GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN EDUCATIONAL ESTABLISHMENTS DHSSPS /DOE 2010 Revised October 2015

OBJECTIVES OF SESSION Update your knowledge on anaphylaxis Be aware of the emergency treatment prescribed for children with this condition Practise the correct technique for auto- injector administration Be aware of how to safely dispose of the auto-injector

WHAT IS ANAPHYLAXIS? Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing life-threating problems involving the airway and /or breathing and /or circulation. In most cases, there are associated skin and mucosal changes

COMMON CAUSES Peanuts Tree nuts Milk Egg Sesame Fish Shellfish Wasp Bee Latex Penicillin Blood Products Drugs Kiwi

TYPES OF REACTION Uni-phasic – rapidly developing severe reaction involving the airway or circulation. Bi-phasic – early oral and abdominal symptoms, then a symptom-free period of 1 – 2 hours, then increasing symptoms involving breathing and circulation.

MINOR REACTION Feeling hot or generalised flushing of the skin Intense itching and rapid development of a nettle like rash welts Burning sensation of lip and /or metallic taste in mouth Red, itchy, watery, swollen eyes or swollen lips or face Vomiting and diarrhoea with abdominal pain Itchy, runny or congested nose and / or sneezing Dizziness and feeling faint/pallor – may indicate severe reaction in the very young.

TREATMENT FOR MINOR REACTION ANTIHISTAMINE AND INHALERS Follow the child’s individual care plan. Administer the prescribed antihistamine e.g. Piriton and/or inhaler Record the time given and stay with the child Contact parent.

SEVERE REACTION Difficulty in breathing / noisy breathing, wheeze or stridor Swelling of mouth / tongue or feeling of tightness or lump in throat Decreased level of consciousness Collapse, lack of breathing Absent or very weak pulse

TREATMENT OF SEVERE REACTION Give prescribed Auto-injector & record time If unconscious but breathing place in recovery position Call paramedic ambulance 999 Contact parent / carer (contact numbers given over) If no improvement within 5 minutes give auto-injector & record time If no signs of life commence CPR (cardiopulmonary resuscitation) and continue until professional help arrives IF IN DOUBT GIVE AUTO-INJECTOR If Auto-injector is given the child MUST go to hospital for observation even if they have made a full recovery

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AUTOINJECTOR An Auto-injector is prescribed according to the child’s weight to deliver a single dose of adrenaline and reverse the symptoms of anaphylaxis.

STORAGE OF EMERGENCY BOX Accessible at all times during the school day – NOT in a locked room or cupboard. Contains completed care plan with medication in date. Clearly labelled with child’s name and passport photo for clear identification. Avoid extremes of temperature

The Child’s Parent :- Will ensure the school are notified if their child requires an auto injector and when no longer allergic to particular foods or substances Parent will attend school meeting with School Nurse and Principal, young person if age appropriate, to complete auto injector care plan. Will accept responsibility for maintaining and replacing, in school, two up to date auto injectors. The parent should inform the school and school nurse if any change in child’s prescription. ROLES AND RESPONSIBILITIES

It is the duty of the parent to check the expiry date of the Auto-injectors. The parent should return out of date auto-injectors to pharmacy for disposal Will discuss with the school arrangements for lunch and snacks. Will regularly remind the child of the need to refuse any food items offered by others. Will remove all medication at the end of the school year and return to school in September.

The school :- The school principal/or designated teacher will notify the school nurse on becoming aware of a pupil requiring an auto-injector device in school with no care plan is in place in school. The principal or designated teacher will create awareness of pupils allergic condition ensure all staff are aware of trained staff in management of anaphylaxis. The principal or designated teacher will identify adequate numbers of appropriate staff to attend training. School should raise awareness with all staff regarding any activities which can place the child at risk. School should make arrangements for safe handling and availability of auto-injector for pupils leaving the school building on school trips/swimming/sports activities etc

Principal/designated teacher to attend the school meeting with school nurse, parent and young person, if age appropriate, to devise and complete the care plan. Will agree with the parents and if necessary school meals staff on the provision of school meals/snacks etc in attempting to minimise risk. Will ensure safe storage of, and easy access to, the two auto- injectors devices. All school staff must be aware of where these are stored. It is the duty of the parent to check the expiry date of auto- injectors, however schools must be aware of auto injector expiry dates to ensure they are in date at all times in school. Following an anaphylactic incident, a review/debriefing with school staff and school nurse must take place within one week of the incident.

The Pupil (depending on age of child) Post primary pupils may be responsible for carrying their own Auto-injectors WITH THEM AT ALL TIMES especially when away from main building e.g. sports fields/school trips Pupils should be advised to ensure they are safe and responsible at all times with their auto injector. Will be aware of the risk of food sharing Advised to wear medical identifier Report the onset of symptoms to a responsible member of staff

School Health Team :- Provide centralised awareness training on the recognition and treatment of anaphylaxis in partnership with SELB and give advice and support to school staff. School Nurse will arrange with school, parents and young person, if age appropriate, to attend meeting in the school to devise and complete the auto injector care plan. School Nurse will outline the responsibilities within this presentation and give a copy to each person for reference. Participate in any debriefing session/follow up of major or minor incident

Minor reaction Keep calm, stay with pupil and call for help Give prescribed medication e.g. Piriton if asthmatic give 4-6 puffs of reliever (blue) inhaler Record medication administered and the time it is given Locate pupil’s prescribed auto-injector Contact parent or carer Name:_________ Date of Birth:______ Known severe allergies ___________

Give prescribed Auto-injector & record time__________ If unconscious but breathing place in recovery position Call paramedic ambulance 999 Contact parent / carer (contact numbers given over) If no improvement within 5 minutes give Auto - injector & record time_________________ If no signs of life commence CPR (cardiopulmonary resuscitation) and continue until professional help arrives Used Auto-injector accompanies child to hospital IF IN DOUBT GIVE AUTO-INJECTOR Remove Auto-injector and massage the injection site for 10 seconds. Used Auto- injector accompanies child to hospital Form fist around Auto-injector and pull off BLUE cap (JEXT YELLOW cap) Hold Auto-injector 10cm away from outer thigh. ORANGE (JEXT BLACK) tip should point towards outer thigh through clothing if necessary. Jab firmly into outer thigh so that autoinjector is at right angle to outer thigh until a click is heard and hold in place for 10 seconds.

Frequently asked questions In an emergency can I use another pupil’s Auto-injector? Who/how many should attend Anaphylaxis Awareness? How often should we have this training? What do we do with used auto injector? Can we be a ‘nut free’ school?

Today you should have: Updated your knowledge Be aware of the emergency treatment prescribed for children with this condition Practised the correct technique for auto injector administration

WANT MORE INFORMATION? Contact the Anaphylaxis Campaign Tel: Schools pack Video/DVD Managing Medicines in Schools ans Early Years Settings. DH/DfES.

Contact telephone numbers for school nursing Armagh Dungannon Banbridge Craigavon Newry Kilkeel

Thank you for your time.