Emergency Anaphylaxis Plan
Responding to an Anaphylaxis Emergency at School
Anaphylaxis:
Anaphylaxis is a serious allergic reaction that happens very quickly and can lead to death. There are many things that can cause a reaction; food, exercise, medication, latex, insect bites are some of the most common allergens. Serious Anaphylactic symptoms may include, but are not limited to: swelling of lips and tongue, itchy throat, difficulty swallowing, swelling of eyes, blue/grey discoloration, wheezing, difficulty breathing, rapid pulse, fainting, and dizziness. Giving an epinephrine injection and calling emergency services are the best response in an anaphylactic crisis.
Plan for individuals with known anaphylactic reaction:
Plan for *individuals with an unknown anaphylactic reaction: (*This includes any student, staff or person on school grounds)
*Severe Symptoms:
Epi-pen Auto-injector instructions:
References:
2013 Wisconsin ACT 239
FARE - Food Allergy Research and Education
Food Allergy and Anaphylaxis Emergency Care Plan
http://www.foodallergy.org/faap
Michigan Department of Education
https://www.michigan.gov/documents/mde/Epi_Addendum_6-18-14_461400_7.pdf
Responding to an Anaphylaxis Emergency at School
Anaphylaxis:
Anaphylaxis is a serious allergic reaction that happens very quickly and can lead to death. There are many things that can cause a reaction; food, exercise, medication, latex, insect bites are some of the most common allergens. Serious Anaphylactic symptoms may include, but are not limited to: swelling of lips and tongue, itchy throat, difficulty swallowing, swelling of eyes, blue/grey discoloration, wheezing, difficulty breathing, rapid pulse, fainting, and dizziness. Giving an epinephrine injection and calling emergency services are the best response in an anaphylactic crisis.
Plan for individuals with known anaphylactic reaction:
- Students with a known anaphylaxis allergy will have a health plan on file at school, and it will be made available to all staff , food service and the transportation service if necessary.
- Parents will provide appropriate over the counter allergy medication and/or Epi-pen as indicated by health plan.
- Appropriate authorization forms will be filled out and on file in the office. Over the counter medications will have a parent authorization and prescription medications will have a physician/parent authorization on file.
- Training will be provided for staff at each school as deemed appropriate by the school nurse.
- School nurse will provide video instruction and hands on training in order to prepare staff to administer epinephrine and will document such training.
Plan for *individuals with an unknown anaphylactic reaction: (*This includes any student, staff or person on school grounds)
- Each school will have a supply of epinephrine that is appropriate to the student population.
- Epi-pen Jr. 0.15 mg if estimated weight is between 33-66 pounds.
- Epi-pen 0.30 mg if estimated weight is 66 pounds or greater.
- *Staff that have received anaphylaxis training and epi-pen training will be able to deliver an epinephrine injection to someone who is not known to have an anaphylactic reaction.
- Stock epinephrine will be monitored and ordered by the school nurse.
- Hands on training will be provided yearly to staff.
- School board will have a policy in place to govern the procedure for administration of emergency medication. (Neola 5330.01 - Epinephrine Auto injectors (Epi-Pens)
- Instruction about liability. (2013 Wisconsin Act 239.5)
- (5) Immunity from civil liability; exemption from practice of medicine. A school and its designated school personnel, and a physician, advanced practice nurse prescriber, or physician assistant who provides a prescription or standing protocol for school epinephrine auto-injectors, are not liable for any injury that results from the administration or self-administration of an epinephrine auto-injector under this section, regardless of whether authorization was given by the pupil's parent or guardian or by the pupil's physician, physician assistant, or advanced practice nurse prescriber, unless the injury is the result of an act or omission that constitutes gross negligence or willful or wanton misconduct. The immunity from liability provided under this subsection is in addition to and not in lieu of that provided under s. 895.48.
- Video about administration of medication and epinephrine
- Education about signs and symptoms of anaphylactic response will be provided
- Epi-pen trainers will be used to give hands on practice with Epi-pen auto injector
- Instruction about contacting emergency services after administration of Epinephrine
- Training shall be provided by a licensed Registered Nurse.
- DPI approved sources will be used.
- Hands on use of a TRAINER auto-injector
- What to do in an anaphylaxis event will be made available as a resource.
- If the person having symptoms does not have a health plan or a known allergy and you are not sure if it is an allergic reaction contact the school nurse. If unable to reach the school nurse contact the main office to find out who in your building is trained to identify anaphylaxis and give an epi-pen.
- Based on symptoms - *Severe or **Mild determine if person is having an anaphylaxis event. It is safer to give epinephrine than to do nothing. An anaphylaxis event is LIFE THREATENING.
- If you are alone and ARE able to provide epinephrine call out for help as you go to get epinephrine. Do not take extra time to find people to help until you have given the injection.
- If you are alone and DO NOT KNOW how to give epinephrine, call for help to locate someone who can give epinephrine and call 911.
*Severe Symptoms:
- Lung - Shortness of breath, wheezing, repetitive cough
- Heart - Pale, blue, faint, weak pulse, dizzy
- Throat - Tight, hoarse, trouble breathing/swallowing
- Mouth - Significant swelling of tongue and/or lips
- Skin - hives all over body, widespread redness
- Gut - Repetitive vomiting, severe diarrhea
- Other - feeling like something bad is going to happen, anxiety, confusion
- Or a combination of Symptoms from different body areas.
- INJECT EPINEPHRINE IMMEDIATELY!
- CALL 911.
- Lay the person flat, raise legs and keep warm. If they are having difficulty breathing or they are vomiting keep them sitting up or lie the person on their side. If they are not breathing begin CPR if trained and call for help.
- If symptoms do not improve, or symptoms return, another dose of epinephrine can be given 5 minutes or more after last dose.
- Notify emergency contacts / Call School nurse.
- Give Epi-pen to EMT/EMS services when they arrive and and tell them time of injection.
- Nose - Itchy/runny nose, sneezing
- Mouth - Itchy Mouth
- Skin - A few hives, mild itching
- Gut - Nauseous, discomfort
- For Mild Symptoms from MORE than one area, Inject epinephrine.
- For Mild Symptoms from only ONE area:
- If ordered by a healthcare provider antihistamines may be given.
- Stay with the person. Alert emergency contacts and school nurse.
- Watch closely. If symptoms become more severe - Inject Epinephrine.
Epi-pen Auto-injector instructions:
- Remove the Epi-pen auto injector from it’s plastic carrying case.
- Hold auto-injector in your fist. “Blue to the sky - Orange to the thigh.”
- Pull off the blue safety release cap with other hand.
- Hold on to the person’s leg to keep it still.
- Fully press orange tip into mid outer thigh.
- When you hear a distinct “click” hold for 3-10 seconds.
- Remove from thigh and massage area. Orange tip will become longer and cover the needle.
- Hand used syringe to EMT/EMS when they arrive.
- Complete incident report as necessary.
- Contact school nurse if not already involved.
- School nurse will order appropriate replacement as needed.
References:
2013 Wisconsin ACT 239
FARE - Food Allergy Research and Education
Food Allergy and Anaphylaxis Emergency Care Plan
http://www.foodallergy.org/faap
Michigan Department of Education
https://www.michigan.gov/documents/mde/Epi_Addendum_6-18-14_461400_7.pdf