2. Anaphylaxis in Schools Version for 2015-2016 School Year

3. Overview Sabrina’s Law Expectations for School Staff Definition of Anaphylaxis Recognition Action How to use an Auto-injector

4. Sabrina’s Law Legislation: Bill 3 (January 1, 2006) Mandates publicly funded School Boards to establish and maintain an anaphylaxis policy Intended to educate school communities and prevent anaphylactic incidents It does not create allergen-free schools

5. Anaphylaxis Policy Requirements Strategies to reduce risk of exposure Communication plan Regular training Individual emergency plan Request information from parents Maintain file for each anaphylactic student

6. Required for Individual Plan Type of allergy, monitoring, avoidance strategies and appropriate treatment Individualized and readily accessible emergency procedure with emergency contact information Storage of epinephrine auto-injector

7. Sabrina’s Law states: No action for damages shall be instituted respecting any act done in good faith or for neglect or default in good faith in response to an anaphylactic reaction, unless damages are result of gross negligence.

8. Expectations for School Staff Know emergency plan (copy of plan should be in your day planner) Know the location of emergency medication Administer epinephrine auto-injector

9. Expectations for School Staff Written consent to administer auto- injector is required In case of emergency, if written consent is not yet received, the auto-injector can be given to pupil it is prescribed to

10. Key Recommendations Epinephrine is the first line medication Antihistamines and asthma medications must not be used first for anaphylaxis After receiving epinephrine, the person must go to hospital

11. Key Recommendations A second dose can be given 5 to 15 minutes after first dose if symptoms have not improved or they return Expect that you will be required to administer the auto-injector

12. What is anaphylaxis? Severe systemic allergic reaction Can cause death Requires immediate action i.e. give the auto-injector and dial emergency medical services (911)

13. Triggers Most Common Foods - milk, egg, peanut, tree nuts, fish and shellfish, mustard, sulphites, soy, sesame seeds, wheat Insect stings

14. Triggers (cont’d) Other potential triggers: medications latex exercise-induced unknown (idiopathic)

15. Common Symptoms F.A.S.T. F: Face - itchiness, redness, swelling of face or tongue, metallic taste in mouth A: Airway - trouble breathing, swallowing or speaking S: Stomach - pain, vomiting, diarrhea T: Total – rash, itchiness, swelling, weakness, paleness, sense of doom, loss of consciousness, uterine cramps

16. Characteristics of Symptoms Symptoms do not appear in any order May appear immediately or hours after contact with the allergen Symptoms may vary or become more severe with each exposure to allergen

17. Characteristics of Symptoms These can also be symptoms of other conditions. If they appear in a person diagnosed with anaphylaxis after potential exposure, ACT! Look for your Anaphylaxis Resource Kit for copies of the ‘think F.A.S.T.’ poster

18. Action Identify the individual (should wear Medic- Alert bracelet/necklace) Get the person to the ground where they are If experiencing breathing problems, keep in an upright position If dizzy or fainting, place person on their back with legs raised above heart level If vomiting, place on their side with head down If getting worse, (but conscious and not vomiting) place on their back

19. Action (cont’d) Remain with the student Send someone for auto-injector Have someone else dial 911 Inject Auto-injector and record the time Remain with student. If breathing improves, lay the student down, cover, tilt head back and elevate feet Have someone else notify emergency contact Be prepared to give a second dose in 5 to 15 minutes if the reaction continues, progresses or returns

20. What else? In doubt? Give Auto-injector to student it is prescribed to Used Auto-injector goes to hospital Dosage is weight related, so make sure you get the right auto-injector for the right student ALLERJECT Blue label 15-30 kg Orange label 30 kg and over EPI-PEN Junior has green label 15-30 kg Adult has yellow label 30 kg and over

21. Allerject™ 0.15 mg Used for individuals weighing 15 to 30 kg (33-66 pounds) Allerject™ 0.3mg Used in individuals weighing more than 30 kg (66 pounds)

22. The orange cover extends to fully cover the needle after use.

23. Questions and Answers Can I use an expired Auto-injector? The companies cannot recommend the use of expired auto-injector, however, if it is all that is available and the medication is not discoloured, use it. Encourage parents to register on www.epipen.ca or www.allerject.ca for reminders of expiration

24. Questions and Answers Do I have to take the auto-injector to field trips, cross country meets and sports events etc.? Yes. The auto-injector must go everywhere the student goes. What should I do if I accidentally inject myself? You must go to the hospital

25. Questions and Answers Where should an auto-injector be kept? Auto-injectors must be accessible. Do not keep them locked up or in backpacks. Backpacks may not be easily identified in an emergency

26. Click on Auto-Injectors for Demonstration Videos

27. Hold firmly with orange tip pointing downward. Remove blue safety cap by pulling straight up. Do not bend or twist. Swing and push orange tip firmly into mid-outer thigh until you hear a “click.” Hold on thigh for 10 seconds. Two Step Epipen Administration Procedure ‘Blue Sky, Orange Thigh’

28. 1.Pull Allerject™ from the outer case 2. Pull off RED safety guard 3. Place BLACK end against the middle of the outer thigh (through clothing, if necessary), then press firmly and hold in place for five seconds. 4. Seek immediate medical or hospital care. Four Step Allerject Administration Procedure

29. Key Points to Remember You do not need to contact parents for consent to give an auto-injector to the individual it is prescribed for Antihistamines (e.g. Benadryl) can be given after the auto-injector, not before Ensure that you use the correct person’s auto- injector (dose is based on weight) Do not put your thumb on either end of the Epipen auto-injector

30. Resources www.anaphylaxis.ca www.epipen.ca www.allerject.ca www.aaia.ca www.eworkshop.on.ca/allergies www.allergysafecommunities.ca