ANAPHYLAXIS MANAGEMENT POLICY Ratinale Anaphylaxis is a serius health issue fr a percentage f the ppulatin. Guidelines have been develped t assist all Victrian schls t meet their duty f care t students at risk f anaphylaxis and t supprt thse students. The Guidelines supprt schls in cmplying with legislatin, mst critically the Educatin and Training Refrm Act 2006, which specifies that a schl must have an anaphylaxis management plicy if it has enrlled a student in circumstances where the schl knws (r ught reasnably t knw) that the student has been diagnsed as being at risk f anaphylaxis Ministerial Order 706 - Anaphylaxis Management in Victrian Schls, prvides the regulatry framewrk fr the management f anaphylaxis in all Victrian schls and prescribes what must be included in an anaphylaxis management plicy as well as prescribing the training requirements fr schl staff wrking with students wh are at risk f anaphylaxis. The Guidelines include infrmatin n anaphylaxis including: legal bligatins f schls in relatin t anaphylaxis Schl Anaphylaxis Management Plicy staff training Individual Anaphylaxis Management Plans risk minimisatin and preventin strategies schl management and emergency respnses adrenaline autinjectrs fr general use Cmmunicatin Plan Risk Management Checklist. Schls are required by law t have a plicy and prcedures fr managing anaphylaxis in place and must review and update the plicy fr strict cmpliance with the guidelines fund at Department f Educatin and Training (DET) Plicy Advisry Guide > A Z Index at the website belw (updated 07 July 2017) which is the key reference and supprt fr Tarneit West Primary Schl (Interim Name). Training Victria has implemented an nline mdel fr anaphylaxis training, utilising the Australasian Sciety f Clinical Immunlgy and Allergy (ASCIA) e-training fr Victrian Schls. This new apprach has been infrmed by advice frm medical experts and ur valued schl stakehlders. The benefits f the ASCIA e-training curse include reduced burden n schls and increased quality and cnsistency f training. T supprt schls t undertake the e-training, a small number f staff in each schl will be trained t be able t assess ther staff s cmpetency in using an autinjectr in persn. Ministerial Order 706 has been amended t allw fr the new nline training mdel. Under this mdel it is recmmended that all Victrian schl staff undertake the new Australasian Sciety f Clinical Immunlgy and Allergy (ASCIA) e-training curse nce every tw years and have their cmpetency in using an autinjectr tested in persn within 30 days f cmpleting the curse. The nline ASCIA e-training curse is fully funded fr all Victrian schl staff. The curse will take apprximately ne hur and can be accessed at https://etrainingvic.allergy.rg.au/ In rder t meet legislative requirements staff will als need t have their cmpetency in using an autinjectr (e.g. EpiPen ) tested in persn within 30 days f cmpleting the curse. Every gvernment schl will be cntacted by the Asthma Fundatin in 2016 and invited at n cst t the schl, t nminate tw staff members frm each campus t undertake face-t-face training 1
t skill them in prviding cmpetency checks. These staff will perfrm the rle f Schl Anaphylaxis Supervisr and be the cntact fr anaphylaxis management requirements in the schl, including leading the twice-yearly schl briefings. Once Schl Anaphylaxis Supervisrs have cmpleted their training the schl can transitin t the nline mdel. A Schl Anaphylaxis Supervisr Checklist has been develped t guide schls with the requirements f this rle. Training agencies that have the Curse in Verifying the Crrect Use f Adrenaline Autinjectr Devices 22303VIC in their scpe f practice are required t use this checklist t guide their training with Victrian schls. Alternatively schls can pt t undertake fee-based face-t-face training in ne f the accredited anaphylaxis training curses that meet the requirements f MO706: Curse in First Aid Management f Anaphylaxis 22300VIC Curse in Anaphylaxis Awareness 10313NAT. registered training rganisatins that deliver anaphylaxis training can be fund at the Australian Gvernment Department f Educatin and Training site at: www.training.gv.au In summary, schl staff must cmplete ne f the fllwing ptins t meet the anaphylaxis training requirements f MO706: Optin 1 All schl staff - ASCIA Anaphylaxis e-training fr Victrian Schls fllwed by a cmpetency check by the Schl Anaphylaxis Supervisr. This curse is prvided by ASCIA, is free fr all Victrian schls and valid fr tw years. AND 2 staff per schl r per campus (Schl Anaphylaxis Supervisr) - Curse in Verifying the Crrect Use f Adrenaline Autinjectr Devices 22303VIC. This curse is prvided by the Asthma Fundatin, is free t gvernment schls and is valid fr 3 years. Optin 2 Schl staff (as determined by the principal) - Curse in First Aid Management f Anaphylaxis 22300 VIC (previusly 22099VIC). This curse is prvided by an RTO that has this curse in their scpe f practice and is paid fr by each schl. The training is valid fr 3 years. Optin 3 Schl staff (as determined by the Principal) - Curse in Anaphylaxis Awareness 10313NAT. This curse is prvided by any RTO that has this curse in their scpe f practice and is paid fr by each schl. The training is valid fr 3 years. Please nte: First aid training des NOT meet the requirements f anaphylaxis training requirements under MO706. Twice-yearly anaphylaxis briefing requirements All schls with a child at risk f an anaphylactic reactin are required t undertake twice yearly briefings n anaphylaxis management under MO706. A presentatin has been develped t help schls ensure they are cmplying with the legislatin. The briefing presentatin incrprates infrmatin n hw t administer an EpiPen and it is expected all staff will practice with the prvided EpiPen trainer devices. As part f the briefing, schl staff shuld familiarise themselves with the children and yung peple in the schl at risk f an anaphylactic reactin and their Individual Anaphylaxis Management Plans. Any persn wh has cmpleted Anaphylaxis Management Training in the last tw years can lead the briefing. If the nline training ptin is selected, the Schl Anaphylaxis Supervisr may be the mst apprpriate staff member fr this rle. A facilitatin guide and speaking ntes have als been develped, see: Department resurces belw 2
Purpse T ensure Tarneit West Primary Schl (Interim Name) manages children at risk f anaphylaxis. T ensure the schl cmplies with legislatin and DET plicy and guidelines. T ensure the schl cmplies with the revised Ministerial Order 706 (MO706). T ensure all staff can respnd t an anaphylactic reactin. T prvide, as far as is practicable, a safe and supprtive envirnment in which children at risk f anaphylaxis can participate equally in all aspects f schling. T raise awareness f anaphylaxis and the schl s anaphylaxis management plicy in the schl cmmunity. T engage with parents/carers f children at risk f anaphylaxis in assessing risks, develping risk minimisatin strategies and management strategies fr the child. T ensure that each staff member has adequate knwledge abut allergies, anaphylaxis and the schl s plicy and prcedures fr respnding t an anaphylactic reactin. Definitin Anaphylaxis is a severe and sudden allergic reactin that is ptentially life threatening. The mst cmmn allergens in schl aged children are peanuts, eggs, tree nuts (e.g. cashews), cws milk, fish and shellfish, wheat, sy, sesame, latex, bee r ther insect stings and sme medicatins. A mild t mderate allergic reactin includes swelling f the lips, face and eyes, hives r welts, tingly muth, abdminal pain and/r vmiting (signs f a severe allergic reactin t insects). Anaphylaxis (a severe allergic reactin) can include any ne f nisy r difficult breathing, swelling f the tngue r swelling/tightness in the thrat, difficulty talking r a harse vice, wheeze r persistent cugh, pale pallr and flppiness in yung children, abdminal pain and/r vmiting (signs f a severe allergic reactin t insects). Implementatin Tarneit West Primary Schl (Interim Name) will cmply with Ministerial Order 706 (effective 3 December 2015) and assciated guidelines. The schl acknwledges its respnsibility t develp, review and update its Anaphylaxis Management Plicy. In accrdance with DET plicy, the schl has develped a mandatry pre-requisite Health Care Needs Plicy. The schl will nt ban certain types f fds (e.g. nuts) as it is nt practicable t d s, and is nt a strategy recmmended by the DET r the Ryal Children s Hspital. Hwever, the schl will request that parents d nt send thse items t schl if at all pssible; that the canteen eliminate r reduce the likelihd f such allergens, and the schl will reinfrce the rules abut nt sharing and nt eating fds prvided frm hme. In the event f an anaphylactic reactin, the schl s first aid and emergency management respnse prcedures and the child s Individual Anaphylaxis Management Plan will be fllwed. The schl will: ask the child whether she/he has self-administered an adrenaline aut-injectr (such as EpiPen /Anapen ) if the child has nt previusly dne this, administer the adrenaline aut-injectr call an ambulance cntact the child s emergency cntact persn and then cntact Security Services Unit n 9589-6266. The decisin abut whether a child is able t carry ut and ptentially self-administer the autinjectr is made while develping the child s ASCIA Actin Plan fr Anaphylaxis. Staff duty f care extends t administering an aut-injectr even if the child s ASCIA Actin Plan fr Anaphylaxis states the child can self-administer. 3
When a child self-administers their wn adrenaline aut-injectr, they have a respnsibility t infrm staff s that an ambulance can be called. Nte: Children have a right t self-administer their wn adrenaline aut-injectr but may nt be physically able t d s. Using an EpiPen Prir t use the schl will: Cnfirm the expiry date t ensure it is in-date (nt expired). If the device has expired, use an alternative device if easily accessible. If n ther ptin is available r easily accessible, then USE the expired device. Check the viewing windw t ensure the adrenaline is nt cludy r disclured. If the device is cludy r disclured, use an alternative device if easily accessible. If n ther ptin is available r easily accessible, then USE the cludy r disclured device. Ensure the device is the crrect medicatin fr the individual being treated, r the device is the schl adrenaline aut-injectr fr general use. Where pssible these devices shuld nly be used by staff trained t use it. Hwever, in an emergency they may be administered by any persn fllwing instructin frm the child s ASCIA Actin Plan fr Anaphylaxis. 1. Remve the EpiPen frm the plastic cntainer. Nte: Children under 20kg are prescribed an EpiPen Junir which has a smaller dse f adrenaline. 2. Frm a fist arund the EpiPen and pull ff the blue safety cap. 3. Place the range end against the uter mid-thigh and (with r withut clthing). 4. Push dwn hard until a click is heard r felt and hld fr 10 secnds. 5. Remve the EpiPen, being careful nt t tuch the needle, and return it t its plastic cntainer. 6. Nte the time yu gave the EpiPen. 7. Call an ambulance n 000 as sn as pssible. 8. The used autinjectr must be handed t the ambulance paramedics alng with the time f administratin. 9. Reassure the child experiencing the reactin as they are likely t be feeling anxius and frightened. D nt mve the child. 10. Ask anther staff member t mve ther children away and reassure them separately. 11. Watch the child clsely in case f repeat reactin. Imprtant: Where there is n marked imprvement and severe symptms as described in the child s ASCIA Actin Plan fr Anaphylaxis are present, a secnd injectin f the same dse may be administered after 5 t 10 minutes. Please Nte: EpiPen and EpiPen Jr adrenaline (epinephrine) autinjectrs with a 3 secnd label will start t enter pharmacies in Australia and New Zealand frm 13 June 2017 nwards. 4
The devices have nt changed, just the instructins n the label, which nw include: Reduced injectin time frm 10 t 3 secnds this is based n research cnfirming efficacy and delivery f adrenaline thrugh the 3 secnd delivery. Remval f the massage step after the injectin this has been fund t reduce the risk f tissue irritatin. EpiPen s with a 10 secnd label can cntinue t be used and shuld nt be replaced unless they have been used, are just abut t expire r have expired. All EpiPen s shuld nw be held in place fr 3 secnds, regardless f the instructins n the label. Hwever, if they are held fr 10 secnds it will nt affect the way that the adrenaline wrks. T access updated ASCIA Actin Plans fr Anaphylaxis, ASCIA anaphylaxis e-training curses, the 3 secnd EpiPen training vide and ther resurces g t www.allergy.rg.au/anaphylaxis Whilst it is imprtant that schl staff are made aware f the changes, there is n need fr immediate re-training n the 3 secnd EpiPen. The Department f Educatin and Training will update the Schl Anaphylaxis Supervisr Checklist. When this is dne the Asthma Fundatin f Victria will e-mail the schl a cpy. When verifying the staff at schl, sme f them will have cmpleted the ASCIA e-training instructing them t hld fr 10 secnds and massage the injectin site. If the staff member des this as part f the verificatin prcess, they are still fund cmpetent, and at the end f the verificatin sessin they will be infrmed f the changes t the administratin. In cmplying with Ministerial Order 706, the Principal will ensure an Individual Anaphylaxis Management Plan fr each child diagnsed at risk f anaphylaxis is develped by the parents/carers and the diagnsing medical practitiner and presented t the schl a template f an Individual Anaphylaxis Management Plan can be fund in Appendix 3 f the guidelines at www.educatin.vic.gv.au/schl/teachers/health/pages/anaphylaxisschl.aspx the Individual Anaphylaxis Management Plan will be reviewed regularly as described belw preventin strategies are in place fr in and ut f schl activities (fr specific strategies, please see belw) in the event f an anaphylactic reactin, the schl s first aid and emergency management respnse prcedures and the student s Individual Anaphylaxis Management Plan will be fllwed a cmmunicatin plan in accrdance is develped t prvide infrmatin t all staff (including vlunteers and casual relief staff), children and parents abut anaphylaxis and the schl s management plicy. It will include the steps the schl will take t respnd t an anaphylactic reactin whether the child is in class, the schl yard, n camp r an excursin r a special event day the Anaphylaxis Risk Management Checklist (dc 39 (dc 142.5 kb) is cmpleted n an annual basis. purchasing spare r 'backup adrenaline aut-injectin devices(s) as part f the schl first aid kit(s), fr general use. regular training and updates fr schl staff in recgnising and respnding apprpriately t an anaphylactic reactin, including cmpetently administering an EpiPen 5
the cmpletin f an Annual Anaphylaxis Risk Management Checklist Schl staff will implement and mnitr the Individual Anaphylaxis Management Plan. Please nte: The plan will be in place as sn as practicable after the child enrls and where pssible, befre their first day f schl. If necessary, an interim plan will be develped in the meantime. In this case, the Principal will cnsult with parent/carers abut the interim plan and whether r nt training and a briefing has been cmpleted fr all staff. The Principal will ensure that training/briefing ccurs as sn as pssible after the interim plan is develped. The Individual Anaphylaxis Management Plan must set ut the fllwing: Infrmatin abut the diagnsis, including type f allergy r allergies, the child has, symptms and the emergency respnse t administer the child s adrenaline autinjectr shuld the child display symptms f an anaphylactic reactin (based n the diagnsis frm a medical practitiner). Strategies t minimise the risk f expsure t allergens whilst the child is under the care r supervisin f schl staff, fr in-schl and ut-f-schl settings including camps and excursins. Please refer t Preventin Strategies belw. The name f the persn/s respnsible fr implementing the strategies. Infrmatin f where the child s medicatin will be stred. Emergency cntact details fr the child. The emergency ASCIA Actin Plan signed by the medical practitiner and given t the parents n diagnsis. Emergency prcedures t be taken in the event f an allergic reactin. An up t date pht f the child. The Management Plan will be reviewed annually, if the cnditin changes r immediately after a child has an anaphylactic reactin at schl r if the child is t participate in an ff-site activity such as a schl camp r will attend a special event such as the schl fete r a class party. The Principal will ensure that whilst the child is under the care r supervisin f the schl, sufficient trained staff are present. It is the respnsibility f the parent/carer t Prvide the emergency prcedures plan (ASCIA Actin Plan). Infrm the schl if their child s cnditin changes, and if relevant, an updated ASCIA Actin Plan). Prvide an up t date pht when the plan is prvided and subsequently reviewed. Prvide the schl with an Adrenaline Autinjectr that is current and nt expired. Update infrmatin at least annually and/r if the child is t participate in a schl camp. Parents/carers can be asked t prvide an additinal adrenaline aut-injectr t be stred in an easily accessible lcatin knwn t all staff. The schl will cmmunicate regularly with the student s parents abut the student s successes, develpment, changes and any health and educatin cncerns. Training The principal is respnsible fr ensuring that relevant staff are trained in accrdance with MO 706 and are briefed at least twice each calendar year. At Tarneit West Primary Schl (Interim Name), this is all staff. In cmplying with the training requirements f MO706, the schl will: nminate tw staff members frm each campus t undertake the face-t-face training prvided by the Asthma Fundatin chse ne f the three ptins as abve and if a child at risk f an anaphylactic reactin is enrlled, all staff will be prvided with twice yearly briefings (led by any persn wh has cmpleted Anaphylaxis Management Training in the last tw years) n anaphylaxis management including infrmatin n hw t administer an EpiPen and practise with the Epipen trainer that will be prvided. As part f the briefing, all staff must familiarise themselves with the child/children in 6
the schl at risk f an anaphylactic reactin and their Individual Anaphylaxis Management Plans. The schl will use the presentatin has been develped t help schls ensure they are cmplying with the legislatin. The first briefing will take place at the beginning f Term 1. New staff will be trained as part f the inductin prcess. Fr checklists fr supervisrs and ther infrmatin, please refer t the website belw. Please refer als t the schl s Health Care Needs Plicy. Preventin Strategies The schl will use the checklist and recmmendatins in the Anaphylaxis Guidelines (pages 20-28) t implement Risk Minimisatin and Preventin Strategies in-schl and ut-f-schl settings which include (but are nt limited t) the fllwing: during classrm activities (including class rtatins, specialist and elective classes; between classes and ther breaks; in the canteen; during recess and lunchtimes; befre and after schl; and special events including incursins, sprts, cultural days, fetes r class parties, excursins and camps. Sme f the preventin strategies that will be implemented by the schl t assist anaphylaxis management include: prviding prfessinal develpment fr all staff including the identificatin and respnse t anaphylaxis and the prper use f an EpiPen /Anapen. identifying susceptible children and knwing their allergens infrming the cmmunity abut anaphylaxis via the newsletter nt allwing fd sharing and restricting fd t that apprved by parents keeping the lawns well mwn and ensuring children always wear shes requiring parents t prvide an Emergency Management Plan develped in cnsultatin with a health prfessinal and an EpiPen /Anapen if necessary, bth f which will be maintained in the first aid rm fr reference as required ensuring the schl keeps a spare, in date EpiPen /Anapen fr adult and child use in a central lcatin At Tarneit West Primary Schl (Interim Name), the persn respnsible fr implementing these strategies is Nadia Betti. Schl Management and Emergency Respnse In the event f an anaphylactic reactin the schl s first aid and emergency respnse prcedures and the effected child s Individual Anaphylaxis Management Plan must be fllwed. Schl staff wh are respnsible fr the care f children at risk f anaphylaxis have a duty t take steps t prtect children frm risks f injury that are reasnably freseeable. This may include administratrs, canteen staff, casual relief staff and vlunteers. Members f staff are expected t: Knw the identity f children wh are at risk f anaphylaxis. Understand the causes, symptms, and treatment f anaphylaxis. Obtain training in hw t recgnise and respnd t an anaphylactic reactin, including administering an EpiPen /Anapen. Knw the schl s first aid emergency prcedures and what yur rle is in relatin t respnding t an anaphylactic reactin. Keep a cpy f the child s ASCIA Actin Plan (r knw where t find ne quickly) and fllw it in the event f an allergic reactin. 7
Knw where the child s EpiPen /Anapen is kept. Remember that the EpiPen /Anapen is designed s that anyne can administer it in an emergency. Knw and fllw the preventin strategies in the child s Anaphylaxis Management Plan. Plan ahead fr special class activities r special ccasins such as excursins, incursins, sprt days, camps and parties. Wrk with parents/carers t prvide apprpriate fd fr the child. Be aware f the pssibility f hidden allergens in fds and f traces f allergens when using items such as egg r milk cartns in art r cking classes. Be careful f the risk f crss-cntaminatin when preparing, handling and displaying fd. Make sure that tables and surfaces are wiped dwn regularly and that children wash their hands after handling fd. Raise child and schl cmmunity awareness abut severe allergies and the imprtance f their rle in fstering a schl envirnment that is safe and supprtive fr their peers. The schl will ensure that an up-t-date list f all children at risk f anaphylaxis is maintained at all times. During n-site nrmal schl activities, the child s Individual Anaphylaxis Management Plan and ASCIA Actin Plan is lcated in the schl s sick bay. Excursins/Schl Camps All children must have returned a signed permissin nte t be able t attend the excursin. Cpies f cmpleted permissin ntes and medical infrmatin will be carried by excursin staff at all times. The Teacher-in-Charge f an excursin (r camp) will ensure the child s ASCIA Actin Plan is included. The schl will prvide a first aid kit fr each excursin/camp. The Teacher-in-charge is respnsible fr cllecting these prir t leaving. The schl will require the parents/carers t cmplete the Department s Cnfidential Medical Infrmatin fr Schl Cuncil Apprved Schl Excursins frm. Please refer als t the schl s Camps & Excursins Plicy. In chsing a camp venue, the camp management s attitude t and understanding f anaphylaxis will be assessed. The Teacher-in-Charge will cnfer with parents/carers abut the fd t be cnsumed at camp and will arrange with the camp management that such items are nt included in the menu. Parents/carers must prvide an Adrenaline Autinjectr t be taken n the camp. The schl will include ne in the first aid kit. At least ne trained staff member will attend the excursin/camp. If necessary, in cnsultatin with the parents/carers, the child may be excluded frm a scheduled camp activity e.g. a bush walk and will be supervised at camp. If deemed necessary, the schl will supprt the attendance f the child s parent/carer n the camp. Adrenaline Autinjectrs fr General Use The principal will arrange the purchase f Adrenaline Autinjectr(s) fr General Use and as a back up t thse supplied by parents. The principal will determine the number f additinal Adrenaline Autinjectr(s) required. In ding s, the principal will take int accunt the fllwing relevant cnsideratins: 8
the number f children enrlled at the schl wh have been diagnsed as being at risk f anaphylaxis; the accessibility f Adrenaline Autinjectrs that have been prvided by parents f children wh have been diagnsed as being at risk f anaphylaxis; the availability and sufficient supply f Adrenaline Autinjectrs fr General Use in specified lcatins at the Schl, including in the schl yard, and at excursins, camps and special events cnducted r rganised by the Schl; and Adrenaline Autinjectrs fr General Use have a limited life, usually expiring within 12-18 mnths, and be replaced either at the time f use r expiry, whichever is first (A nminated staff member will be respnsible fr checking and replacing the Adrenaline Autinjectrs fr General Use.) Cmmunicatin Plan The principal is respnsible fr ensuring that a Cmmunicatin Plan is develped t prvide infrmatin t all staff, children and parents abut anaphylaxis and the schl s anaphylaxis management plicy. The Cmmunicatin Plan will include infrmatin abut what steps will be taken t respnd t an anaphylactic reactin by a child in a classrm, in the schl yard, n schl excursins, n schl camps and special event days. Vlunteers and casual relief staff f children at risk f anaphylaxis will be infrmed f children at risk f anaphylaxis and their rle in respnding t an anaphylactic reactin by a child in their care by the assistant principal r wellbeing fficer. All staff will be briefed nce each semester by a staff member wh has up t date anaphylaxis management training n: the schl s anaphylaxis management plicy the causes, symptms and treatment f anaphylaxis the identities f children diagnsed at risk f anaphylaxis and where their medicatin is lcated hw t use an autadrenaline injecting device the schl s first aid and emergency respnse prcedures the lcatin f, and access t, the Adrenaline Autinjectrs that have been purchased by the schl fr general use r prvided by parents Impact at Schl An anaphylactic reactin can be traumatic fr the student and thers witnessing the reactin. In the event f an anaphylactic reactin, students and staff may benefit frm pst-incident cunselling, prvided, fr example, by the schl nurse, guidance fficer, student welfare crdinatr r schl psychlgist. It is imprtant t be aware that sme students with anaphylaxis may nt wish t be singled ut r seen t be treated differently. Evaluatin This plicy will be reviewed annually r if guidelines change (latest DET update early July 2017). Ratificatin Octber 2017 Review Date 2018 Plicy Number 4 Versin Number 1 Date Prduced September 2017 9
References: www.educatin.vic.gv.au/schl/principals/spag/health/pages/anaphylaxis/aspx www.educatin.vic.gv.au/schl/principals/spag/health/pages/respndanaphylaxis.aspx x (MO706 effective 3 December 2015) 10