Supporting Children and Students With Prevalent Medical Conditions In Schools: Anaphylaxis Procedure

This procedure has been created to support Policy/Program Memorandum No.161 (PPM161): Supporting 
Children and Students with Prevalent Medical Conditions in Schools, Sabrina’s Law, 2005, and Durham District School Board Policy #5134.

The goals of this procedure are:

• to eliminate preventable serious reactions and death due to anaphylaxis; and 
• to reduce the risk of exposure for anaphylactic students to potential allergens, without depriving the student of normal relations or placing unreasonable restrictions on others in the school community.

This procedure should assist school Principals, staff, parents/ guardians and students in preparing mutually 
acceptable anaphylaxis plans. Since parents/guardians, students (if age appropriate) and staff have 
responsibilities in this matter, consultation, on-going communication and regular training are essential for a 
successful plan.

1.1 Anaphylaxis is a serious allergic reaction that is rapid in onset and can cause death. Multiple body 
systems can be affected including skin, cardiovascular, respiratory and gastrointestinal. 

1.2 Triggers for anaphylaxis may include such things as food (e.g., peanuts, tree nuts, egg, milk, shellfish, 
fish, soy, sesame seeds, wheat, sulphites), insect stings, medications, latex and exercise

1.3 Schools within the DDSB can be considered “Allergy Aware” and ”Allergy Safe” as one cannot 
guarantee that the school environment is 100% allergen free. Where possible the learning 
environment should be free from any trace of the allergen

SCHOOL ALLERGY AND ANAPHYLAXIS PLAN

All school and individual allergy and anaphylaxis plans must adhere to DDSB Privacy Policy, Regulation, and Procedure #3105.

2.1 The parents/guardians or students (if age appropriate) are responsible for:

2.1.1 Informing the school Principal that their child is at-risk for an anaphylactic reaction. Parents 
must provide appropriate medical documentation including recommendations for the individual student’s plan of care.

2.1.2 Completing the health information on the Student Registration Form

2.1.3 Considering the merits of their child wearing medical identification such as MedicAlert ®

2.1.4 Immediately informing the Principal if there is a change in medical diagnosis (i.e. if there are 
additional allergens of concern or the student is no longer at-risk for anaphylaxis)

2.2 The student is responsible for:

2.2.1 Wearing medical identification e.g. MedicAlert® (http://www.medicalert.ca/www.medicalert.ca), if available

2.3 The Principal is responsible for:

2.3.1 Ensuring that parents/guardians/students be asked to supply information on life-threatening allergies including appropriate medical documentation and recommendations for the individual student’s plan of care.

2.3.2 Identifying students at risk for anaphylaxis to all staff.

2.3.3 Posting the Anaphylaxis Emergency Plan (Appendix 2, p.2) or similar in prominent but discrete locations accessible by employees only (e.g., in the staff room or the school office). Consultation with the parent(s)/guardian(s) and the student is strongly recommended. 

2.3.4 Posting an emergency response protocol (see Appendix 5 – 911 Protocol – Anaphylaxis or 
similar)

2.3.5 Developing a process for notifying supply teachers (e.g. briefing the supply teacher, posting a sign on the classroom door and/or a note in the supply teacher binder) (See Appendix 6 –Attention Supply Teachers)

2.3.6 Considering application to Medic Alert’s “No Child Without Program” (http://www.nochildwithout.ca/www.nochildwithout.ca) 

THINK F.A.S.T.

Face: itchiness, redness, rash, swelling of face and tongue

Airway: trouble breathing, swallowing or speaking

Stomach: stomach pain, vomiting, diarrhea

Total Body: rash, itchiness, swelling, weakness, paleness, sense of doom, loss of consciousness

Signs and symptoms of anaphylaxis can appear alone or in any combination and not necessarily in the order listed above.

4.1 The Principal is responsible for ensuring that:

All employees and others who are in direct contact with students on a regular basis receive regular training (at least once per year, preferably at the beginning of each school year) on:

• Triggers of anaphylaxis
• Ways to reduce the risk of exposure
• Recognition of the signs and symptoms of anaphylaxis (Appendix 4 – Signs And Symptoms Of An Anaphylactic Reaction)
• How to use an epinephrine auto-injector

A record of employees and others who have completed the training is maintained.

4.2 Employees and others include, but are not limited to: 

• Regular administrative staff
• Classroom staff
• Clerical staff
• Supply teachers
• Custodians
• Lunch supervisors
• Parent volunteers
• Bus drivers

4.3 Training includes information which may be presented by one or several of the following:

Professional Organizations:

Anaphylaxis Canada (www.anaphylaxis.org) can provide speakers as well as a comprehensive package of training materials for schools including "Anaphylaxis: A Handbook for School Boards" 

The Allergy Asthma Information Association (AAIA) (www.aaia.ca) can provide speakers as well as a 
comprehensive package of training materials for schools 

Physician or health care provider
Identified student's parent(s) or guardian(s)

5.1 Epinephrine, also known as adrenaline, is utilized in the emergency treatment of anaphylactic reactions. Epinephrine helps to reverse symptoms of anaphylaxis by opening the airways, improving blood pressure, and accelerating heart rate

5.2 EpiPen® and Allerject™ are the two epinephrine auto-injectors that are presently available in Canada. Both auto-injectors are available in 0.15 mg and 0.30mg dosages, that are prescribed based on weight 

5.3 The Principal is responsible for:

• Advising parent(s)/guardian(s) or student (if age appropriate) of the wisdom of having several epinephrine auto-injectors available
• Recommending that epinephrine auto-injectors be carried by the student at all times depending upon age and maturity of the student)
• Ensuring that epinephrine stored by the school is kept in unlocked, accessible locations that are:
• Maintained at room temperature
• Protected from light
• Known to all staff 
• Advising employees that auto-injectors are only to be used on the student for whom they are intended due to differences in dosage and the risk for under dosing

5.4 The employees are responsible for:

• Responding appropriately to an anaphylaxis emergency (See Appendix 3 – Emergency Protocol For Anaphylaxis and Appendix 5 – 911 Protocol - Anaphylaxis)
• Recognizing that a student experiencing anaphylaxis may NOT be physically able self-administer 
  epinephrine 
• Adhering to the manufacturer's instructions for the administration and disposal of the auto-injector 
  products (e.g. EpiPen® and Allerject™)

5.5 The parent(s)/guardian(s) or student (if age appropriate) is responsible for:

• Providing appropriate medication (i.e. epinephrine auto-injector) for their child
• Providing at least two (2) epinephrine auto-injectors. Prudence suggests having additional epinephrine auto-injectors available for use during treatment of an anaphylactic event. Additional doses of epinephrine may be needed if symptoms worsen or do not improve within ten (10) to fifteen (15) minutes; also additional dose(s) may be needed if the epinephrine has been incorrectly administered
• Providing epinephrine auto-injectors that are clearly labeled with:
• Name of the student
• Name of the prescribing physician, and;
• Expiry date 
• Immediately replacing the epinephrine auto-injector(s) when stale-dated
• Informing the Principal where their child's epinephrine auto-injector(s) will be kept (i.e. at least one (1) worn by the student and one (1) back-up in the office) 
• Ensuring that the epinephrine auto-injector is carried by their anaphylactic child (if age appropriate) at all times

6.1 Safety, health and well-being of students are the primary responsibility of the anaphylactic student's 
family and are a shared responsibility among the anaphylactic student's family, school employees 
and the school community

6.2 Principals and School Community Councils are encouraged to consider non-food related items as the 
focus of special events. It is recommended that caution be exercised when food is used in fund-raising events 

6.3 The Principal is responsible for ensuring:

• Implementation of avoidance strategies to create a safe environment for anaphylactic students 
  including:
• Adult supervision of young children while eating
• Cleaning surfaces, toys, etc. that may have been contaminated with allergens
• All children washing hands before and after eating
• A communication plan is developed for the dissemination of information on life threatening allergies to parents, students and employees in order to create awareness and support for anaphylactic students. (See Appendix 7 - Template: Letters To Parents)
• Emphasis to the school community about the hazards of cross-contamination and that the school as a whole is an allergen safe environment, not just the classroom(s) of anaphylactic students 
• That a process is in place where the entire student population is educated regarding the seriousness of anaphylaxis and how to assist anaphylactic students
• Appropriate and reasonable food restrictions are considered for school related activities (e.g., crafts, parties, fund-raisers, etc.)
• The use of "Safe Food Lists" is discouraged

6.4 Principal's responsibilities related to excursions:

• Allowing a parent or other designate of any anaphylactic student to accompany all off-site excursions (e.g., class trips, field trips, sporting events etc.) where possible. At the Secondary school level, a buddy system could apply
• Advising parent(s)/guardian(s) and student (if age appropriate) about the excursion as far in advance as possible in order to allow time to evaluate the excursion for potential allergic risks 
• Requesting that a minimum of two (2) epinephrine auto-injectors accompany the anaphylactic student on all excursions
• Ensuring that an excursion supervisor has a copy of the anaphylactic student's Anaphylaxis Emergency Plan (p.2 of Individual Student Allergy Management Plan - Appendix 2) 
• Ensuring that staff has immediate access to a telephone or cell phone while on excursions
• Advising parent(s)/guardian(s) and student(s) (if age appropriate) when the excursion involves travel to an area of poor telephone/cellular phone coverage

6.5 The anaphylactic student, depending on level of understanding, is responsible for:

• Learning to avoid specific triggers/allergens
• Learning to recognize the signs and symptoms of anaphylaxis (See Appendix 4 – Signs And Symptoms Of An Anaphylactic Reaction)
• Immediately notifying an adult as soon as an accidental exposure has occurred or symptoms appear
• Only eating foods from home
• Not sharing or trading food or drink
• Washing hands before and after eating using soap and water

6.6 The school community is responsible for:

• Awareness of the hazards of cross-contamination and that the school as a whole is an allergen safe environment, not just the classroom(s) of anaphylactic students
• Responding cooperatively to requests from the school to eliminate allergens
• Respecting the needs of anaphylactic students
• Refraining from bullying anaphylactic students 
• Washing hands before and after eating using soap and water
• Not sharing or trading food or drink with anaphylactic students

(See Appendix 2 - Individual Student Allergy Management Plan)

7.1 The Individual Student Allergy Management Plan shall contain: 

• Details about informing employees and others who are in direct contact with the student on a regular basis of the type of allergy
• Monitoring and avoidance strategies and appropriate treatment
• A readily accessible emergency procedure for the student, including emergency contact information, and storage for epinephrine auto-injectors, where necessary

7.2 The Principal (in collaboration with the parent(s)/guardian(s), the student (if age appropriate) and 
relevant employee(s)) is responsible for:

• Developing and completing an Individual Student Allergy Management Plan for each anaphylactic student that is intended to meet individual student and school needs

7.3 The parent(s)/guardian(s) or student (if age appropriate) are responsible for ensuring the completion 
of:

• "Physician Instructions" and "Pre-authorization for the Administration of Medication" sections of the Individual Student Allergy Management Plan 

7.4 The Principal is responsible for:

• Maintaining a file for each anaphylactic student containing the Individual Student Allergy 
  Management Plan 

8.1 Principal shall arrange for a debriefing session in order to:

• Review the incident in question
• Attempt to identify the exposure 
• Evaluate the response
• Formulate lessons learned

8.2 Debriefing session should involve (at a minimum)

• The Principal, parent(s)/guardian(s), the student (if age appropriate) and any relevant employee(s)

9.1 The Principal is responsible for:

• Creating and maintaining a record of all anaphylactic events. Refer to appendix 8.
• Reporting on the number of students with anaphylaxis, and all anaphylactic events to the Operations Department.