I recently heard Kim Turner speak at the USAnaphylaxis Summit hosted by AANMA. In her speech she explained negligence and reckless, willful and wanton conduct which in layman terms means that once an individual is certified in doing something (epi training) they are held legally responsible to act accordingly (using epi). If harm is done due to the certified individual not acting accordingly (delaying use of epi), then said individual can be held legally accountable (sued). The Good Samaritan Law only protects the teacher if they are outside of the workplace. Keep this in mind when reading the following information.
Think about the last part of that sentence…
the only one required to administer epinephrine is a nurse or someone who willingly took the training knowing that it now holds them legally responsible to do so.
I once spoke with my friend and fellow blogger, Jenny with Multiple Food Allergy Help, in regards to her speaking with her school staff about having EpiPens® locked up in the nurse’s office. This is what she said:
I had told the school that I wanted them to stand on the playground, while a 2nd person runs to a teacher, then to the nurses office finds a particular [student name] Epipen® in the locked filing cabinet, then run that back to them on the playground. While being timed. Now see if you can hold your breath that long.
While thinking of Jenny’s example, does anyone think it possible that the epinephrine could be administered immediately? Like the CDC guideline suggests?
How many of you think this situation would be considered a delayed use of epinephrine?
We can even change this example around and have the EpiPens® on the individual and the story remains the same. However, instead of one child gasping for breath while waiting for medicine to arrive, you have one child gasping for breath waiting for a certified individual that is legally protected to administer the medicine. Why? Because the laws and guidelines in place protect the teachers and schools not the child.
Our next goal needs to be requiring additional individuals certified in administering life-saving epinephrine in ALL schools!
EBL Food Allergies
Excerpts From the CDC Document “Voluntary Guidelines for Managing Food Allergies in the Schools”
The recommended first line of treatment for anaphylaxis is the prompt use of epinephrine. Early use of epinephrine to treat anaphylaxis improves a person’s chance of survival and quick recovery.
It is not possible to set one guideline for when to use epinephrine to treat allergic reactions caused by food. A person needs clinical experience and judgment to recognize the symptoms associated with anaphylaxis, and not all school or ECE program staff have this experience.
Some schools and ECE programs offer clinical services from a doctor or registered nurse. In these cases, the doctor or nurse can use the clinical guidelines to assess children and make decisions about treatment, including if or when to use epinephrine. However, many schools and most ECE programs do not have a doctor or nurse onsite to make such an assessment. In these cases, a staff person at the scene should call 911 or EMS immediately. If staff are trained to recognize symptoms of an allergic reaction or anaphylaxis and are delegated and trained to administer epinephrine, they also should administer epinephrine by auto-injector at the first signs of an allergic reaction, especially if the child’s breathing changes. In addition, school or ECE program staff should make sure that the child is transported without delay in an emergency vehicle to the nearest hospital emergency department for further medical treatment and observation.24,35 These actions may result in administering epinephrine and activating emergency response systems for a child whose allergic reaction does not progress to life-threatening anaphylaxis. However, the delay or failure to administer epinephrine and the lack of medical attention have contributed to many fatal anaphylaxis cases from food allergies.25,36–38 The risk of death from untreated anaphylaxis outweighs the risk of adverse side effects from using epinephrine in these cases.
Students who can manage their own food allergies should have quick (within a few minutes) access to an epinephrine auto-injector, both at school and during school-related events.13
Studies have shown that quick access to epinephrine is critical to saving lives in episodes of anaphylaxis.24,25,37 To ensure quick access to epinephrine, auto-injectors should be kept in a safe and secure place that trained staff members can get to quickly during school or ECE program hours.63,68–70 At the same time, staff must also follow federal and state laws, including regulations, and local policies that may require medications to be locked in a secure place. For example, federal Head Start regulations require that all “grantee and delegate agencies establish and maintain written procedures regarding the administration, handling, and storage of medication for every child,” including “labeling and storing, under lock and key, and refrigerating, if necessary, all medications, including those required for staff and volunteers.”51 State regulations and local policies may similarly require locking medications in a secure location. School and ECE program staff should seek guidance from federal and state regulatory agencies and local policy makers when deciding how to store epinephrine auto-injectors
Delays in using epinephrine have resulted in near fatal and fatal food allergy reactions in schools and ECE programs.25,36,37 In a food allergy emergency, trained staff should give epinephrine immediately. Early and appropriate administration of epinephrine can temporarily stop allergic reactions and provide the critical time needed to get medical help.State laws, state nursing regulations, and local school board policies direct the medication administration in school and ECE programs. They often define which medications nonhealth professionals are allowed to administer in schools, including who may administer epinephrine by auto-injector. If nonhealth staff members are permitted to administer epinephrine, training should be required.39,71