526.1 ADMINISTRATIVE REGULATION Allergic Shock (Anaphylaxis) Guidelines
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1 BOARD OF EDUCATION Schl District #33 (Chilliwack) ADMINISTRATIVE REGULATION Allergic Shck (Anaphylaxis) Guidelines In rder fr schl persnnel t effectively respnd t life-threatening allergic shck reactins the fllwing guidelines are recmmended. 1. INFORMATION AND AWARENESS 1.1 Parents - it is expected that parents will identify children with anaphylaxis t the schl principal and prvide infrmatin regarding the fllwing: identifying allergens that trigger reactin. descriptin f a treatment prtcl signed by a physician plus an adequate supply f aut-injectrs (r ther medicatins) regular updates n the child s cnditin. permissin fr the psting and sharing f the child s phtgraphs and medical infrmatin nrmally cntained in the medical alert frm. t prvide a medical alert bracelet t be wrn by the student at all times. 1.2 Schl Staff - the principal r designate shall ensure that: all staff are alerted and the child identified t the staff. all staff are alerted t bard plicy and prcedures n managing anaphylaxis. allergy alert frms are placed in key lcatins. parents are included in the decisin t pst infrmatin. apprpriate staff are instructed in the use f the aut-injectr in the classrm. ensure teachers-n-call are infrmed n any anaphylaxis students when in service. Crss Refs: Anaphylaxis Handbk Adpted: September 28, 1999 Reviewed: February 7, 2005 Revised:
2 1.3 Training f Staff - the principal with the assistance f public health nurses will prvide: annually t staff, teachers-n-call and vlunteers wherever an anaphylaxis child is enrlled in-service n anaphylaxis and hw t respnd t an emergency all teachers and staff including bus drivers, wh are in a psitin f respnsibility fr children with anaphylaxis will receive persnal training in the use f the aut-injectr. in-service training including specific infrmatin frm parents n their child and parent participatin in the use f the autinjectr. infrmatin abut the ptential surces f specific allergens is widely circulated including visible and hidden fd surces f allergens such as in prepared fds, the imprtance f reading labels, and the danger f crss-cntaminatin thrugh shared utensils and nn-fd surces. 1.4 Sharing Infrmatin with Other Students and Parents In elementary schls the principal in cperatin with the public health nurse shuld identify students suffering life-threatening allergies t all students in the schl and enlist their cperatin. This shuld be dne in a manner apprpriate t the child s age and maturity and in cnsultatin with the parents f the child. In secndary schls the identificatin f anaphylaxis students t peers shuld nt take place withut cnsultatin with the anaphylaxis student. Schls are required t instruct students n basic prcedures cncerning anaphylactic shck. 1.5 Sharing Infrmatin with Parents and Parent Organizatins Principals shuld infrm parents f the presence f a student with life threatening allergies in their child s classrm and/r schl and the measures being taken t prtect the student. Parents shuld be asked t cperate and avid including the allergen in schl lunches and snacks. Parents may be infrmed f alternative fds t the allergen, fd labeling, ingredient lists t be prvided when fd is being brught frm hme. Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 2
3 Parents shuld be invlved in establishing specific prgrams fr their wn children, in training staff in emergency prcedures and in reviewing schl plicies t reduce the risk f expsure t allergens. 2. AVOIDANCE OF THE ALLERGEN The fllwing recmmendatins shuld be cnsidered in the cntext f the anaphylactic child s age and maturity. As children mature they shuld be expected t take increasing persnal respnsibility fr avidance f their specific allergens. The balance t be achieved in allergen avidance is t find ways t minimize the risk f expsure withut depriving the anaphylactic child f nrmal peer interactins r placing unreasnable restrictins n the activities f ther children in the schl. It is understd that schls and classrms will exercise discretin in adapting t the needs f individual children and/the allergens which trigger reactins. 2.1 Ideas fr Prviding Allergen-Free Areas If pssible, avid using the classrms f an anaphylactic child as a lunch rm. If the classrm must be used as a lunchrm, establish it as an allergen free area, using a cperative apprach with students and parents. Establish at least ne cmmn eating area r a sectin f a single cmmn eating area as allergen-free. Develp strategies fr mnitring allergen-free areas and fr identifying high risk areas fr anaphylactic students. If allergen-free eating areas cannt be established prvide a safe eating area fr the anaphylactic child. 2.2 Establishing Safe Lunchrm and Eating Area Prcedures The mst minute quantities f allergens can trigger a deadly reactin. The schl shuld exercise cntrl ver all fd prducts nt nly thse directly cnsumed by the anaphylactic student. Require anaphylactic students t eat nly fd prepared at hme. Discurage the sharing f fd, utensils and cntainers. Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 3
4 Increase lunch-hur supervisin in classrms with an anaphylactic child. Encurage the anaphylactic child t take mealtime precautins like: placing fd n wax paper r a paper napkin rather than directly n the desk r table. taking nly ne item at a time frm the lunch bag t prevent ther children frm tuching the fd; and packing up their lunch and leaving it with the lunch supervisr if it is necessary t leave the rm during lunchtime. Establish a hand-washing rutine befre and after eating. Success will depend n the availability f hand-washing facilities. If the schl has a fd service keep the allergen, including all prducts with the allergen as an ingredient, ff the menu. Prvide in-service fr staff and vlunteers with special emphasis n crsscntaminatin and labeling issues. If the schl has a vending machine, ensure that prducts cntaining the allergen are nt available. Ensure that tables and ther eating surfaces are washed clean after eating, using a cleansing agent apprved fr schl use. 2.3 Ideas Regarding Allergens Hidden in Schl Activities Nt all allergic reactins t fd are a result f expsure at meal times. Teachers, particularly in the primary grades, shuld be aware f the pssible allergens present in curricular materials like: play-dugh; bean-bags, stuffed tys (peanut shells are smetimes used); cunting aids (beans, peas); tys, bks and ther items which may have becme cntaminated in the curse f nrmal use science prjects special seasnal activities, like Easter eggs and garden prjects. Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 4
5 Cmputer keybards and musical instruments shuld be wiped befre and after use. Anaphylactic children shuld nt be invlved in garbage dispsal, yard clean-ups r ther activities which culd bring them int cntact with fd wrappers, cntainers r debris. Fds are ften stred in lckers and desks. Allwing the anaphylactic child t keep the same lcker and desk all year may help prevent accidental cntaminatin. 2.4 Ideas fr Hlidays and Special Celebratins 2.5 Field Trips Ideas Establish a class fund fr special events, and have the classrm teacher r the parent f the anaphylactic child prvide nly safe fd. If fds are t cme int the classrm frm hme, remind parents f the anaphylactic child s allergens and insist n ingredient lists. Limit the anaphylactic child t fd brught frm his r her wn hme. Fcus n activities rather than fd t mark special ccasins. In additin t the usual schl safety precautins applying t field trips, the fllwing prcedures shuld be in place t prtect the anaphylactic child. Include a separate serius medical cnditins sectin as a part f the schl s registratin/permissin frms fr all field trips in which the details f the anaphylactic student s allergens, symptms and treatment can be recrded. A cpy f this infrmatin shuld be available n site at any time during the field trip. Require all supervisrs, staff and parents t be aware f the identity f the anaphylactic child, the allergens, symptms and treatment. Ensure that a supervisr with training in the use f the autinjectr is assigned respnsibility fr the anaphylactic child. If practical, cnsider prviding a cell phne fr buses used n field trips Require the parent f the anaphylactic child t prvide several aut-injectrs t be administered every minutes en rute t the nearest hspital if breathing prblems persist r if symptms reccur. Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 5
6 If the risk factrs are t great t cntrl, the anaphylactic child may be unable t participate in the field trip. Parents shuld be invlved in this decisin. 2.6 Ideas fr Substitute Teachers, Parent Vlunteers and Others with Occasinal Cntact Require the regular classrm teacher t keep infrmatin abut the anaphylactic student s allergies and emergency prcedures in a visible lcatin. Ensure that prcedures are in place fr infrming substitute teachers and vlunteers abut anaphylactic students. Invlve substitute teachers and vlunteers in regular inservice prgrams, r prvide separate in-service fr them. 2.7 Anaphylaxis t Insect Venm The schl cannt take respnsibility fr pssible expsure t bees, hrnets, wasps and yellw-jackets, but certain precautins can be taken by the student and the schl t reduce the risk f expsure. Avid wearing lse, hanging clthes, flral patterns, blue and yellw clthing, and fragrances. Check fr the presence f bees and wasps, especially nesting areas and arrange fr their remval. If sft drinks are being cnsumed utdrs, pur them int a cup and dispse f cans in a cvered cntainer. Ensure that garbage is prperly cvered. Cautin children nt t thrw sticks r stnes at insect s nests. Allw students wh are anaphylactic t insect stings t remain indrs fr recess during bee/wasp seasn. Immediately remve a child with an allergy t insect venm frm the rm if a bee r wasp gets in. In case f insect stings, never slap r brush the insect ff and never pinch the stinger if the child is stung. Instead, pluck the stinger ut with a fingernail r credit card. 3. EMERGENCY RESPONSE PROTOCOL Even when precautins are taken, an anaphylactic student may cme int cntact with an allergen while at schl. It is essential that the schl develp a respnse prtcls and that all staff are aware f hw t Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 6
7 implement it. A separate emergency plan shuld be develped fr each anaphylactic child, in cnjunctin with the child s parents, physician, and schl nurse kept in a readily accessible lcatin. The plan shuld clearly identify individual rles. Anaphylactic children usually knw when a reactin is taking place. Schl persnnel shuld be encuraged t listen t the child. If he r she cmplains f any symptms, which culd signal the nset f a reactin, they shuld nt hesitate t implement the emergency respnse. There is n danger in reacting t quickly but there is grave danger in reacting t slwly. 3.1 Emergency Plans Every emergency plan shuld include prcedures t: Cmmunicate the emergency rapidly t a staff persn wh is trained in the use f the aut-injectr. Administer the aut-injectr (NOTE: Althugh mst anaphylactic children learn t administer their wn medicatin by abut age 8, individuals f any age may require help during a reactin because f the rapid prgressin f symptms, r because f the stress f the situatin. Adult supervisin is required). Telephne 911 (Infrm the emergency peratr that a child is having an anaphylactic reactin). If n ambulance service is available transprt the child t hspital at nce. Telephne the hspital t infrm them that a child having an anaphylactic reactin is en rute. Ntify the plice and prvide them with a descriptin f the vehicle and license number if transprtatin is by car. Telephne the parents f the child. If breathing des nt imprve r if symptms reccur administer epinephrine every minutes while waiting fr the ambulance and enrute t the hspital. Assign a staff persn t take extra aut-injectrs, accmpany (r fllw, if necessary) the child t the hspital, and stay with him r her until a parent r guardian arrives. Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 7
8 3.2 Lcatin f Aut-injectrs Aut-injectrs shuld be kept in a cvered and secure area, but unlcked fr quick access. Althugh epinephrine is nt a dangerus drug, the sharp needle f the self injectr can cause injury especially if injected int the fingertip. As sn as they are ld enugh, students shuld carry their wn aut-injectrs. Many yung children carry an injectin kit in a fanny pack arund their waist at all times. An up-t-date supply f aut-injectrs, prvided by the parents shuld be available in an easily accessible, unlcked area f the child s classrm and/r in a central area f the schl (ffice r staff rm) All staff shuld knw the lcatin f the aut-injectrs. Classmates shuld be aware f the lcatin f the autinjectr in the classrm. 3.3 Training Older Students t Assist Older students may be trained t administer the aut-injectr and can play a rle in the emergency respnse, particularly in a secndary schl setting. Infrmatin abut anaphylaxis and autinjectr training may be included in the health curriculum. 3.4 Rle-Playing The schl shuld ccasinally simulate an anaphylactic emergency similar t a fire drill t ensure that all elements f the emergency plan are in place. 3.5 Review Prcess Schl emergency prcedures fr each anaphylactic student shuld be reviewed annually with staff, the schl nurse and parents. In the event f an emergency respnse, an immediate evaluatin f the prcedure shuld be undertaken. Administrative Regulatin Allergic Shck (Anaphylaxis) Guidelines Page 8
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