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Are Schools Prepared to Handle Food Allergy Emergencies?

School Safety in Food Allergy Emergencies

Officials in the state of Virginia are investigating the death of a 7-year-old Chesterfield County girl who appears to have died as a result of a severe peanut allergy reaction. School officials are investigating the procedure that the child’s elementary school followed during the emergency to evaluate if the staff was adequately prepared to handle such incidents. Unfortunately, with the increase in the number of children with food allergies combined with the reduction in education staffing due to financial constraints, this type of tragedy could easily happen anywhere. How prepared are our schools to handle children with severe health conditions such as food allergies?

According to the Food Allergy and Anaphylaxis Network (FAAN), approximately 8% of American kids have an allergy to a food ingredient. The most common are peanuts, tree nuts, eggs, milk, fish, shellfish, soy and wheat. Symptoms can range from mild itching to severe anaphylaxis within minutes of eating the offending food. There is no “cure” for a food allergy; strict avoidance is the only way to avoid a reaction.

Obviously, children spend the majority of their waking hours at school. Most eat at least one meal there, as well as a snack or two. Parents of food-allergic children typically work closely with school officials to ensure that everyone is aware of the allergy, what the child’s plan of care is in the case of an emergency, and usually strictly monitors what a child eats. Unfortunately, as in the case of first-grader Ammaria Johnson, accidents do happen.

Ammaria was allergic to peanuts. She complained to her teachers of hives and shortness of breath during recess after “eating something bad.” It is unclear where she got the offending food, or even exactly what it was. Unfortunately, communication mix-ups appear to have played a role in her death, as the school did not have medication to reverse the anaphylaxis.

Epinephrine (adrenaline) is the first-line treatment for severe allergic reactions. Delayed use of epinephrine has been associated with deaths, says the FAAN. In the case of severe allergies, a doctor will prescribe an epinephrine auto-injector, commonly called an Epi-Pen. In schools, the most common procedure for allergic children is to have parents provide prescribed medication to the school along with an authorization form on how to use the medication if it is needed.

In Ammaria’s case, there was not an Epi-Pen at the school prescribed specifically for her. The school nurse could not give the girl medication prescribed to someone else.

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Schools keep many over-the-counter products on hand for emergencies – band-aids, antiseptic for cuts, etc. But should they keep other types of medications that potentially save lives? The FAAN is working with legislators on a bill that would require schools to stock epinephrine auto-injectors to be used for anaphylactic emergencies. Data shows that up to 25% of all epinephrine administrations occur in the school setting, and that many involve students who were unaware of their allergy.

The “School Access to Emergency Epinephrine Act (S.1884) was introduced in the Senate on November 17th, 2011 and in the House of Representatives (HR.3627) on December 8th. The bill complements one passed last year called the “Food Allergy and Anaphylaxis Management Act (FAAMA)” which requires the US Secretary of Health and Human Services to develop and make available to schools a voluntary policy to manage the risk of food allergy and anaphylaxis in schools and to provide for school-based food allergy management incentive grants to support implementation of public school guidelines.

Should the law pass, this extra safety effort should not replace basic education to school staff. "It's very straightforward. There is no magic to this," said Maria Acebal, head of the FAAN. “When consequences can be life-threatening, then you've got to have schools prepared for an allergic reaction. It's absolutely doable to keep kids with food allergies safe at public school, but it requires education and preparedness." She notes that Ammarie's death "just underscores the need for all teachers to have the basics of food allergy safety as part of their orientation and continuing education."

Parents should also have open communication with their child’s school and have an Individual Health Care Plan (IHCP) in place should there be an emergency situation. Creating a multi-disciplinary team that includes the school nurse, the principal, the child’s teacher(s), the cafeteria/food service manager and any other staff member involved during the school day (ie: bus driver, athletic coach) can go a long way to creating a safe atmosphere for a food-allergic person.

Another piece of legislation that would help parents keep their food allergic child safe at school would be to include the labeling of food ingredients, including food allergens, on school menus. The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires the labels of all foods containing major allergens to declare so in plain language. Unfortunately, this law does not extend to the food that is ultimately served to our children at school lunch. A 14-year-old high school freshman hopes to one day change that.

Lauren Maunus of Florida has written a bill and presented it to state legislators after seeing what her mom had to go through to keep Lauren’s 11-year-old food allergic sister safe at school. "My mom would have to go the county offices to see the labels of foods in the school cafeteria, and if any of the labels changed, she was not informed of it," Lauren said. "It was really scary. This bill would allow my sister, every time she was about to put something in her mouth, to know what was in it before she ate it."

Source for this Article Include:
Food Allergy and Anaphylaxis Network (FAAN)



We will be praying for this family. Certainly this topic comes up quite frequently at our monthly support group meetings (ocfoodallergy com). As a support group leader and a parent of two kids with two different food allergies, I can safely say that food allergy emergencies are very stressful and a common topic at our meetings. Unfortunately it is a probably an issue that is going to get much worse before it improves.
The school nurse could not give medication prescribed for someone else....meaning her fear of violating policy trumped the child's need for life-saving treatment? If so I certainly hope most school nurses have more courage and common sense than this one did.
But WHY wouldn't a school nurse have an epi pen?
Maybe there is not a school nurse on site every day. Maybe the "nurse" is not a professional RN with full medication administration capabilities. These are not acceptable excuses and these questions need to be explored. Is the safety and well being of our children not priority? The solution is NOT to pass these responsibilities off to teachers or health aides. How many student deaths will it take until there is dedicated funding for RN's at every school, full time?
Epi-pens are prescribed to individuals by their physician. As much as I would be nice to have epi pens available to use on anyone who needs it, we do not have the ability, legally, to dispense medications without a medical license.
If there is a school physician consultant arrangement, a school or district can obtain a standing order for emergency epinephrine autoinjector administration by a school RN to any student in need (with preauthorized parent permission). Do a google search on this and you will find many resources to guide you in putting safe and effective policies and procedures in place to ensure the safety of all children and staff. Incidentally, doctors, NP's PA's, and dentists prescribe medication, pharmacists dispense and nurses admininster.
Then a standing order from a physician for the school nurse (if there is one) to draw epinephrine from a vial and give it. Of course nurses don't dispense, but there are "standing protocols" that can be developed for something like this that is life-threatening. I mentioned an epi-pen specifically because they are fast and ready to go.
Please forgive any confusing information. I am not suggesting that you need to draw epi from a vial! There are other manufacturers of auto injectors other than Epi-pens, though the Epi-pen seems to be the best designed one on the market, last I checked.
I understand. I was replying to Kimberlie. Thank you.
It is not policy, it is law. What if the child for whom the medication was prescribed needed it and there was none available because it was given to another student. And you assume that there WAS a school nurse.
Many of us (school nurses) have had this conversation. Most of us would rather lose our license by giving a kid someone elses EPI-PEN than to lose a child's life. The better solution is to have the schools stock a pen. We have 7 schools in our district and our DON (director of nursing) has opted not to stock the pens, which cost $100 per pen. The pens expire after 1 year. Every year you would spend $700 on them. How much is a life worth to a school district? All it takes is one time.
Thank you for your comment - it's real and it's valuable.
I believe that the school nurse or whoever chose not to give this child another child's medication acted in the best interest of both children. There was an incident where a child who did not have their Epi Pen at school and needed it was given another child's EpiPen and it saved their life. Unfortunately that 2nd child came in that same day in anaphylaxis and their Epi Pen was no longer available and that child died. I know it is not an easy call to make and it is very sad. What we need is parents who will bring in their meds on time, unexpired. Insurance company's who won't charge $200 for a life saving medication and legislation that allows a standing order for Epinephrine in the school setting.
One important piece of info missing from this story is that the school does not have a School Nurse. An unlicensed person who took a med administration course is the person administering medications at that school.
The state of Nebraska has addressed this issue by instituting an emergency response protocol for life threatening allergic reactions. Google "Attack on Asthma Nebraska" and lobby for a similar program in your state. The school nurse is responsible for educating and training a team in each school so even a school without an RN on site will know how to respond in an emergency. The program has saved many lives and provided peace of mind for families, students, and school personnel.
This protocol may be acceptable for students who have a diagnosed severe allergy but about 25% of all instances of anaphylaxis occur in people without a previously known or diagnosed allergy. This other type of situation needs the professional assessment and care of a fulltime, onsite RN to differentiate between a severe asthma attack or some other condition which may appear like an allergic reaction. Why must we cut corners on the health, safety and well being of our children? These things should be the number one priority in schools.
We all know the ideal would be to have a registered nurse in every school, but the reality is many districts stretch nurses thin by routinely assigning them several elementary schools. In these situations a protocol such as the one instituted in NE is better than nothing at all. I agree, our childrens' health and safety should be the number one priority in schools and I hope to see a day when every school district superintendent agrees.
You are preaching to the choir. I'm willing to bet everyone on this thread agrees that every school should have a full time RN, but unfortunately most districts view it as a luxury - not a necessity. Until the ideal becomes a reality most of us are stuck training unlicensed personnel to do our job in our absence. Having a program like the one in NE is better than having nothing at all.
Buying an epi-pen per school is only part of the problem. If a district does not have a supervising physician, there is no one to order the Epi-Pen making it a mute point as to whether the district is willing to pay the money or not. If there is to be a law requiring an Epi-Pen available, then the physician order needs to be dealt with at the introduction of the law, "Who will be the ordering physician for the uncovered schools?"