GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN EDUCATIONAL ESTABLISHMENTS DHSSPS /DOE 2010

1. GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN EDUCATIONAL ESTABLISHMENTS DHSSPS /DOE 2010

2. OBJECTIVES OF SESSION • Update your knowledge on anaphylaxis • Be aware of the emergency treatment prescribed for children with this condition • Practise the correct technique for auto-injector administration • Be aware of how to safely dispose of the auto-injector

3. WHAT IS ANAPHYLAXIS? • Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing life-threating problems involving the airway and /or breathing and /or circulation. In most cases, there are associated skin and mucosal changes

4. COMMON CAUSES • Wasp • Bee • Latex • Penicillin • Blood Products • Drugs • Kiwi • Peanuts • Tree nuts • Milk • Egg • Sesame • Fish • Shellfish

5. TYPES OF REACTION • Uni-phasic – rapidly developing severe reaction involving the airway or circulation. • Bi-phasic – early oral and abdominal symptoms, then a symptom-free period of 1 – 2 hours, then increasing symptoms involving breathing and circulation.

6. MINOR REACTION • Feeling hot or generalised flushing of the skin • Intense itching and rapid development of a nettle like rash welts • Burning sensation of lip and /or metallic taste in mouth • Red, itchy, watery, swollen eyes or swollen lips or face • Vomiting and diarrhoea with abdominal pain • Itchy, runny or congested nose and / or sneezing • Dizziness and feeling faint/pallor – may indicate severe reaction in the very young.

7. TREATMENT FOR MINOR REACTION ANTIHISTAMINE AND INHALERS • Follow the child’s individual care plan. Administer the prescribed antihistamine e.g. Piriton and/or inhaler • Record the time given and stay with the child • Contact parent.

8. SEVERE REACTION • Difficulty in breathing / noisy breathing, wheeze or stridor • Swelling of mouth / tongue or feeling of tightness or lump in throat • Decreased level of consciousness • Collapse, lack of breathing • Absent or very weak pulse

9. TREATMENT OF SEVERE REACTION • Give prescribed Auto-injector & record time • If unconscious but breathing place in recovery position • Call paramedic ambulance 999 • Contact parent / carer (contact numbers given over) • If no improvement within 5 minutes give auto-injector & record time • If no signs of life commence CPR (cardiopulmonary resuscitation) and continue until professional help arrives • IF IN DOUBT GIVE AUTO-INJECTOR • If Auto-injector is given the child MUST go to hospital for observation even if they have made a full recovery

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14. AUTOINJECTOR An Auto-injector EpiPen or Jextis prescribed according to the child’s weight to deliver a single dose of adrenaline and reverse the symptoms of anaphylaxis. • Child dose 0.15mgs • Adult dose 0.3mgs

15. STORAGE OF EMERGENCY BOX • Accessible at all times during the school day – NOT in a locked room or cupboard. • Contains completed care plan with medication in date • Avoid extremes of temperature. • Clearly labelled with child’s name.

16. ROLES AND RESPONSIBILITIES The Child’s Parent :- • Will ensure that the school are fully informed about the child’s allergy including when no longer allergic to particular foodsor substances • Care plan to be completed by parent and returned to school promptly • Will accept responsibility for maintaining and replacing in school, two up to date auto injectors. If the child has been prescribed an Auto-injector device that the school has no experience of using, the school and school nurse should be immediately informed.

17. It is the duty of the parent to check the expiry date of the Auto-injectors. The parent should return out of date auto-injectors to pharmacy for disposal • Will discuss with the school arrangements for lunch and snacks. • Will regularly remind the child of the need to refuse any food items offered by others. • Will encourage their child to wear a medical identification device • Will remove all medication at the end of the school year.

18. The school :- • The school principal (or designated teacher) will notify school nurse on becoming aware of a pupil requiring an adrenaline Auto-injector device e.g. EpiPen / Jext or Anapen in school • The principal or designated teacher will make staff aware of pupils allergic condition and who trained staff are (temporary /substitute teachers) • The principal or designated teacher will identify adequate numbers of appropriate staff to attend training. Annual updated anaphylaxis centralised training will be offered • Inform staff of activities which could put the pupil at risk • School trips – school should make arrangements for safe handling and transportation of Auto-injector

19. Should discuss details of care plan and child’s condition with parents. • The principal will ensure that the care plan is signed appropriately. If care plan not returned or updated it is the responsibility of school to follow up with parent. • Will agree with the parents and if necessary, the area catering manager on the provision of school meals/snacks. • Will ensure safe storage of, and easy access to, the two auto- injectors devices together with care plan. All trained staff must be aware of where these are stored. • It is the duty of the parent to check the expiry date of Auto- injectors, however schools should be aware of expiry dates on medication to ensure that they not left with out of date medication.

20. The Pupil (depending on age of child) • Post primary pupils may be responsible for carrying their own Auto-injectors WITH THEM AT ALL TIMES especially when away from main building e.g. sports fields • Will be aware of the risk of food sharing • Advised to wear medical identifier • Report the onset of symptoms to a responsible member of staff

21. School Health Team :- • Provide centralised training on the recognition and treatment of anaphylaxis in partnership with SELB and give advice and support to school staff. • Participate in any debriefing session/follow up of major or minor incident • Will contact the parents and school, on an annual basis, seeking updated information and send a copy of care plan to parents for completion • The named school nurse for your school will only make 2 attempts via telephone to contact parents regarding the annual updating of Autoinjector care plan. This is the parents responsibility. • If care plan not returned a letter will be sent to parents , GP and Principal stating this could place their child at risk should an emergency situation arise. • School nurse along with school designated teacher will review care plan when returned by parent and sign appropriately

23. Name:_________ Date of Birth:______ Minor reaction Known severe allergies  ___________ • Keep calm, stay with pupil and call for help • Give prescribed medication e.g. Piriton • if asthmatic give 4-6 puffs of reliever (blue) inhaler • Record medication administered and the time it is given • Locate pupil’s prescribed auto-injector • Contact parent or carer

25. Give prescribed Auto-injector & record time__________ • If unconscious but breathing place in recovery position • Call paramedic ambulance 999 • Contact parent / carer (contact numbers given over) • If no improvement within 5 minutes give Auto-injector & record time_________________ • If no signs of life commence CPR (cardiopulmonary resuscitation) and continue until professional help arrives • Used Auto-injector accompanies child to hospital • IF IN DOUBT GIVE AUTO-INJECTOR Form fist around Auto-injector and pull off BLUE cap (JEXT YELLOW cap) Hold Auto-injector 10cm away from outer thigh. ORANGE (JEXT BLACK) tip should point towards outer thigh through clothing if necessary. Jab firmly into outer thigh so that autoinjector is at right angle to outer thigh until a click is heard and hold in place for 10 seconds. Remove Auto-injector and massage the injection site for 10 seconds. Used Auto-injector accompanies child to hospital

26. Frequently asked questions • In an emergency can I use another pupil’s Auto-injector? • What do I do if a care plan is not returned by parent? • Who should attend Anaphylaxis Awareness? • Is prescription required from GP?

27. Today you should have: • Updated your knowledge • Be aware of the emergency treatment prescribed for children with this condition • Practised the correct technique for auto injector administration • Be aware of how to safely dispose of the injector.

28. WANT MORE INFORMATION? • Contact the Anaphylaxis Campaign • Tel: 01252 542029 • www.anaphylaxis.org.uk • www.allergyinschools.org.uk • www.cateringforallergy.org • Schools pack • Video/DVD • Managing Medicines in Schools ans Early Years Settings. DH/DfES.

29. Contact telephone numbers for school nursing • Armagh 028 3741 2510 • Dungannon 028 8771 3084 • Banbridge 028 4066 2866 • Craigavon 028 3834 1431 • Newry 028 3083 4309 • Kilkeel 028 4176 0829

30. Thank you for your time.