector.
- Has successfully completed an annual return demonstration of administration of epinephrine auto-injector and has been deemed competent by the District Nurse.
This policy has been reviewed and approved by the District Medical Advisor
The district will maintain a supply of two stock doses of 0.15mg and 0.3mg epinephrine at each school building within the district. Stock epinephrine will be located within each building’s AED. Stock epinephrine standing orders must be renewed annually and with any change in prescriber.
Epinephrine auto injector dose:
- 0.15mg (JR. dose) - if student is less than 66 pounds
- 0.3mg (Adult/Regular dose) - if 66 pounds or greater
The medication will be stored in a secure but unlocked area that is clearly labeled “EpiPens” for “Severe Allergic Reactions.”
To determine JR. or Adult dose- When in doubt as to whether or not the person is 66 pounds or under, a measuring device (tape measure) with a length of 135cm would approximate the weight of 66 pounds. Measuring tape cut to the specific length of 135cm will be prepared for every health room and stored with the EpiPens. Unlicensed assistive personnel will be trained that if a student is shorter than the measuring device, the 0.15mg dose should be used. If the student is taller than the device, the 0.3mg dose should be used. Training will emphasize that if in doubt as to size/weight of the student, the higher dose should be used.
Common Triggers/Allergens and/or extreme sensitivity to one or more of the following:
- Food- peanuts, tree nuts, soybeans, milk, fish, shellfish, and wheat pollen
- Insect sting, usually bee or wasp
- Exercise or asthma triggers
For Any SEVERE SYMPTOMS after suspected or known ingestion of one or more of the following:
- LUNG: Short of breath, wheeze, repetitive cough
- HEART: Pale, blue, faint, weak pulse, dizzy, confused
- THROAT: Tight, hoarse, trouble breathing/swallowing
- MOUTH: Significant swelling (tongue and/or lips)
- SKIN: Many hives over body
- GUT: Repetitive vomiting, severe diarrhea
Or MORE than ONE MILD symptom from different body areas:
- NOSE: Itchy/runny nose, sneezing
- MOUTH: Itchy mouth
- SKIN: A few hives, itchy rashes, swelling (e.g., eyes, lips)
- GUT: Mild nausea/discomfort
1. If student or other person in the building is suspected of having an anaphylactic reaction (see symptom list above) INJECT EPINEPHRINE IMMEDIATELY (per training instructions by the District Nurse). It is safer to give epinephrine than to delay treatment.
2. Call 911, tell rescue squad epinephrine was given; request an ambulance with epinephrine.
3. Continue monitoring.
4. Stay with the person.
5. Request that someone alert District Nurse and parent/guardian.
6. Note time when epinephrine was administered.
7. If available, a second dose of epinephrine can be given 5 minutes or more after the first if symptoms persist or recur. Inject second dose in other leg. Note the time
8. For a severe reaction, consider keeping student lying on back with legs raised.
9. Administer CPR if needed.
10. Remain with the student (or other person) and treat student even if parents cannot be reached.
11. Upon arrival of emergency medical personnel, care and responsibility of the person is then handed over. (Even if symptoms subside, 911 must still respond and individual must be evaluates by a physician. The student will not be allowed to remain at school or return to school on the day epinephrine is administered).
After epinephrine administration:
- Complete appropriate documentation (incident report, medication administration, etc.).
- School staff involved in emergency response and those on the medical alert team should meet to debrief on the incident and make any necessary changes to policy or procedure or emergency action plan.
Epinephrine should be stored in a safe, unlocked and accessible location, in a dark place at room temperature (between 59-86 degrees F). The District Nurse, will assume the responsibility for maintaining a monthly schedule for tracking the medication status, contents of medication, and expiration dates as well as ordering replacement epinephrine for those expired or used. The solution should be clear; if it is discolored or contained solid particles, the unit should not be used and will get discarded.
Note- Non-student specific epinephrine may be permitted to be taken on field trips based on the Building Administrator’s discretion for that particular activity. If a student or other person is appearing to have an anaphylactic reaction on a field trip (who does not have their own prescribed epinephrine and the stock supply of epinephrine was not brought on this particular trip) immediately call “911.” Stock epinephrine and/or trained staff may not be available for administration during before or after school events (practices, games, etc.), and in this case “911” should be called if needed.
Food Allergy and Anaphylaxis Network. (2011). Food Allergy Action Plan. Available at:http://www.foodallergy.org/files/FAAP.pdf
Food Allergy and Anaphylaxis Network (FAAN). (2001). School Guidelines for Managing Students With Food Allergies. Available at:http://www.foodallergy.org/school/guidelines.html
National Association of School Nurses. (2014). Implementation of a Stock Epinephrine Protocol. Available at: http://nas.sagepub.com/content/29/6/287.full.pdf+html
National Association of School Nurses. (2011). Suggested Nursing Protocol for Students without an Emergency Care Plan. Available at:http://www.nasn.org/portals/0/resources/faat_no_ECP.pdf
Wisconsin State Legislature. (2013). 2013 WISCONSIN ACT 239. Available at:https://docs.legis.wisconsin.gov/2013/related/acts/239