Anaphylaxis preparedness for Alabama’s schools

By Melanie Sharpton, MSN, RN, ERSN, Benjamin Russell High School, msharpton1@charter.net ; Sweeping changes have made a positive impact for school nurses across Alabama in responding to ; sudden anaphylactic emergencies. During the 2015 legislative session, ACT 2015-405 was signed into law, allowing Alabama schools to stock epinephrine auto-injectors (EAIs). Schools and school nurses are seeking information and guidance as they implement the new law. This is a welcome change and we are eager to establish this level of emergency preparedness and readiness.

Regarding anaphylaxis, school nurses have two populations to consider. The first is those with a previously known diagnosis of anaphylaxis, usually with epinephrine already prescribed. The second population are those yet unknown. Anyone is at risk of developing a sudden onset of anaphylaxis.

Approximately 35-50 percent of all cases of anaphylaxis in emergency settings are due to food allergies. In fact, according to NASN (2015), “20-25 percent of epinephrine administrations involve students or staff whose allergy was unknown at the time of the event.” School nurses across our state have shared spine-tingling personal testimonies of sudden onset anaphylaxis occurring in their  schools among students previously undiagnosed/unknown they also shared how crippled they were in this situation without the drug readily available. We need to equip school nurses to respond quickly and as licensed professionals!

For the known cases of students with anaphylaxis, 16-18 percent of school-aged children who have food allergies had a reaction at school (NASN, 2015). Despite a previous diagnosis, many students do not have a current prescription for EAIs, they do not provide one at school, the drug expires and some students are not capable of self-management. School nurses provide case management to ;those ; students through identification, education, awareness, and the development of individualized health and emergency plans. Sound research reports 15 million people in the U.S. are diagnosed, one in 13 children, and two in every classroom (NASN, 2015). School nurses readily establish individualized health plans (IHPs) and emergency care plans (ECPs) that address chronic illnesses like anaphylaxis. The IHP addresses the allergens when known, signs and symptoms, locations of medication, how to assist students, administration of EAI, and medication safety. These health plans are communicated across all divisions within the school setting--cafeterias, classrooms, transportation services, bus ; drivers, field trips and administrators.

Epinephrine is the universal standard treatment. Sadly, we have seen loss of life among students from anaphylaxis onset at schools across the U.S. Epinephrine is safe, has no absolute contradictions, and delays morbidity and mortality (NASN, 2015). Without stock epinephrine auto-injectors, schools and especially school nurses are under-prepared to respond professionally to a sudden onset of anaphylaxis.

The Alexander City School System, with the help from Eric Tyler, MD, FAAP, of Pediatric Associates of Alex City, was the first system in Alabama to establish protocols to stock epinephrine autoinjectors, and we can help others to implement the same following steps:

• Obtain prescription

• Develop protocol

• Dosing between pediatric and adults

• Storage, packaging, and delivery of medications

• Initial and ongoing training of unlicensed staff

• Documentation of epinephrine administration in an emergency situation

On behalf of school nurses across our state, please consider supporting and sponsoring stock epinephrine auto-injectors in your areas and communities. Contact the school nurses in your areas and feel free to contact me for further guidance.

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