Consulting with Schools on Health Issues

D. ANAPHYLAXIS AND EMERGENCY CARE

Because all schools need to be prepared to deal with health emergencies, including anaphylaxis, planning for such emergencies is an excellent entry point for pediatricians who want to become more involved in their local schools.

1. Anaphylaxis and Schools

• Anaphylaxis is a sudden, severe allergic reaction that may involve the skin, the respiratory tract, the gastrointestinal tract, and, sometimes, the cardiovascular system.
• For every 200 students attending a school, 2 to 4 are likely to have a significant food allergy, and 1 is likely to be allergic to a stinging insect. Fatal anaphylactic reactions have been reported at schools.
• School personnel should be familiar with anaphylaxis and be prepared to act.

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To help prevent poor outcomes from such allergic reactions, pediatricians can

• Help with identification of all students with known allergies and file information in an accessible and central location ("Emergency Cards").
• Review school policy and staff procedures for administering epinephrine.
• Provide prescriptions for epinephrine to be used by school nurses for anaphylactic reactions among students or school staff not previously suspected of having an allergy (check your state's Good Samaritan laws).
• Perform in-service teaching for school nurses and other staff for recognizing anaphylaxis and administering epinephrine.
• Be sensitive to the fact that many people do not like to handle needles.

2. Preparing Schools for Emergencies

When planning emergency care in a school, make sure you consider

• State laws such as Good Samaritan laws, and rules on administration of medication, standing orders, scope of practice hours, and indemnification
• School district policy and procedures including training of staff, union issues, and standing orders.
• Qualifications of staff who may be involved in emergency care (assessment, interventions, and management)
• Emergency Medical Services (EMS) response, such as the time needed to get to the school, qualifications and skill levels of responder, equipment, and transport time to the hospital.

When planning emergency care for a specific student, consider collaboration needed between the primary physician, the parent or guardian, and the school nurse with regard to

• Assessment or indicators of reaction in this particular student
• Medication orders from physician with parent or guardian's permission
• Maintaining an adequate supply of medication in school
• Other treatment orders or unique interventions for this student
• Detailed directions for staff in the form of an individualized emergency health care plan for this student
• Appropriate order of steps for effective intervention
• Training of staff to carry out the plan