1. GET TRAINED © It’s time for all school staff to GET TRAINED to know how to respond in an emergency to life threatening allergies! This program is supported by an unrestricted grant from Mylan Specialty Adapted by Cindy Roach, RN, MSN for use with Shorewood School District Staff ----Fall 2013

2. What Would You Do?  Kate has a bee sting allergy  Her class is on a field trip  She tells the teacher that she was stung –  The teacher sees that she is pale and can hear that she is wheezing  Her tongue starts to swell, she gasps for air  Kate is experiencing anaphylaxis Kate

3. You have moments to react  Kate is having a life-threatening allergic reaction  Without prompt treatment with a drug called epinephrine, Kate could die within minutes  Do you know what to do?  Do you know how to give epinephrine?

4. TODAY YOU WILL LEARN HOW TO SAVE A CHILD’S LIFE Per Shorewood District Policy, ALL staff receive annual allergy “knowledge” training

5. Objectives  Learn the signs and symptoms of anaphylaxis  Learn general information about how to administer an epinephrine auto-injector  Review the use of an Allergy Action Plan in responding to a student health emergency Learn to save the life of a child like Kate!

6. SHOREWOOD DISTRICTWill Work Toward:  Providing a safe and healthy learningenvironment for all students;  Providing students with allergies accessto school activities;  Reducing the likelihood of severe orpotentially life-threatening allergicreactions;  Ensuring a rapid and effective responsein the case of a severe or potentially life-threatening allergic reaction; and  Providing appropriate, continuingallergy management-related educationand training to District employees.

7. What is Anaphylaxis? Latex Allergies Insect Sting Allergies Food Allergies

8. What is an allergic reaction?  An allergy occurs when the immune system mistakenly attacks a food protein or normally harmless substance – it perceives the food or substance as a harmful or foreign one  Exposure to the offending food or allergen may trigger the sudden release of chemicals, including histamine, resulting in symptoms of an allergic reaction  The symptoms may be mild or severe – may progress over minutes or hours FAAN, 2012

10. Allergic Reactions  Common allergens include:  Bee stings  Latex  Food Allergies - most common allergens: FAAN, 2012 MilkEgg PeanutTree nuts (walnuts, cashews, pecans, etc.) FishShellfish SoyWheat

11. Anaphylaxis (“anna-fill-axis”)  Anaphylaxis is a severe allergic reaction that can be life-threatening  It must be treated immediately  The drug of choice is epinephrine  The time to learn how to give life-saving medication is now – it needs to be given without delay Its time to GET TRAINED! Sicherer & Simons, 2007

12. Allergic Reactions  Preventing an exposure is key  For students with a diagnosed allergy:  Know who can help! Talk to your school nurse or health aide  Know how to react! Know the signs and symptoms of anaphylaxis Learn about the student’s Allergy Action Plan Know where your student’s medication is and how to help in an emergency Robinson & Ficca, 2011

13. Prevention of venom induced anaphylaxis What to do:  Have professionals remove hives or nests  Wear white, smooth finish clothes, ankle- high shoes  Keep outdoor areas free of garbage What NOT to do:  Use scented products  Wear bright colors  Go barefoot  Drink from open cans when contents are not visible

14. Allergy Response  Remove student from allergen if possible – or remove allergen from student  Assess student symptoms – be prepared to initiate an Allergy Action Plan quickly  Administer an epinephrine auto-injector WITHOUT DELAY  Call 911 for an ambulance  Epinephrine may need to be repeated in 5 – 20 minutes  Have two auto-injectors available if possible Sicherer & Simons, 2007

15. Allergy Management  Collaboration is vital – everyone should be aware of students with allergies  Must be willing to work as a team to keep these students safe Robinson & Ficca, 2011 Classroom TeachersSchool Administration Specials TeachersNutritional Services staff Student Instructional Support Personnel Custodians Co-curricular advisorsAthletic Coaches Lunch/Playground supervisors EVERYONE!!!

17. Signs and Symptoms Mild to Severe

18. What does it look like? Mild Allergic Reaction:  MOUTH: Itchy mouth  SKIN: A few hives around mouth/face, mild itch  ABDOMINAL AREA/ STOMACH: Mild nausea/discomfort FAAN, 2012

19. What does it look like? Anaphylaxis: Any SEVERE SYMPTOMS after suspected or known ingestion:  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: Obstructive swelling (tongue and/or lips)  SKIN: Many hives over body FAAN, 2012

20. What does it look like? Anaphylaxis: Any SEVERE SYMPTOMS after suspected or known ingestion:  Or combination of symptoms from different body areas:  SKIN: Hives, itchy rashes, swelling (e.g., eyes, lips)  ABDOMINAL AREA/ STOMACH : Vomiting, diarrhea, crampy pain FAAN, 2012

21. How will I know what to do?  District Nurse will develop an “Allergy Action Plan” for students with a diagnosed allergy  Includes steps to follow  Should be reviewed regularly Be prepared to act!

22. Allergy Action Plan FAAN, 2012  Individual – specific to the student  Should go to all school staff who interact w/student  Information should be treated with care

23. FIELD TRIPS  Notify health aide or nurse so medications will be ready  Invite parents/guardians to accompany student on field trip;  If parent/guardian is unable to go along, consult with the principal to identify a trained staff member to accompany the student on the trip and who will administer epinephrine auto-injector in case of emergency;  Plan for prevention of exposure to serious adverse allergens;  For overnight and/or extend trips, every reasonable effort will be made to inform parents/guardians of planned meals and to discuss allergen free meals;  Take meds on field trips or anytime off campus. Epinephrine auto- injector should not be stored in extreme hot or cold temperatures;  Allow students who are approved to self-administer medication to carry their own epinephrine auto-injector;  Carry a cell phone or other means of communication to use if emergency help is required;  Consider ways to wash hands before and after eating; and  Store meals/snacks of students with serious adverse allergic conditions separately to minimize cross contamination.

25. Epinephrine Administration Know what to do! Act Quickly!

26. Epinephrine  Epinephrine is the drug of choice for anaphylaxis  Should be administered PROMPTLY  Some protocols call for epinephrine to be administered with or without symptoms  A delay in treatment can have devastating results Robinson & Ficca, 2011 Sicherer & Simons, 2007

27. Epinephrine  Universal standard for treatment of anaphylaxis  Delayed administration associated with increased morbidity and mortality  Impressive safety profile:  No absolute contraindications to use of epinephrine  Cases of cardiac arrhythmias only tend to occur in elderly patients with pre‐existing cardiovascular disease National Association of EMS Physicians, 2011

28. State Laws and Regulations  Each state has unique laws and regulations  Virtually every state has passed legislation to allow students to carry prescribed epinephrine at school  Depending on the wording of the law, the permission to carry may also extend to activities held on school property, and during transportation to and from school or school‐related events  Review of laws for WISCONSIN

29. Wisconsin State Law  Statute 118.29(2)(a)2m.  2m. Except for epinephrine administered under subd. 2., may use an epinephrine auto−injector to administer epinephrine to any pupil who appears to be experiencing a severe allergic reaction if, as soon as practicable, the school bus operator, employee or volunteer reports the allergic reaction by dialing the telephone number “911” or, in an area in which the telephone number “911” is not available, the telephone number for an emergency medical service provider.

30. Wisconsin State Law  Statute 118.29(3) EMERGENCY CARE; CIVIL LIABILITY2m. Any school bus operator validly authorized under ss. 343.12 and 343.17 (3)(c)to operate the school bus he or she is operating and any public, private, or tribal school employee or volunteer, county children with disabilities education board employee or volunteer, or cooperative educational service agency employee or volunteer, other than a health care professional, who in good faith renders emergency care to a pupil of a public, private, or tribal school is immune from civil liability for his or her acts or omissions in rendering such emergency care. The immunity from civil liability provided under this subsection is in addition to and not in lieu of that provided under s. 895.48 (1).

31. Epinephrine Auto-Injectors  Epinephrine Auto- injectors are easy to use  Come with instructions  Trainers available for practice use  Websites have video demonstrations – know the auto- injector prescribed for your student and know how to administer it! Epi-Pen  video http://www.epipen. com/how-to-use- epipen Epipen4schools.com Auvi-Q  video https://www.auvi- q.com/ Adrenaclick  http://adrenaclick.co m/how_to_use_adrena click_epinephrine_inje ction_USP_auto_inject or.php Generic Coming soon

32. Epinephrine Auto-injectors Epi-Pen  Adult: 0.3 mg  Epi-Pen Jr.: 0.15 mg  IM injection into thigh Auvi-Q  Adult: 0.3 mg  Available in 0.15 mg as well

33. Epinephrine Auto-injectors Adrenaclick  Adult 0.3mg  Also available in 0.15mg

34. Review – Steps to Follow If student has symptoms of anaphylaxis:  Follow the Allergy Action Plan – call the health aide or nurse if available  Give the epinephrine auto-injector without delay – give 2 nd dose if protocol calls for it  Call 911 to transport student to hospital  Get support from administration to call parent Do not leave student alone!

36. Document and Debrief  Complete an accident/incident report to record that you gave an epinephrine auto-injector dose and the symptoms you witnessed  Have a debriefing meeting with the nurse and your building principal after giving an epinephrine auto-injector  Talk about how response went  Talk about feelings  Talk about ways to improve in the future Robinson & Ficca, 2011

37. You Can Do It!  You know what to do when a student is having a life-threatening allergic reaction  You know the importance of giving epinephrine  You know how to save the lives of children like Kate! Kate

38. GET TRAINED © Thank you for completing the KNOWLEDGE portion of ALLERGY TRAINING. If you will be taking students with serious allergies on a field trip, you will need to schedule the SKILLS training. Please contact: Cindy Roach, RN at 414-961-2888 (SHS health office) 262-385-5794 (cell phone) or Email: croach@shorewood.k12.wi.us

39. References  Food Allergy and Anaphylaxis Network (2012). Retrieved from: http://www.foodallergy.org/  Robinson, J. & Ficca, M. (2012). Managing the student with severe food allergies. Journal of School Nursing, 28(3), 187-194. doi: 10.1177/1059840511429686.  Sicherer, S. & Simons, F.E. (2007). Self- injectable epinephrine for first aid management of anaphylaxis. Pediatrics, 119(3), 638-646. doi: 10.1542/peds.2006-3689.

40. References  For more information – know the brand of epinephrine auto-injector that your student has been prescribed:  Epi-Pen  : www.epipen.comwww.epipen.com  Auvi-Q  : https://www.auvi-q.com/https://www.auvi-q.com/  Adrenaclick®: http://adrenaclick.com/http://adrenaclick.com/