Wallingfrd Public Schls Fd Allergy/Glycgen Strage Disease Management Plan Rev.4/13
CONTENTS I. List f Fd Allergy Management Team II. III. IV. Gal f the Plan Overview f Glycgen Strage Disease, Fd Allergies and Anaphylaxis Medicatins V. Preventin: Rles and Respnsibilities a) Parent b) Student c) Schl Administratr d) Schl Nurse e) Classrm Teacher/Specialist f) Schl Fd Service g) Transprtatin Department h) Schl Medical Advisr i) Athletic Directr, Caches, Trainers, Persns in charge f After Schl Activities VI. VII. VIII. IX. Mnitring the Effectiveness f the District Plan Appendix A Implementatin Respnsibilities Appendix B Anaphylaxis Signs and Symptms Appendix C Field Trip Check List fr Life Threatening Health Cnditins X. Appendix D Medical Alert Ntice t Parent XI. Appendix E Occurrence Reprt 1 f 257
I. Current Fd Allergy Management Team Memembers Cmmittee C-chairs: Kathy Neeln, MS, RN Nurse Crdinatr Sharlene Wng, SFNS Directr f Fd Service Dr, Carls Valentin Schl Medical Advisr Susan Bradanini, RN Schl Nurse, Highland Jseph Piacentini Principal Mran Middle Schl Carrie Latrre Principal Rck Hill Schl Charles Farley Cach VJ Sarull Athletic Directr, Sheehan Elise Hazelwd Directr f Health fr the Twn Lisa Taylr, RN Schl Nurse, Pnd Hill Diane Gibsn, RN Schl Nurse, Sheehan Mary Ann Crce Transprtatin Rb Mancusi Directr f Pupil Persnnel 2 f 257
Original Fd Allergy Management Team Members Cmmittee C-Chairs: Kathy Neeln, RN Nurse Crdinatr Dr. Carls Valentin Schl Medical Advisr Patricia Crwley Principal Parker Farms Schl Carl Mikulski Principal Yalesville Schl Debbie Pach, RN Nurse Yalesville Schl Diane Gibsn, RN Nurse Mran Middle Schl Maureen Kvach Teacher Yalesville Schl Sharlene Wng, SFNS Directr f Fd Service Dr. Jseph Bivna Directr f Pupil Persnnel Allysn Glass, Principal Rck Hill Schl Paul Reynlds Assistant Principal Dag Hammerskjld Schl Lisa Taylr, RN Nurse Pnd Hill Cyndi Mitchell, RN Nurse Sheehan High Schl Dnna Dysinger Teacher Mran Middle Schl Jeanette Fx Debbie Brauch Central Kitchen Manager Sheehan HS Cafeteria Manager Dag Hammerskjld Schl Patty Pursell PE Teacher Marsha Dherty Transprtatin Clerk Charles Farley Cach Sheehan HS Rick Gibsn EMS Lcal Representative Elise Hudd Laura Bell Cassandra Carlan Directr Department f Health Parent Parent Kristen Wlery Student Sheehan High Schl 3 f 257
II. Primary Gals Fd allergies can be life threatening. The risk f accidental expsure t fds can be reduced in the schl settings if schls wrk with students, parents, and physicians t minimize risks and prvide a safe educatinal envirnment fr fd allergic students. The fcus f ur Fd Allergy Management/Glycgen Strage Disease Plan is preventin, educatin, awareness, cmmunicatin and emergency respnse. The Fd Allergy Management plan is the basis fr the develpment f the prcedural guidelines that will be implemented at the schl level and prvide fr cnsistency acrss all schls within the district. The gals fr the district wide plan include: T maintain the health and prtect the safety f students wh have life-threatening fd allergies in ways that are develpmentally apprpriate, prmte self-advcacy and cmpetence in self-care. T maintain the health and prtect the safety f students wh have GSD. T ensure that interventins and individual health care plans fr students with lifethreatening fd allergies and GSD are based n medically accurate infrmatin and evidence-based practices. T define a frmal prcess fr identifying, managing, and ensuring cntinuity f care fr students with life-threatening fd allergies and GSD frm kindergarten thrugh grade 12 III. Overview f Glycgen Strage Disease Glycgen Strage Disease (GSD) is an inherited disrder in which an abnrmal amunt r type f glycgen is stred in the liver. The abnrmal strage results frm the liver s inability t adequately regulate the metablism f glycgen and glucse. GSD ccurs when an enzyme (prtein prduced by the bdy) is missing that regulates cnversin f sugar (glucse) int its strage frm (glycgen) r the release f glucse frm glycgen. Many sugars (including glucse) are present in fds and are used by the bdy as a surce f energy. After a meal, bld glucse levels rise. The bdy stres the extra glucse that is nt needed right away as glycgen in the liver and muscles. Later, as the bld glucse levels in the bdy begin t decrease, the bdy uses this stred energy. These sugars stred in the frm f glycgen, need t be prcessed by enzymes in the bdy befre they can carry ut their functins. If the enzymes needed t prcess them are missing, the glycgen r ne f its related starches can accumulate causing prblems. There are many, many different types f GSDs which are put int grups based n the particular enzyme that is missing. The cnditin is rare, ccurring in apprximately ne ut f 20,000 peple. 4 f 257
Severity f illness is dependent n the effect f the missing enzyme and its impact n the bdy s ability t metablize glycgen and glucse. Symptms f Glycgen Strage Disease Symptms f GSD usually result frm the buildup f glycgen r frm an inability t prduce glucse when needed. Because GSD ccurs mainly in muscles and the Liver, thse areas shw the mst bvius symptms. Symptms f GSD may include: grwth failure muscle cramps lw bld sugar enlarged liver swllen belly The age when symptms begin and hw severe they are depends n the typed f GSD. Treatment f Glycgen Strage Disease Treatment f GSD depends n the type f GSD. Sme GSD types cannt be treated; thers can be treated by cntrlling the presenting symptms. Fr the types f GSD that can be treated patients must carefully fllw a special diet. Frequent high carbhydrate meals during the day. Fr sme children, eating several small meals rich in sugars and starches every day helps prevent bld sugar levels frm drpping. Crnstarch. Fr sme yung children ver the age f 2, giving uncked crnstarch every fur t six hurs including during vernight hurs can als relieve the prblem. Cntinuus tube feeding. In rder t maintain apprpriate bld glucse levels, gastrintestinal tube feedings with slutins cntaining high cncentratins f glucse may need t be administered. Yunger children may have t use this treatment methd during the night until they get lder. In the daytime the feeding tube is smetimes suspended, but the patient must eat fd rich in sugars and starches abut every three hurs. Drug treatment. GSD tends t cause uric acid (a waste prduct) t accumulate, which can cause gut (painful inflammatin f the jints) and kidney stnes. Overview f Fd Allergies and Anaphylaxis in Schl-Age Children A fd allergy is an exaggerated respnse by the immune system t a fd that the bdy mistakenly identifies as being harmful. Once the immune system decides that a particular fd is harmful, it prduces specific antibdies t that particular fd. The next time the individual eats that fd the immune system releases mderate t massive amunts f chemicals t prtect the bdy. These chemicals trigger a cascade f allergic symptms that can affect the respiratry system, gastrintestinal tract, skin and cardivascular system. 5 f 257
In sme peple symptms appear in nly ne bdy system, while in thers symptms appear in several systems. These symptms can range frm mild t severe and may be life-threatening depending n the individual and the type f expsure. Scientists estimate that apprximately 12 millin Americans suffer frm ptentially life-threatening fd allergies. Of these 12 millin, 3 millin are schl-aged children. At the present time, there is n cure fr fd allergy and avidance is the nly way t prevent an allergic reactin. It is extremely imprtant t understand that althugh eight fds are respnsible fr mst life threatening allergic reactins an individual can have a life-threatening allergic reactin t any fd, including fruits, vegetables and meats. Greater than 90 percent f allergic reactins are caused by the fllwing eight fds: Peanuts Sy Tree nuts (walnut, Milk Wheat cashew, pecan, Egg Shellfish hazelnut, almnd, Fish etc.) Mst, but nt all, childhd allergies t milk, egg, sy and wheat are utgrwn by age 5. Peanut and tree nuts typically cause the mst severe allergic reactins, and apprximately 90 percent f fatal and near-fatal reactins are due t these fds. Allergies t peanut, tree nuts, fish and shellfish are ften cnsidered life lng. The principal rute f expsure, which leads t allergic reactins, is ingestin f the fd allergen. Fr sensitized individuals, ingestin f even very minute amunts f fd can, in certain instances, result in fatal reactins withut rapid interventin. While, it is pssible fr a child t have an allergic reactin t tactile (tuch) expsure r inhalatin expsure, research has shwn that they are extremely unlikely t result in severe r lifethreatening reactins. Nevertheless, if children with life-threatening fd allergies tuch the allergens and then put their fingers t their eyes, nse r muth, the expsure becmes and ingestin and may cause anaphylaxis. The quantity f fd necessary t trigger an allergic reactin may depend upn multiple variables. Each individual s level f sensitivity may fluctuate ver time. The type and severity f symptms can vary fr a specific fd in an individual and fr different fds in smene with multiple fd allergies. What is Anaphylaxis? Anaphylaxis is a serius allergic reactin that in a small percentage f cases can cause death. It can happen in peple wh have allergies r asthma, and it may be caused by a number f nrmally harmless things called allergens. Mst ften it is cause by fds, insect sting and medicines. Anaphylaxis characteristically is usually an immediate reactin, ccurring within minutes f expsure, althugh nset may ccur ne t tw hurs after ingestin. In up t 30 percent f 6 f 257
anaphylactic reactins, the initial symptms may be fllwed by a secnd wave f symptms tw t fur hurs later and pssibly lnger. In the event f an anaphylactic reactin, epinephrine aut-injectr (epi-pen) is the treatment f chice and shuld be given immediately. Smetimes, if symptms d nt subside a secnd epinephrine aut-injectr is necessary. Studies shw that fatal and near-fatal anaphylactic reactins are smetime assciated with nt using an epi-pen r delaying the use f the epinephrine treatment. When in dubt, it is better t give the epi-pen and call 911. Fatalities are mre likely t ccur when epinephrine administratin is withheld. Cmmn symptms f anaphylaxis are: -Red rash, hives, -Swllen and/r itchy thrat, lips r swllen areas f the bdy -Wheezing (breathing that sunds like whistling frm chest) -Cughing, difficulty breathing, shrtness f breath -Truble swallwing, harse vice, chest tightness -Nausea, vmiting, stmach cramps, abdminal pain, diarrhea -Anxiety, Sense f impending dm An individual experiencing anaphylaxis may present with ne r mre f these symptms. Anaphylaxis may ccur in the absence f any skin symptms such as itching and hives. Fatal anaphylaxis is mre cmmn in children with fd allergies wh are asthmatic even if the asthma is mild r well cntrlled. Fatal anaphylaxis is mre cmmn in children wh present with respiratry symptms, r gastrintestinal (GI) symptms such as abdminal pain, nausea r vmiting. In many fatal reactins, the initial symptms f anaphylaxis were mistaken fr asthma r mild GI illness, which resulted in delayed treatment with epinephrine aut-injectr. Children experiencing anaphylaxis shuld be bserved in the emergency department fr a minimum f 4 t 6 hurs r lnger after initial symptms subside, t mnitr fr signs r symptms f a secnd wave f symptms. Key Pints t Remember Fr children at risk fr fd anaphylaxis the mst imprtant management strategy in the schl is PREVENTION Yu are never alne It takes a team t ensure the best fr ur students. Help is usually a phne call away. GSD Every student with GSD must have an individual health care plan specific t the student s Page 7 f 25
health care needs. It is develped in cllabratin with the dctr, parent and schl nurse. IV. Educate, Educate, Educate This nging prcess changes with the students needs and as the staff changes. The best plan is t educate ur schl cmmunity abut the issues that face students with life threatening allergies. Special events/nn-rutine days The greatest risk fr a life threatening allergic reactin exists when the nrmal rutine is brken. Examples are classrm parties, field trips, a substitute teacher, and after schl events. Be Prepared. Always have the Emergency Actin Plan (EAP) available and think ahead t prevent pssible expsures t a fd allergen. Symptms vary greatly CALL 911 if ingestin is suspected r if anaphylactic symptms ccur. Administer emergency medicatin as rdered by the physician. Banning f Specific Fds Banning f fds can create a false sense f security, which can lead t less respnsible appraches t effective management strategies, educatin and emergency respnses. Bans will nt render the envirnment abslutely safe because schls can nt ensure that allergenic fd des nt inadvertently cme int the schls. Banning ffending fds detracts frm the schls respnsibility t prperly plan fr children with life threatening fd allergies and t educate all schl persnnel accrdingly. Therefre, the schls will have the ptin f establishing allergen free znes, such as a child s individual classrm, allergen free lunch tables(s) r areas in the cafeteria. Individual student and family privacy needs and preferences will be cnsidered in determining apprpriate plans and nt all students will need r want t use an allergenfree zne during the schl day. The specifics fr each individual student will be addressed in the students Individual Health Care Plan (IHCP). Medicatins In rder t prmte rapid, life saving steps in an emergency, emergency medicatin such as epinephrine aut injectrs and glucagn shuld nt be lcked during the schl day. While they must nt be accessible t any student r unauthrized staff member, they shuld be kept in a safe, accessible and reasnably secure lcatin that can be prperly supervised by a nurse r ther authrized and trained staff member. Parents will be required t supply an extra set f emergency medicatins fr availability during extra-curricular athletic activities and ff-site schl activities that ccur utside the regular schl day. This practice allws the schl day medicatins t be prperly stred and lcked after regular schl hurs t ensure that they will be available withut fail. Page 8 f 25
If a student is cleared fr self-carry and administratin f the medicatin this requirement will nt apply. Thse students cleared t self-administer will be required t be in pssessin f his/her medicatin n at all times. Parents f students with life threatening allergies wh participate in extended schl day activities must discuss a plan with whever is supervising the activity. If there is n nurse available and the student des nt have authrizatin t self-administer their medicatins the plan wuld be t call 911 shuld an incident ccur.. During the regular schl day schl nurses are respnsible fr the training and supervisin f qualified staff, which are; principals, teachers, caches, full time physical and ccupatinal therapists in the administratin f medicatins. The aut-injectr cartridge is the nly allwed injectable medicatin trained certified staff is allwed t administer t thse students with life threatening fd allergies. Lcatin Emergency Medicatin The determinatin f the lcatin f emergency medicatins will be sufficiently flexible t allw the student, parent, administratr and nurse t chse the best ptin fr students when develping the IHCP. Emergency medicatin will mst ften be kept in the health ffice fr thse students wh d nt self-administer their medicatin. When the schl nurses, parent and student develp the IHCP, they will determine if this ptin is apprpriate fr the student. The parent and nurse will have t determine if ther lcatins in the schl may be mre apprpriate and/r necessary t lcate the emergency medicatin. Smetimes, several lcatins, which culd include the student s classrm, may be apprpriate, especially in very large buildings. The schl nurse always has a stck supply f Epi-pens fr use in an emergency. During the schl day the emergency medicatin will be available in an unlcked cabinet s that the medicatin will be easily accessible in the event f an emergency. Self-administratin f Medicatin Students will be allwed t self carry and/r self administer their medicatin prvided; they have the written rder frm an authrized prescriber and authrizatin f a parent r guardian The medicatin is transprted t schl and maintained under the student s cntrl in accrdance with the Bard f Educatin s plicy n self- administratin f medicatin. The principal and teachers are infrmed f the student s self-administratin plan. Eligibility f Sectin 504 Page 9 f 25
Since the law prvides that a team f knwledgeable persns must make eligibility determinatins n a case-by-case basis, this plan cannt make determinatin regarding 504 eligibility. This plan requires that each 504 request will be lked at by the 504 team and determine if it meets the requirements fr 504 eligibility. Whether students with life-threatening fd allergies and GSD are identified under Sectin 504 as disabled individuals r nt, the schl district will prvide these students with an IHCP in rder t address their health and safety needs. V. Preventin: Rles and Respnsibilities a) Parents Infrm the schl nurse f their child s fd allergy and/r GSD diagnsis prir t pening f schl (r as sn as pssible after a diagnsis). Make the schl nurse aware f the allergy/and r GSD diagnsis via ne r all f the fllwing rutes: parent phne call, parent visit t schl, health infrmatin n emergency card cllected annually, health histry and survey frm, health assessment recrd and/r histrical dcumentatin n student s cumulative health recrd. Prvide the schl nurse with a way t reach yu at any time (cell phne, beeper, etc.) Prvide the schl nurse with health infrmatin frm yur health care prvider. Prvide the schl nurse with a Fd Allergy and Anaphylaxis Treatment Plan, GSD Treatment Plan r ther similar dcument that includes medicatin rders cmpleted by a licensed health care prvider. Participate in develping an Individualized Health Care Plan (IHCP) with the schl nurse and ther schl team members when apprpriate. Prvide the schl nurse with written permissin t cmmunicate with yur health care prvider. Prvide yur schl nurse with permissin t share this infrmatin n a need t knw basis within the schl system. Prvide the schl nurse with at least ne up-t-date epinephrine aut-injectrs. Prvide the schl nurse with any medicatin if rdered fr a student with GSD. Prvide the schl with fd r medical supplies needed fr a student with GSD. Cnsider prviding a medical alert bracelet fr yur child. Page 10 f 25
Parent sectin cntinued: Prvide the schl nurse with at least annual updates n yur child s allergy status and/r GSD status. Parent must understand that a fd allergic child in schl will nt be allwed t eat any fd unless brught frm hme r specifically apprved by the parent. Nurses r ther schl persnnel will nt be respnsible t read fd labels t determine if a fd is safe fr the student eat. Supply an extra set f emergency medicatins fr availability during extra-curricular athletic activities and ff-site schl activities that ccur utside the regular schl day. Prvide alternate snacks that may be kept in the elementary schl fr classrm parties and unexpected events. Review each mnth s menu t see if they cntain any ptentially ffending allergens. Review the list f student respnsibilities with yur child and be sure he/she understands his rle. Rle-play different scenaris s that yur child will knw what t d in any situatin. Encurage yur child t share with friends that his/she is allergic t certain fds and what can happen if ingested. It is imprtant that children take n mre respnsibility fr their fd allergies as they grw lder and are develpmentally ready. Cnsider teaching them t: Carry wn epinephrine aut-injectr. Cmmunicate the seriusness f the allergy. Cmmunicate symptms as they appear. Read labels. Recgnize ptentially dangerus situatins and make gd safety decisins. Administer wn epinephrine aut-injectr and be able t train ther in its use. Remember ur ultimate gal is that students eventually learn t keep themselves safe by making gd chices and advcating fr themselves. Page 11 f 25
b) Students Learn t recgnize symptms fr an allergic reactin and fr thse with GSD hypglycemia. Fllw safety measures established by parent(s)/guardian(s) and schl team at all times. D nt share r trade fds r water bttles with anyne. D nt eat anything with unknwn ingredients r knwn t cntain the allergen(s). Learn/knw what t eat t prevent hypglycemia. D nt eat any fds at schl unless brught frm hme r previusly apprved by parent(s)/guardian(s). Infrm an adult as sn as accidental expsure ccurs r symptms appear. Ask a friend t help yu if yu cannt get t an adult. Wash hands befre and after eating. Carry yur epinephrine aut-injectr at all times, if apprved by yur parent, physician and schl nurse. If yu cannt carry yur aut-injectr yu must make prvisins t have it available t yu. Reprt any instances f teasing r bullying t an adult immediately. The rle that students with life-threatening fd allergies play in staying safe at schl will increase as they grw lder therefre develpmental age and learning capabilities will be evaluated by the schl nurse and parent when develping the IHCP. Yunger children will nt be expected t assume the same respnsibilities fr their safety as lder children. Page 12 f 25
c) Schl Administratr Supprt faculty, staff and parents in implementing all aspects f the life-threatening allergy management and GSD plan. Prvide fr training and educatin (at least annually) fr faculty and staff regarding: Anaphylaxis and anaphylactic reactins t fds, insect stings, medicatins, latex Overview f GSD Risk reductin prcedures Hw t administer an epinephrine aut-injectr in an emergency Emergency Prcedures Cafeteria management and fd preparatin fr fd service persnnel Prvide r put in place an emergency cmmunicatin plan fr all schl activities, including transprtatin and field trips that invlve a student with life-threatening allergies and/r GSD. Ensure that at least tw, but preferably three, staff members are trained in the recgnitin f early symptms f anaphylaxis, hypglycemia and medicatin administratin. Cnsider the impact when prviding PTO spnsred events that invlve fd, animals r ther ptential allergens. Cnsider the impact n allergic children and set up a plan t infrm parents and develp a plan t keep the students with allergies safe. Prvide educatin t the PTO n the tpic f life threatening fd allergies s that they may be mre aware when planning activities spnsred by the PTO. Determine an allergy free table in the cafeteria if and when necessary in cnsultatin with the parent and schl nurse. Designate smene t wash the table using separate supplies frm the ther tables. Use warm sapy water befre the first lunch wave and after each lunch wave. This table will be sanitized with each washing. Page 13 f 25
d) Schl Nurse Prir t entry int schl r as sn as pssible after learning f the diagnsis f a life-threatening allergic cnditin and/r GSD, cmmunicate with the student s parent/guardian t develp a draft f an IHCP. Ensure that the Emergency Actin Plan (EAP) includes the student s name, pht, allergen, symptms f allergic reactins and/r GSD symptms, risk reductin prcedures, emergency prcedures and that it is distributed t all apprpriate staff, including the transprtatin department. Familiarize teachers with the EAPs and IHCPs f their student by the pening f schl, r as sn as plans are written. Ensure that ther staff members wh have cntact with students with life-threatening allergies r GSD shuld be familiar with their IHCPs and/r EAPs n a need-t-knw basis including principal, specialists, fd service persnnel, aides, physical educatin teacher, caches/trainers, fd and cnsumer science teacher, art and music teachers, custdian, and transprtatin department. Cnduct educatin fr apprpriate staff regarding life-threatening allergens and GSD, symptms, risk reductin prcedures, emergency prcedures and hw t administer and epinephrine aut-injectr. Track educatin f all staff trained and/r updated in epi-pen administratin and signs and symptms f anaphylaxis. Since it is a very rare disease and very patient specific, training f staff regarding GSD will be dne by the schl nurse n a case by case basis. Ensure that all IHCPs and EAPs are in an easily accessible place in the nurse s ffice and clearly marked. Determine with parent where aut-injectr will be kept. Pst lcatin where epinephrine aut-injectrs can be fund. D nt lck up aut injectrs during the schl day. Determine if student is cmpetent and capable fr self-carry/self administratin by having the student cmplete and demnstrate cmpetency in the self-administratin checklist, btaining rders frm the physician and btaining apprval frm the parent. Discuss field trips with parent and student t decide n strategies fr managing the fd allergy and/r GSD. Check medicatins peridically fr expiratin dates and ntify parent t respnd accrdingly. Page 14 f 25
Arrange fr peridic fllw-up t review effectiveness f the IHCP, at least n an annual basis, r as ften as necessary. Make sure that yur IHCPs and EAPs fr students with life threatening allergies and GSD are clear and easily accessible t substitute nurses. Page 15 f 25
e) Classrm Teacher/Specialist Participate in the develpment f the student s IHCP and EAP if and when necessary. Review and fllw the EAP f any student(s) in yur classrm with life-threatening allergies and/r GSD. Keep accessible the student s EAP with pht in the lessn plan and Substitute Teacher flder. Act immediately and fllw the EAP if a student reprts signs f an allergic reactin. Act immediately and fllw the EAP if a student with GSD reprts r exhibits signs and symptms f hypglycemia. Never allw a child yu suspect f having an allergic reactin r an hypglycemic episde t be withut adult supervisin Request that the classrm has a functining intercm, walkie-talkie r ther cmmunicatin device fr cmmunicatin with the schl nurse. Be sure vlunteers, student teachers, aides, specialists and substitute teachers are infrmed f the student s fd allergies r diagnsis f GSD and necessary safeguards. Crdinate with parent, (if willing) and pssibly the schl nurse a lessn plan abut fd allergies, anaphylaxis r GSD in age apprpriate terms fr the class. Educate classmates t avid endangering, islating, stigmatizing r harassing students with fd allergies and/r GSD. Be aware f hw the student with fd allergies and/r GSD is being treated; use this pprtunity t teach cmmunity caring; and enfrce schl rules/plicies abut bullying and threats. Participate with the planning fr student s re-entry t schl after an anaphylactic reactin and/r severe hypglycemic episde. SNACKS/LUNCHTIME Prhibit students frm sharing r trading snacks r water bttles. Avid crss cntaminatin f fds by wiping dwn eating surfaces with sap and water r hand wipes befre and after eating as applicable. Tables shuld als be washed with sap and water in the mrning if an after-schl event has been held in the evening befre. Reinfrce hand washing befre and after eating. Cleansing hand with hand wipes is als an acceptable practice. Page 16 f 25
NOTE: The use f liquid hand sanitizing gel des nt remve prtein allergens frm the hands, s it shuld nt be used t cleanse hands t remve fd particles. CLASSROOM ACTIVITIES Avid use f allergenic fds fr classrm activities (e.g., arts and crafts, cunting, science prjects, parties, hlidays and celebratins, cking, pet fds, r ther prjects). Welcme parental invlvement f fd allergic students in rganizing class parties and special events. Cnsider nn-fd treats fr rewards and incentives. FIELD TRIPS Cllabrate with the schl nurse and parents, prir t planning a field trip. Review student Emergency Actin Plans when selecting field trip destinatins in rder t avid high-risk places. Ensure the epinephrine aut-injectrs and instructins are taken n field trips and remain with the student r in the care f a parent r a trained qualified staff member during the curse f the field trip. Ensure that functining tw-way radi, walkie-talkie, cell phne r ther cmmunicatin device is taken n a field trip and that there are adults present wh are trained per the district Administratin f Medicatin Plicy in the administratin f an epinephrine aut-injectr. Ensure that the child with life-threatening fd allergies is assigned t a qualified staff member trained in recgnizing symptms f life-threatening allergic reactins, trained t use an epinephrine aut-injectr, and trained in emergency prcedures. Cnsider eating situatins n field trips and plan fr preventin f expsure t the student s life-threatening fds. Cnsider ways t wash hands befre and after eating (e.g. prvisin f hand wipes, etc.). Knw where the clsest medical facilities are lcated and 911 prcedures. Invite parents f a student at risk fr anaphylaxis and GSD t accmpany their child n field trips. Hwever, the student s safety r attendance must nt be cnditined n the parent s presence. Page 17 f 25
f) Schl Fd Service Cntinue its plicy f nn-use f fd items with peanuts n the schl lunch menu. Obtain the list f students with life threatening fd allergies and the EAP (if requested) frm the schl nurse in rder t identify students with life threatening fd allergies. Ensure that staff will be trained t recgnize the signs f a fd induced allergic reactin and be trained in the use f the EAP. Prvide menus in advance t parents and students. Review each mnth s menu t see if they cntain any ptentially ffending allergens and be prepared t share this infrmatin with the parent/student. It is recmmended that parents g t the Fd Service Office t read any fd labels prir t any fd being served t their children. Nte: unidentified vegetable il will be cnsidered the il student is allergic t. Make fd substitutins prvided the apprpriate dcumentatin is cmpleted by a dctr, in cmpliance with USDA regulatins fr students with disabilities and students withut disabilities. The dcumentatin must cntain specific infrmatin regarding the fd t be mitted and the fd item t be used as a substitutin. Fllw safe fd handling and fd preparatin prcedures t avid any ptential crss cntaminatin f fd allergens. Have access t a functining intercm r phne t summn the schl nurse r apprpriate individual in the event f an anaphylaxis emergency. Page 18 f 25
g) Transprtatin Department Encurage educatin fr all schl bus drivers regarding life-threatening allergies, GSD and what t d, if they suspect a student is having a reactin. Ensure that the bus cmpany prvides a functining emergency cmmunicatin device t all drivers. Cmmunicate the plicy regarding fds r beverages n schl buses. Prvide schl bus dispatcher with list f students with life-threatening fd allergies and GSD. Page 19 f 25
h) Schl Medical Advisr Prvide cnsultatin t and cllabrate with schl nurse(s) n clinical issues and prtcls which may include: Standing rders fr emergency medicatins including epinephrine; and Recmmendatins fr interventins (fr knwn and unknwn reactrs) in cases f Anaphylaxis. Signs and Symptms f hypglycemia Guide the district in the develpment f prcedures fr preventin f anaphylaxis and emergency planning t ensure safety withut undue interference with a child s nrmal develpment r right f thers. Participate in staff training regarding life-threatening fd allergies and GSD as needed. Assist in the develpment f educatinal prgrams fr students t prmte wellness. Prvide input and versight fr the schl district s fd management and GSD plan. Page 20 f 25
i) Athletic Directrs, Caches, Trainers & ther On-Site Persns in Charge f Cnducting After-Schl Activities Cnduct sprts and after schl activities in accrdance with all schl plicies and prcedures regarding life-threatening allergies and GSD. Call 911 in any emergency. Obtain a list f fd allergic and GSD student(s) participating in sprts r an after schl activity and cnsult with the schl nurse. Caches and trainers must attend frmal training in epi-pen and inhalant administratin minimally prir t caching and then with every CPR/AED recertificatin. Make sure that an emergency cmmunicatin device (e.g., walkie-talkie, intercm, cell phne, etc.) is always present. Knw hw t access the Emergency Medical System (EMS-911) system frm each site f any activity. Obtain a cpy f the Emergency Actin Plan (EAP) f students with life-threatening allergies and GSD. Have medicatin available in the first aid kit, if a student is unable t carry medicatin. Page 21 f 25
VI. Mnitring the Effectiveness f the District Plan The mnitring f the effectiveness f this plan shall ccur: The schl district team will review the plan at least annually and apprve changes as needed. After each emergency event invlving the administratin f medicatin fr a life threatening allergy the nurse crdinatr, principal f the schl, the schl nurse, and if necessary the medical advisr shall debrief and plan accrdingly with invlved parties. The dcumentatin f the debriefing will be kept in the nurse crdinatr s ffice. Occurrence reprts will be reviewed at the annual review. Page 22 f 25
VII. Appendix A Implementatin Respnsibilities: Fd Allergy Management/GSD Plan I. Administratrs: (Principals and Assistant Principals): A. Distribute the plan 1. Faculty (including interns) a. Insert in the faculty handbk b. Discuss the plan at the first faculty meeting 2. Para s a. Insert in the faculty handbk b. Discuss the plan at the first Para meeting 3. Additinal Nn-Certified Staff (building aides, clerical, custdian) a. Make them aware f the plan during rientatin PTO/PTAC b. Discuss the plan at a PTO/PTAC meeting 4. Athletic Directr/Middle Schl Principal a. Distribute plan t all caches and trainers b. When needed cntact schl nurse t attend caches meetings t educate caches n plan II. Building Nurse A. Attend first mnthly schl staff meeting alng with the principal review with staff the Fd Allergy/GSD Plan B. Infrm faculty and staff they must review their individual respnsibilities identified in the plan C. Review the appendices with the staff D. Distribute Plan as needed t parent f student with LTFA and GSD E. Educate certified nurse assistants t the plan III Persnnel A. Will add the plan t the substitute handbk B. Will discuss the plan with the substitutes IV. Nurse Crdinatr: A. Distribute plan t all staff via e-mail annually B. Educate new nurses and substitute nurses t the plan Page 23 f 25
C. Meet with EMS Crdinatr fr the Twn f Wallingfrd t infrm f plan D. Meet with Principal f Hly Trinity Schl and discuss respnsibilities E. Ensure that the Fd Allergy Management/GSD Team Meets annually in the Spring V. PPS A. Distribute and discuss the plan with the staff f the all prgrams, Leadership Team and cntracted emplyees (i.e... OT, PT.) VI. Fd Service Persnnel A. Fd Service Directr will distribute the plan B. Fd Service Directr will prvide training C. The Fd Service Directr and the nurse crdinatr will rganize the annual meeting f the Fd Allergy/GSD Management Cmmittee. VII. Transprtatin A. Distribute the plan and review the plicy with the bus cmpany Resurces: Fd Allergy Assciatin f Cnnecticut; http://www.faact.rg State Department f Educatin; http://www.sde.ct.gv/sde/health Page 24 f 25
VIII. Appendix B ANAPHYLAXIS SYSTEMS AND SYMPTOMS Systems: Symptms: *Student may have ne r mre f the fllwing symptms. Muth Skin GI Thrat Lung Heart Itching & swelling f lips, tngue, r muth Hives, itchy rash, and/r swelling abut the face r extremities Nausea, abdminal cramps, vmiting and/r diarrhea Itching and/r tightness in thrat, harseness r hacking cugh Shrtness f breath, repetitive cughing, and/wheezing Rapid heart rate, lightheadedness, dizziness, lss f cnsciusness, sense f impending dm Students wh are asthmatic r present with gastrintestinal symptms (GI) are at higher risk fr severe a reactin. Nte: The severity f symptms can quickly change. All abve symptms can ptentially prgress t a life threatening situatin. Page 25 f 25
IX. Appendix C Field Trip Check List fr Life Threatening Health Cnditins Key reminders: 1. Plan ahead 2. Call 911 in an emergency. When in dubt, CALL. Check List: Is fd t be distributed at any time during r at the field trip site? Is sap and water available t wash hands r will yu be bringing hand wipes fr this purpse? If students will be eating, students must clean hand with wipes r sap and water after eating. Is there fd used in anyway such as t feed animals r used in any demnstratin? Emergency Actin Plans (EAP) fr ALL students with plans. Emergency Medicatin (must g n bus with trained persn and student). Determine hw t cntact emergency services, t and frm lcatin. Verify ALL student health issues, and infrm all participating teachers. Trained staff must be readily available t administer student meds. Remember: Parent vlunteers cannt by law be assigned respnsibility fr administering medicatin t students with life threatening cnditins r prviding medicatin t students unless it is their wn child. Page 26 f 25
X. Appendix D MEDICAL ALERT NOTICE TO PARENTS Date: Dear Parent/Guardian, This letter is t infrm yu that a student in yur child s classrm has a severe fd allergy t, which culd be life threatening. It is ur gal t ensure that every student in ur schl is safe. We are asking yur assistance in prviding the student with a safe learning envirnment. Because this student cannt be in cntact with fds cntaining this/these allergen(s), we are requesting that yu avid sending these fds t schl fr snacks r treats. Even very small amunts f these prducts culd result in a severe allergic reactin. Smetimes these elements may be hidden in prcessed fds. Please discuss the fllwing with yur child: D nt ffer, share r exchange any fds r water bttles with ther students at schl. Hand washing with sap and water, after eating is necessary t decrease the chance f crss cntaminatin n surfaces at schl. If yur child rides the bus, remind them that there is a n eating n the bus plicy. Thank yu fr yur assistance and cperatin in this matter. If yu have any questins r cncerns please call. Sincerely, Principal Name Page 27 f 25
XI. Appendix E OCCURRENCE REPORT Required t be cmpleted in the event f epi-pen administratin Occurrence: Date f ccurrence Time and Lcatin f ccurrence: Occurred t: Name: DOB: Male Female Witness: Name: Occurrence Descriptin: Please give a cncise, bjective descriptin f the ccurrence. State significant facts in the rder in which they ccurred. Use the back f this frm if mre space is needed. Signature f persn preparing reprt Printed Name Date (Persn preparing this reprt frward reprt t the Principal within 24 hurs f ccurrence.) ================================================================================ Fllw-up (initial and date) Principal Nurse Nursing Crdinatr Medical Advisr Actin: Describe actin(s) taken t minimize re-ccurrence Signature f Persn Investigating Reprt Date Original filed in Nurse s ffice and a cpy sent t Nurse Crdinatr Page 28 f 25