1. Assisting Students With Severe Allergies: Epinephrine Auto-injector Training HARLANDALE INDEPENDENT SCHOOL DISTRICT STUDENT SUPPORT SERVICES School Health Services

2. 2 Training Overview  PURPOSE: Students with severe allergies may experience life-threatening allergic reactions known as anaphylaxis. Trained school employees who respond quickly and appropriately may save a student’s life. The purpose this educational activity is to train identified school employees to respond successfully and appropriately if an anaphylactic emergency occurs for specific students.

3. 3 Training Overview  Training Content: Anaphylaxis Basics Student Specific Instructions Documentation & Reporting Possible Review of Specific Student Information Responding in Case of Anaphylaxis  Verbal Description  Demonstration  Return Demonstration

4. 4 Training Overview  To meet the requirement of training by law, you must: Attend the full training session Demonstrate that you can correctly carry out the treatments needed Return the demonstration of the Epinephrine auto-injector skills.

5. 5 Training Overview  By virtue of this required training: You are eligible (if officially assigned by the school administrator) to perform the treatments for which you were trained only for the specific student(s) assigned to you.

6. 6 Training Overview  Please note that: The skills taught during this training are to be used at school or school related functions only for meeting the needs of the student(s) that you are assigned to assist. The skills are not transferable to other settings.

7. 7 Training Overview  Refer to section of district policy FL (Legal)- P, Page 3 of 23 District procedures should ensure immediate access to the epinephrine auto-injector and the medical prescriber’s written orders and instructions. Immediate transport to an emergency medical facility should be required after administration of epinephrine. Schools should consider a standard of training staff to administer the Epinephrine injection.

8. 8 Anaphylaxis Basics  What is anaphylaxis? Anaphylaxis is an allergic emergency. Anaphylaxis is a severe allergic reaction that can result in death within minutes. Death may be caused by:  Swelling that shuts off the airway or  A dramatic drop in blood pressure.

9. 9 Anaphylaxis Basics  What causes anaphylaxis? It is a rapid, severe allergic reaction that occurs when a person is exposed to an allergen (something to which the person is allergic). Exposure to the allergen triggers the body to release chemicals into the bloodstream to protect itself from the allergen. In people with severe allergies the chemicals released by the body can cause breathing difficulty, swelling, dizziness, shock, and even death.

10. 10 Anaphylaxis Basics  What are some common triggers for anaphylaxis? Bee, wasp, yellow jacket and fire ant stings Foods such as peanuts, milk, eggs, fish, shellfish and some food additives Medications Latex, found in elastic waistbands, balloons, and some gloves Exercise (rare) In some cases the exact trigger is not known

11. 11 Anaphylaxis Basics  What are the common signs and symptoms of anaphylaxis? Most distinctive signs and symptoms:  Hives, itchy skin  Swelling or flushing (sudden redness) of the throat, lips, tongue, or around the eyes  Wheezing, shortness of breath, coughing, hoarseness

12. 12 Anaphylaxis Basics  Other common symptoms include: Metallic taste or itching in the mouth Abdominal cramps, nausea, vomiting, or diarrhea Increased heart rate Sudden decrease in blood pressure and paleness

13. 13 Anaphylaxis Basics  More signs and symptoms Sudden feeling of weakness Anxiety or an overwhelming sense of doom Collapse Loss of consciousness

14. 14 Anaphylaxis Basics  Every person is different and symptoms vary.  It is important, if possible, to know the specific symptoms for the student that you will assist.  Symptoms appear within a few seconds after the exposure to the trigger.

15. 15 Anaphylaxis Basics  Anaphylaxis is a medical emergency.  Death can occur within minutes.  Anaphylaxis requires immediate attention.

16. 16 Anaphylaxis Basics  How is anaphylaxis treated? Preventing anaphylaxis is the first goal. Persons with a known allergy should try to avoid substances that trigger severe allergic reactions. Avoiding allergens is not always possible.  Difficult to predict the movement of flying insects (bees)  Ingredients in food are not always obvious

17. 17 Anaphylaxis Basics  So, what treatment is needed in the event of anaphylaxis? Epinephrine injection is the medication used to treat anaphylaxis. Epinephrine used for students with known allergies comes in a spring loaded syringe already filled with the right amount of medication (epinephrine auto-injector).

18. 18 Anaphylaxis Basics  Epinephrine is a chemical that narrows the blood vessels and opens the airways.  This reverses the low blood pressure and wheezing caused by the allergic reaction.  How is epinephrine packaged? 0.30 milligrams (mg) – usually for individuals weighing more than 66 pounds 0.15 mg – usually for individuals weighing less than 66 pounds

19. 19 Anaphylaxis Basics  The student’s health care provider will decide how much epinephrine is right for the student.  The epinephrine auto-injectors will already have the prescribed amount in the syringe.

20. 20 Anaphylaxis Basics  Side effects of epinephrine include: Severe headache Blurred vision Flushed skin Fast or irregular heart rate Sweating Nausea and vomiting Pale skin Dizziness Weakness or muscle tremors Apprehension, nervousness, and anxiety

21. 21 Anaphylaxis Basics  How should the epinephrine auto- injector be stored? Keep at room temperature. Do not refrigerate. Keep out of direct sunlight. Store in its plastic container. District policy requires it to be secured at all times unless the student is meets requirements to “self-carry” or self- administer.”

22. 22 Anaphylaxis Basics  After using an epinephrine auto-injector it is important to call 911 to get emergency care for the student.  Emergency care is important because the effects of epinephrine can wear off and there is a chance of a second reaction.  Send the used epinephrine auto-injector with the student to the emergent care facility.

23. 23 Anaphylaxis Basics  Questions and Answers

24. 24 Student Specific Instructions  Confidentiality The Family Educational Rights & Privacy Act (FERPA) is a federal law that requires school employees to keep information about students confidential. Everyone will have GENERAL training. The information shared during this training about a student may be shared with others in the school setting only if there is a legitimate need for the other person to have knowledge of the student’s information. Information about a student may be shared with emergency care workers called to assist the student in the event of an emergency.

25. 25 Student Specific Instructions  Review Student’s Individual Health Care Plan  Review Student’s Emergency Action Plan  Consider challenges to academic instruction like projects implementing food, and field trips.  District is considering an “Approved Birthday Party” List for the parents.

26. 26 Responding in Case of Anaphylaxis  Standard Precautions Standard Precautions are safeguards that are taken to reduce the risk of transmission of bloodborne pathogens. Bloodborne pathogens are disease causing organisms such as viruses that can be transferred from person to person through blood or other body fluids. Standard Precautions should be taken in all situations where there is possible exposure to blood and body fluids other than sweat.

27. 27 Responding in Case of Anaphylaxis  Epinephrine Auto-injector Caution  Accidental injection into the hands or feet may result in loss of blood flow to the affected area. If this occurs go immediately to the nearest emergency department for treatment.  Do not remove the safety cap until you are ready to inject this medication. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed.

28. 28 Responding in Case of Anaphylaxis  Medications Six rights related to providing a medication:  Right student  Right medication  Right dose (amount)  Right time (appropriate time)  Right route (method of giving the medication)  Right reason

29. 29 Documentation  The Nurse will have the forms needed for proper documentation. You must note the time the Epinephrine was given for documenting and reporting to EMS.  Your documentation will provide a description of the events and the care that you provided.  The documentation sheet will become a part of the student’s health record and will be considered a legal document.  If you make a mistake when writing your notes, a single strike through is the only acceptable correction.  Do not use abbreviations.  Sign your legal name.

30. 30 Documentation  What to document? Note time of event What you observed What the student reported or did What you did What happened after you did what you did Note time of injection Note time of call to EMS and parent/legal guardian and the results of call Note notification of appropriate individuals following event

31. 31 Reporting  Student Assistance Any assistance provided to an assigned student must be reported immediately to the school administrator on duty and/or the school nurse. The nurse who is providing oversight for the school must be notified within 24 hours. A nurse will review the event and actions taken.

32. 32 Practice in Responding in Case of Anaphylaxis  Epinephrine Auto-injector Procedure Verbal Description of Process Instructor Demonstration Return Demonstration  The nurse is responsible for monitoring the expiration date of the epinephrine auto-injectors maintained at school. Remind parents that they are responsible for monitoring the expiration date of epinephrine auto-injectors for students who are self-medicating.

33. 33 Practice Responding in Case of Anaphylaxis  Scenarios based on student’s emergency action plan  Practice Time

34. 34 Thank You!  Questions or concerns Your questions, comments, concerns are always welcome.  Now, and  If you think of something later do not hesitate to ask me for clarification.

35. 35 References  American Academy of Allergy, Asthma & Immunology (www.aaai.org)www.aaai.org  Anapen (www.anapen.com) (www.anapen.com/a_anapen/a_anapen.htm)www.anapen.comwww.anapen.com/a_anapen/a_anapen.htm  EpiPen (www.allergic-reactions.com) (www.allergic- reactions.com/pdf.PatientInsert.pdf) (www.allergic- reactions.com/howtouse.aspx)www.allergic-reactions.comwww.allergic- reactions.com/pdf.PatientInsert.pdfwww.allergic- reactions.com/howtouse.aspx  Food Allergy & Anaphylaxis Network (www.foodallergy.org)www.foodallergy.org  Litarowsky, Murphy, & Carham (October 2004). Evaluation of an Anaphylaxis Training Program for Unlicensed Assistive Personnel, The Journal of School Nursing, 20(5), 279 – 284.  National Association of School Nurses, Position Statement: The Role of School Nurses in Allergy/Anaphylaxis Management. (www.nasn.org)www.nasn.org  Twinject (www.twinject.com) (www.twinject.com/hcp/useinstru.asp)www.twinject.comwww.twinject.com/hcp/useinstru.asp