2. Any delegate administering an EpiPen injection must receive child specific training. The delegate must be willing to assume the responsibility. The delegate must be willing to learn the procedure for treating anaphylaxis. The delegate must be checked for competency by the school nurse utilizing the “Epi Training Form” The delegate should secure a CPR Providers course completion card issued by American Red Cross but this is not required.

3. ANAPHYLAXIS It is a rapid, severe allergic reaction that occurs when a person is exposed to an allergen, often triggered by bees or other insects, food, including Peanuts, other nuts, milk, shellfish, latex, and others. Initial symptoms: hives, swelling of lips, throat, tongue, wheezing, shortness of breath, coughing, hoarseness, nausea, vomiting and abdominal cramps. If symptoms left untreated the situation may become life threatening.

4. ALLERGIC REACTIONS FOODSENVIRONMENTALBEESASTHMA

5. RECOGNIZE THE PROBLEM CALL FOR ASSISTANCE –NURSE OR DELEGATE OBTAIN EPI-PEN-FROM DESIGNATED LOCATION ADMINISTER EPI-PEN PER IHCP CALL 911 STAY WITH VICTIM KEEP EMPTY EPI-PEN TO GIVE TO FIRST AIDE RESPONDER NOTIFY THE PARENT TREATMENT OF ANAPHYLAXIS

6. WHERE SHOULD THE EPI-PEN BE? Self medication policy and form must be on file in order for a student to carry their own Epi Pen.

8. At most of the Toms River Schools, Epi-Pens are kept in both the nurses’ offices and in a designated safe spot, convenient for all designees. ALWAYS KNOW WHERE YOUR PENS ARE!!!!

9. EPI PEN TRAINING Review concepts and procedures for Standard Precautions Review definition of anaphylaxis: signs and symptoms Act according to steps listed in IHCP Thoroughly check that the medication is the right medication for the right student Check for the expiration date of the Epi Pen to be injected

10. STEPS TO USE THE SYRINGE 1.Hold black tip near outer thigh (always apply to thigh) The needle will go through clothing. 2.Pull off gray activation cap 3.Swing and jab firmly into thigh until Auto-injector functions. Hold in place to count of 10. Massage the injection area for 10 seconds. 4.Save syringe to take to ED.

11. Review the steps Remove Gray activation cap Black tip to be placed against thigh Hold black tip against thigh for the count of 10 and then massage for the Count of 10. Save auto injector to accompany student to hospital. Did you call 9-1-1???? Did you notify the parent???

12. Designee Requirements Must be a willing volunteer Must have received training from the school nurse annually and as necessary Epinephrine Auto-Injection Training Form must be signed by the delegate and school nurse Designee must review the signs and symptoms for each individual they are responsible for

13. References: The Food Allergy and Anaphylaxis Network http://www.foodallergy.org/downloads.html