1. Life-Threatening Allergies Why and How to Create a District Management Plan Peg Stanish BSN RN 10/23/14

2. What it IS: Immune system response to a harmless substance (food) that the body senses is an invader.

3. What it ISN’T: Food poisoning--organism Food intolerance—does not involve the immune system— localized signs such as gas, bloating, etc. Aversion—texture, etc. Phobia

4. Most common allergies in children are: Peanuts Tree nuts Milk Eggs Soy Fish Wheat

5. Most common allergens in adults are: Fish Shellfish Peanuts Tree nuts

6. Individual response to the “invader” varies. Some people may develop hives just from touching a substance.

7. Anaphylaxis A sudden and severe reaction which involves several areas of the body, including:

8. Skin: Itchy eyes/throat Hives Tingly lips/throat Eczema Swelling Redness

9. Respiratory : Wheezing Shortness of breath Cough Stuffy or runny nose

10. Gastrointestinal: Nausea Vomiting Abdominal cramping Diarrhea

11. Cardiac: Decreased B/P Elevated heart rate Chest pain Feeling of impending doom

12. ALL reactions need prompt attention. Untreated anaphylaxis may result in death. Do NOT hesitate to give appropriate medication or call for EMS to assist.

13. Medications work to reduce symptoms: Epinephrine (adrenaline)—injection--Epi Pen or AuviQ— drug of choice for anaphylaxis. Always call EMS if this drug is administered. Person may need assistance giving the shot. Antihistamines—give after epinephrine. Inhaler—for asthma or respiratory symptoms after epi

14. How to Begin Child Nutrition Supervisor and District RN come together to meet and discuss feasibility in a particular district. Make commitment to meet and learn together, put dates on calendar. Utilize current, official resources to form framework. Consider sustainability as the plan takes shape. Acknowledge that subject is emotional for parents with students going to school. Anticipate parent requests.

15. Prior to managing LTAs, your district may have a defining moment that causes you to realize you need a program…and FAST! Procedures for handling food allergies may be as easy as 3 simple words: AWARE AVOID ACT

16. AWARE Health conditions received in the clinic, nurse notifies Child Nutrition of food allergy. Packet is sent home to parent for completion and doctor signature on emergency care plan. Child Nutrition restricts allergen in computer so that student cannot choose the harmful item(s) in cafeteria line.

17. When completed paperwork is returned, the School Nurse reviews orders, oversees education for/training of staff, RN develops individual health plan, monitors emergency medications, and periodically assesses effectiveness of program for each student, in conjunction with Child Nutrition. CN receives orders and assists with daily management through menus and building staff training. Both departments speak with parents and attend conferences, if requested.

18. AVOID (the cornerstone) Minimize ingestion of or contact with the specific allergens, as is reasonably possible in a public school setting. Avoid means of cross-contamination in the kitchen and classroom. Plan for emergencies, field trips, etc. Practice frequent and thorough handwashing. Soap and water is preferred method.

19. ACT!!! Follow instructions on the student’s emergency care plan, as trained to perform. DO NOT HESITATE to act—help or administer medication and contact nurse or EMS, depending on setting. Follow protocol per district procedure for food allergies.

20. What We Learned Parents are very concerned about the safety of their students. Parents want to be heard. Take time to listen. Meeting a parent in person is always time well-spent. Having a scientific approach will lead to an evidence-based program that will serve you well. Separate emotion and fear from the science and research. Use current research. Consistency is key. Reasonable accommodations do not cost money. Include latex and insect stings in the plan. Encourage your principals to provide adequate time for training. A team approach that begins with Child Nutrition and Nursing is amazing! Student safety is the result.

21. Bits and pieces: Each child’s plan is unique, but the common goal of avoidance is by ingestion. Allergists trump general or ER MDs. Most children eat a school meal (or two!), even though the safest option is for meals to come from home. 97%+ of our students eat school meals. We cannot guarantee that a food reaction will never happen but we will be prompt in our actions to keep the students safe. So…..

22. YOU are an important part of the plan to keep kids safe and to act, should a food reaction occur. Action may be as simple as calling for help or 911. Keep up the good work, and thanks for ALL you do each and every day! I have included The FTCSC plan in the handouts, which also includes the packet we give parents—2-way release, the USDA form (MD orders), responsibilities of parents and students. Other responsibilities are available on the CDC site. And now a word from Carol Gelatt, BSN, RN, Coordinated School Health Specialist for IDOE, who will speak briefly about the new IN epinephrine in schools law.

23. Great Resources: CDC—Voluntary Guidelines for Schools http://www.cdc.gov/healthyyouth/foodallergies/pdf/13_243135_A_Food_Allergy _Web_508.pdf FARE—Food Allergy Research and Education www.foodallergy.org www.foodallergy.org FAME—Food Allergy Management and Education Manual—St. Louis Children’s Hospital http://www.stlouischildrens.org/health-resources/advocacy-outreach/food- allergy-management-and-education/food-allergy-management-and NASN—National Assoc. of School Nurses http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis NSBA—National School Boards Association http://www.nsba.org/services/school-board-leadership-services/food- allergiesschool-health

24. Contact Information: Peg Stanish BSN RN Supervisor of Health Services Franklin Township Schools 6141 S. Franklin Rd. Indianapolis, IN 46259 Peg.Stanish@ftcsc.k12.in.us (317)803-5011