FOOD ALLERGIES FOOD ALLERGIES

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1 Food Allergies Inside: Management Overview Recommendations for Managers Training Tips for Managers Information for Restaurant Employees Symptom and Cause Poster

2 FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES Dear Customer, Fireman s Fund and the restaurant industry have experienced an increasing number of liability claims involving Food Allergies. While the number of claims is small, it is growing and individual claims are large, when they occur. Medical emergencies due to acute food allergies are serious and every restaurant should have an appropriate response plan. This educational booklet provides managers with a valuable overview of food allergies, how to prevent customer reactions, and steps to take should an incident occur. Staff training tips are provided with supporting fact sheets. A placard to serve as an ongoing reminder of the main points is included. To learn more about Fireman s Fund safety programs for restaurants, contact your agent, broker or Fireman s Fund representative. FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES FOOD ALLERGIES

3 Food Allergies: Management Overview Food Allergies are serious business! Many people suffer from food allergies, an increasing problem with the variety of our food sources. A food allergy incident involving your customer can affect your facility s reputation, lead to expensive litigation and damage your business profitability. The following information can reduce this risk by helping you: recognize allergic reactions, learn how to prevent them, and know what to do when they occur. Many people have adverse reactions to certain foods. Children are far more likely to have a food sensitivity, and often outgrow their food allergies. They are most often allergic to cow s milk, peanuts, eggs, soy and wheat. There is no cure for food allergies. Experts estimate that from 1 to 2% of adults and 2 to 8% of children are prone to foodinduced anaphylaxis. About 2,500 cases are reported each year, including 100 fatalities. According to a report in the August 6, 1992 issue of The New England Journal of Medicine, life-threatening reactions are increasing due to the growing complexity of our food supply and variety in menus. What are food allergies? Many people have adverse reactions to various foods. Intolerance to lactose (milk sugar) is most common. One survey indicated that up to 17% of U.S. households believe at least one member is food-allergic. While dietary intolerances are common, true food allergies which produce severe reactions are not. The following terms help to explain the difference: Food intolerance (or food sensitivity) is an adverse reaction to food that does not involve the immune system Food allergy (or hypersensitivity) is an adverse reaction which involves the body s immune system Anaphylaxis is a severe systemic reaction which sends the body into anaphylactic shock and, unlike food intolerance or food allergy, can result in death Anaphylaxis (the most severe allergic reaction) can cause severe symptoms in 5 to 15 minutes, although life-threatening reactions may progress over a period of hours. The symptoms include: difficulty breathing, swelling or itching of the lips, mouth and/or throat, nausea, vomiting, diarrhea, itching, hives, eczema and redness of the skin, drop in blood pressure, loss of consciousness. Any food can cause anaphylaxis, and as little as one-fivethousandth of a teaspoon has caused death. Peanuts cause up to half of reported cases. Tree nuts, shellfish, milk, eggs, wheat, soy, sulfites, monosodium glutamate (MSG) and fish are the other common sources of food allergens. Beans, berries, corn, Yellow Dye No. 5 and gum arabic are also known to cause problems. Recommendations for Managers What should you do about food allergies? 1. Provide accurate information on food ingredients for your staff Know what ingredients have been used and where to find the information. Establish a recipe management system to assure that food preparers will document any substitutions, particularly those containing common food allergens. Request ingredients from suppliers where labels are not clear. Provide food preparers with thorough information on sources of food allergies and how to read food labels. 2. Leave the responsibility for choosing an appropriate meal with the customer Help customers with information on food ingredients and food preparation. Assign a person on each shift to answer questions about food ingredients and meal preparation. Be direct in helping customers and be very clear on what you do not know. 3. Remind your customers of their responsibilities Customers planning or hosting catered events, banquets and buffets should be asked to determine whether special meals will be needed for their guests with food allergies. Add a notice on your menu: Food allergies? Please notify your waitperson or If you have any food allergy, please tell your server FOOD ALLERGIES 1

4 4. Implement procedures for serving customers with food allergies Identify who will be responsible for monitoring meal preparation for a food-allergic customer. Provide guidelines for food preparers to prevent crosscontamination in the preparation of allergen-free foods. 5. Prepare for emergencies Train waitstaff to recognize the symptoms of anaphylactic shock and post this information for their ready reference. Establish a three person emergency team for each shift. one staff member to stay with the afflicted customer. one person to call emergency medical services. one person to reassure other customers and provide prompt access for the emergency medical service. Prepare your emergency team to take prompt action. instruct waitstaff to inquire immediately when a customer shows symptoms of anaphylactic shock or appears to be in distress, and to notify your emergency team immediately ask if the customer is carrying medication that will help. call 911 or other emergency medical assistance and alert them to the possibility of an allergic reaction. Practice an emergency response. Designate someone responsible for following up on an emergency. provide information on the incident, food ingredients and food preparation for medical staff gather information about the afflicted customer, including employees and other customers who witness the incident notify restaurant management and insurance representatives 6. Prepare for incidents that happen without your knowledge Keep a record of your daily menus and food suppliers. Use a recipe management system and keep a record of ingredient substitutions for a minimum of two years. Maintain a schedule of table assignments for waitstaff. What should be done after an incident occurs? After the emergency has been met, you will want to resolve the incident efficiently and economically, and get your business quickly back to normal. These are common sense steps you can take to preserve your rights and protect your reputation: 1. Promptly notify your insurance representative and your insurance carrier 2. Document the incident, as soon as possible Develop a chronology of the event including times when the customer arrived, when the meal was served, when the incident occurred, when emergency medical assistance was called and when they arrived. Get names, phone numbers, and addresses of everyone in the customer s party, and of other customers who witnessed the incident, and note their comments. Have each employee who came in contact with the customer document their memory of the incident, including conversations with the customer or members of his/her party, any mention of dietary needs, requests for menu ingredients, mention of food allergies, etc. Record exactly what each person in the party was served and how much of each item served to the customer was consumed (if possible, preserve the customer s food and a copy of the meal order and payment documentation for your insurance carrier). Identify the recipes and list the name and quantity of any substitute ingredients used in the meals served to the customer and his/her party. Identify the sources (suppliers) of the food ingredients. 3. Provide information about the incident only to emergency medical staff and to your insurance carrier Instruct employees to refer all inquires concerning the incident to your management. Designate a management representative to receive all inquiries or requests for information, keep a record of these requests, and refer them directly to your insurance carrier. Instruct employees not discuss the incident with members of the press or release recipes for the food served. Do not admit fault or accept responsibility for the incident, alleged injury or related costs (refer all such issues to your insurance carrier). 4. It is appropriate to show your concern for the welfare of your customers Call the afflicted customer to inquire about their health, express your concern and empathy for their situation. FOOD ALLERGIES 2

5 Training Tips For Managers In order to effectively prepare for food allergy incidents, the staff need to be aware of their role and responsibilities. We suggest that a training session be held to cover the main points of the information presented in this booklet. To assist you in this process we ve provided an employee handout which can be photocopied and given to staff as a training reinforcement tool. We ve also produced a placard to post in a place (kitchen, break room, etc.) where employees will be reminded of the key points. Safety training need not be a lengthy or complicated process. Most employees will find a short (5-10 minute) presentation and discussion interesting and worthwhile. Many restaurants have a daily line up to discuss specials of the day and any pertinent changes affecting the operation. This is an excellent time to introduce and discuss safety topics. 4. demonstrate how to respond during a food allergy reaction 5. understand their role in any follow up investigation of incidents Other Resources What You Need To Know About Food Allergies published by the National Restaurant Association 1200 Seventeenth Street N.W. Washington, D.C Understanding Food Allergy published by the American Academy of Allergy Asthma & Immunology 611 East Wells Street Milwaukee, WI The Food Allergy Network 4744 Holly Avenue Fairfax, VA During the session, the trainer should focus on: Communicating the seriousness of the issue Communicating how the employees need to be involved in the prevention, recognition and handling of food allergy reactions Soliciting questions and comments from staff about ways to handle food allergies at the facility Motivating employees to take an active role in dealing proactively with customers who have food allergies Remind the employees of the need to be vigilant in applying the controls set forth in the restaurant s program as an accident or incident can occur at any time. Review the main points of the employee handout included in this booklet. Employee educational objectives for this session (Food Allergies): At the end of training employees will: 1. convey a knowledge of which foods often cause allergic reactions 2. assist customers who inquire about ingredients in prepared meals 3. identify several of the symptoms of a food allergy reaction FOOD ALLERGIES 3

6 Information for Restaurant Employees on: Food Allergies An increasing number of people suffer from food allergies, and customers who suffer severe allergic reactions can affect your facility s reputation and lead to expensive law suits. The following information can reduce this risk by helping you to: Recognize allergic reactions, learn how to prevent them, know what to do when they occur. What, exactly are food allergies? The following terms help to explain about food allergies and their degrees of severity: Food intolerance (or food sensitivity) is an adverse reaction to food that does not involve the immune system Food allergy (or hypersensitivity) is an adverse reaction which involves the body s immune system Anaphylaxis is a severe systemic reaction which sends the body into anaphylactic shock and, unlike food intolerance or food allergy, can result in death Any food can cause anaphylaxis, and as little as one-fivethousandth of a teaspoon has caused death. Peanuts cause up to half of reported cases. Tree nuts, shellfish, milk, eggs, wheat, soy, sulfites, monosodium glutamate (MSG) and fish are the other common sources of food allergens. Beans, berries, corn, Yellow Dye No. 5 and gum arabic are also known to cause problems. What are the symptoms? Anaphylaxis (the most severe allergic reaction) can cause severe symptoms in 5 to 15 minutes, although life-threatening reactions may progress over a period of hours. The symptoms include: difficulty breathing, swelling or itching of the lips, mouth and/or throat, nausea, vomiting, diarrhea, itching, hives, eczema and redness of the skin, drop in blood pressure, loss of consciousness. 2. Leave the responsibility for choosing an appropriate meal with the customer Help customers with information on food ingredients and food preparation. Be direct in helping customers and be very clear on what you do not know. 3. Implement procedures for serving customers with food allergies Identify who will be responsible for monitoring meal preparation for a food-allergic customer. Follow guidelines for food preparers to prevent crosscontamination in the preparation of allergen-free foods. 4. Prepare for emergencies Train to recognize the symptoms of anaphylactic shock. Support the establishment of a three person emergency team for each shift: one staff member to stay with the afflicted customer one person to call emergency medical services one person to reassure other customers and provide prompt access for the emergency medical service Prepare your emergency team to take prompt action. waitstaff should inquire immediately when a customer shows symptoms of anaphylactic shock or appears to be in distress notify the emergency team immediately ask if the customer is carrying medication that will help call 911 or other emergency medical assistance and alert them to the possibility of an allergic reaction Practice an emergency response drill. Designate someone responsible for following up on an emergency. provide information on the incident, food ingredients and preparation for medical staff gather information about the afflicted customer, and from employees and other customers who witness the incident notify restaurant management and insurance representatives What should you do about food allergies? 1. Provide accurate information on food ingredients Know what ingredients have been used and where to find the information. Request ingredients information from food preparers when unsure. FOOD ALLERGIES 4

7 What should be done after an incident occurs? 1. Promptly notify your manager of the incident 2. Assist managers to document the incident Develop a chronology of the event including times when the customer arrived, when the meal was served, when the incident occurred, when emergency medical assistance was called and when they arrived. Document your memories of the incident, including conversations with the customer or members of his/her party, any mention of dietary needs, requests for menu ingredients, mention of food allergies, etc. Record exactly what each person in the party was served and how much of each item served to the customer was consumed (if possible, preserve the customer s food and a copy of the meal order and payment documentation for your insurance carrier). (For Food Preparers) Identify the recipes and list the name and quantity of any substitute ingredients used in the meals served to the customer and his/her party. Identify the sources (suppliers) of the food ingredients. 3. Provide information about the incident only to emergency medical staff and to your insurance carrier Employees shall refer all inquires concerning the incident to management. Employees should not discuss the incident with members of the press or release recipes for the food served. Do not admit fault or accept responsibility for the incident, alleged injury or related costs (refer all such issues to your management team). FOOD ALLERGIES 5

8 FOOD ALLERGIES CAN KILL! As little as.005 teaspoon of a substance can cause a severe reaction Be forthright when customers ask about food ingredients If you do not know that a menu item is free of the ingredient SAY SO! If you do not know that there is no cross-contamination from cookware or serving utensils If you are not sure that sauces, dressings, and garnishes are free of the ingredient SAY SO! SAY SO! Symptoms Include: Causes Include: Wheezing, Shortness of Breath, Swelling, Tightening of Throat, Nausea, Cramping, Loss of Consciousness Peanuts, Tree nuts, Wheat, Milk, Eggs Fish, Shellfish Soy, Sulfites, MSG Call 911 immediately if you witness the above symptoms