Emergency Medical Plan For Students - A School District Development Project

Transcription

1 Emergency Medical Management: Guidelines for Schools on the North Shore September 2008

2 Table of Contents 1.0 PURPOSE DEFINITIONS AND CRITERIA... 4 ** DESCRIPTION OF ANAPHYLAXIS ROLES & RESPONSIBILITIES PRINCIPAL RESPONSIBILITIES CHECKLIST TEACHER/STAFF RESPONSIBILITIES CHECKLIST STUDENT RESPONSIBILITIES CHECKLIST PARENT RESPONSIBILITIES CHECKLIST RESPONSIBILITY OF PUBLIC HEALTH NURSE PROCEDURE FOR COMPILING MEDICAL ALERT LIST Identify Students To Be Included On The Emergency Medical Management (Medical Alert) List Contact Parent/Guardian Develop Medical Alert List Organize Emergency Medications Distribute Medical Alert List Staff Education and Training MATERIALS REFERENCES RESOURCES APPENDIX A-NEWSLETTER INSERT APPENDIX B-LETTER TO PARENT September

3 10.0 APPENDIX B-1-INFORMATION SHEET APPENDIX B-2 ANAPHYLAXIS INFORMATION FORMS APPENDIX C-MEDICAL ALERT LIST APPENDIX D-COVER SHEET APPENDIX E-NO RESPONSE LETTER TO PARENT CHILD IN CLASSROOM WITH ANAPHYLAXIS LETTER APPENDIX F-MEDICATION AT SCHOOL REMINDER APPENDIX G-RESOURCES September

4 1.0 PURPOSE To provide administrators, school staff, parents and students with guidelines for the development of an emergency medical plan for students who have medical alert conditions. 2.0 DEFINITIONS AND CRITERIA A medical alert condition is defined as a medically diagnosed, potentially life-threatening health condition that may require emergency medical care while at school. Medical Alert Conditions INCLUDE: Medical Alert Conditions DO NOT INCLUDE: **Anaphylaxis: past history of a severe allergic reaction/s which required or may require emergency care and use of adrenalin (e.g., severe insect bite or food allergy i.e. peanuts) Asthma: a past history of episodes requiring immediate medical treatment; include those children who may need assistance using inhalant medications Blood clotting disorders: that require immediate medical care in the event of injury (e.g., haemophilia) Diabetes Mild allergies that do not require urgent intervention or allergies to medications which can be avoided at school Controlled, stable asthma (needs rescue inhaler less than once/week): stable no hospitalizations within last 2 years Students with a diagnosed weakened immunity due to illness or medications (e.g. chemotherapy). Note: It is important that school staff are aware of immune-compromised students in case there is a communicable disease outbreak, but these students are not included on the medical alert list. Heart conditions: that may require emergency intervention Seizure disorder: ongoing, requiring intervention Special needs students: only if they have a potentially life-threatening condition or if they are likely to need emergency support for current health state e.g. airway management, complex cardiac problems, tube feeds One time seizure over one year ago Attention Deficit/Hyperactive Disorders, behavioural issues **See Appendix B-2 for Forms pertaining to Anaphylaxis See Appendix B-1 for Forms pertaining to all other conditions September

5 ** DESCRIPTION OF ANAPHYLAXIS Signs and symptoms of a severe allergic reaction can occur within minutes of exposure to an offending substance. Reactions usually occur within two hours of exposure, but in rarer cases can develop hours later. Specific warning signs as well as the severity and intensity of symptoms can vary from person to person and sometimes from reaction to reaction in the same persons. While the exact prevalence is unknown, it has been estimated that more than 600,000 or 1% to 2% of Canadians are at risk of anaphylaxis (from food and insect allergy), and that up to 6% of young children less than three years of age are at risk 1. In the school age population, it is estimated that between 2-4% of children are at risk of anaphylactic reactions to foods. An anaphylactic reaction can involve any of the following symptoms, which may appear alone or in any combination, regardless of the triggering allergen: Skin: hives, swelling, itching, warmth, redness, rash Respiratory (breathing): wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhoea Cardiovascular (heart): pale/blue colour, weak pulse, passing out, dizzy/light-headed, shock Other: anxiety, feeling of impending doom, headache, uterine cramps in females Because of the unpredictability of reactions, early symptoms should never be ignored 2, especially if the person has suffered an anaphylactic reaction in the past. It is important to note that anaphylaxis can occur without hives. If an allergic student expresses any concern that a reaction might be starting, the student should always be taken seriously. When a reaction begins, it is important to respond immediately, following instructions in the student s Student Emergency Procedure Plan. The cause of the reaction can be investigated later. The following symptoms may lead to death if untreated: breathing difficulties caused by swelling of the airways; and/or a drop in blood pressure indicated by dizziness, light-headedness or feeling faint/weak. 1 Canadian Society of Allergy and Clinical Immunology. Anaphylaxis in Schools and Other Settings Training strategies need to address the need for a rapid emergency response when symptoms of an anaphylactic reaction appear. Students may be in denial, or unaware, that they are experiencing an anaphylactic reaction. September

6 Action Steps for Medical Alert Management Parent registers student Registration form requests basic health information (general form) Parent indicates child has a medical alert Student is currently enrolled Parent informs school of medical alert diagnosis Yes No Principal meets with parent to discuss: 1. Medical Alert Condition and plan 2. School anaphylaxis plan 3. Need for individual plan: a. Strategies to avoid allergens b. Communication with staff c. Special requirements 4. Student Emergency Procedure Plan to be signed by physician and parent (provides consent to administer medication) Principal gives school board medical alert or anaphylaxis forms to parent Medical Alert confirmed Principal obtains: Consent to share child s information with school staff and post Student Emergency Procedure Plan. Add information to student s record Yes No Parent contacts physician Information returned by parent: All medical forms Signed Student Emergency Procedure Plan or other written instructions from physician Yes Develop individual plan for child in consultation with staff, parent, nurse and student (where appropriate). Organize training. No School treats child as undiagnosed medical alert student School notifies parents that school personnel will not administer medication during an emergency. Standard emergency procedure involving unidentified students is to call emergency medical care (911 where available) and transport student to a hospital. Implementation: Post Student Emergency Procedure Plan. Implement strategies to reduce risk. Make staff and students aware. Work with parent and staff to keep plan up-to-date. Parent provides school with suitable number of auto-injectors, food for diabetics or other medical alert medication September

7 3.0 ROLES & RESPONSIBILITIES The following checklists outline the roles and responsibilities for the principal, teacher(s), student, parent and public health nurse when planning for a student with a medical alert condition. The primary responsibility for ensuring a safe school environment is with the parents, student and school staff. Medical Alert Responsibility Checklists Principal: Use this checklist and either the Medical Alert Information Sheet or the Anaphylactic Student Emergency Procedure Plan (SEPP) to develop an Action Plan (AP) for each medical alert student. Check the boxes when items are completed. 3.1 PRINCIPAL RESPONSIBILITIES CHECKLIST Aware of school district s Anaphylaxis Policy and Student Health and Safety Policy and responsibilities for keeping students with anaphylactic allergies and other medical alert conditions safe while at school and while participating in school-related activities. Inform the parent of the school district s policies and intent to provide a safe environment for students with life threatening allergies. Request parent pick up and complete the appropriate Medical Alert forms from the school office. Set up a time to meet with the parent, teacher and public health nurse to review the Medical Alert information and complete an Action Plan. Develop the Medical Alert Action Plan: Review responsibilities of the parent, student, teacher, principal and public health nurse in developing and implementing the plan. Request parent to ensure student wears a Medical Alert bracelet or necklace. Encourage parent to return completed Medical Alert forms and provide school with appropriate **emergency medication **Emergency Medication refers to any prescribed medication as well as emergency food for diabetic students Best practice suggests that students should carry their own single dose, single-use autoinjectors, and that the parents should provide the school with an additional back-up single dose, single-use auto-injector to be kept in a central, accessible and safe location. September

8 Ensure secondary students know NOT to keep their medication in their lockers. Determine when the AP should be reviewed and write this date on the AP. For students with food allergies, determine if a Child in Classroom with Anaphylaxis letter (Appendix E) should be sent to other classroom parents informing them of a student in the class with anaphylaxis. These letters should be sent out as early as possible in the school year. Request parent s permission to use student s picture on the Medical Alert List. Obtain signatures from parent, student (optional), teacher and principal on the AP. Provide everyone with a signed copy of the AP. Consult with the Public Health Nurse as needed. Inform involved school staff: Activate the student s computer record MEDI screen, which indicates the student has a lifethreatening health condition. Provide a safe unlocked storage area for medical alert list and emergency medication. Inform staff and public health nurse of the location of Medical Alert List and medication. Place a copy of the Medical Alert List in appropriate classrooms, staff room and central designated areas (consult the parent/guardian before posting the child s plan it should be kept in areas which are accessible to staff, while respecting the privacy of the child e.g. staff room, lunch room or cafeteria. Older children are often more reluctant to have their plan posted in the classroom where it is visible to all). Provide a copy of the Medical Alert List to teacher and involved school staff. Inform involved staff of their responsibilities for student safety in the classroom, on school grounds and during field trips/co-curricular/extra-curricular activities. Request assistance from Public Health Nurse to: Review the completed Medical Alert List and use of single dose, single-use auto-injectors. Provide allergen avoidance and anaphylaxis management education including a demonstration on the use of single dose, single-use auto-injectors to school staff and persons reasonably expected to have supervisory responsibility of school-age students (e.g. food service staff, volunteers, bus drivers, custodians). The entire student population should be educated on the seriousness of anaphylaxis and be taught how to help their peers (also include that bullying and teasing students at risk of anaphylaxis is unacceptable). Assist with development of an allergy safe classroom i.e./ handwashing, desk cleaning. Assist with allergy awareness education of classmates. i.e./ letters, posters, education. Provide Medical Alert resources. September

9 3.2 TEACHER/STAFF RESPONSIBILITIES CHECKLIST Be familiar with the names of, and be able to recognize, medical alert and anaphylactic students in your class and school. Be familiar with the student s Action Plan, emergency treatment and location of emergency medication. Inform teacher on-call of student with medical alert conditions and the location of the Medical Alert List and emergency medication. Create a positive and helpful attitude toward student with medical alerts. In consultation with parent/student/public health nurse, provide students with age-appropriate medical alert/ allergy awareness education. For student with food allergies: In consultation with the public health nurse, develop an allergy safe classroom for the student(s) with food allergies. Refer to the School Activities and Food Allergens Resource Document (Appendix G). Encourage students to NOT share food, drinks or utensils. Encourage a non-isolating eating environment for the student(s) with a food allergy (student should eat in classroom with classmates). Encourage all students to wash their hands before and after meals/snacks with soap and running water. Encourage the washing of desks after meals/snacks with soapy water. Do not use foods in crafts (e.g. some tempera paints may contain egg, peanut butter feeders. See School Activities and Food Allergens Resource Document for more examples (Appendix G). On field trips/co-curricular/extra-curricular activities: Take a copy of the Medical Alert List. Take back-up single dose, single-use auto-injectors and ensure anaphylactic students are also carrying their single dose, single-use auto-injector with them (if they have demonstrated maturity to do so, as defined by their parent). Take extra food for diabetic students. Take a cellular phone. Be aware of anaphylaxis exposure risk (food and insect allergies). Inform supervising adults of student with medical alerts and emergency treatment. Request supervising adults to sit near student in vehicle (or bus). September

10 . 3.2 STUDENT RESPONSIBILITIES CHECKLIST Be aware of risks for anaphylactic reactions and take responsibility to avoid these. Know the signs and symptoms of anaphylaxis. Let an adult know if you think you might be having an anaphylactic reaction. If you carry a single dose, single-use auto-injector, keep it with you at all times (students should be encouraged to carry their own single dose, single-use auto-injector when age appropriate as determined by parent. For secondary students NOT in your locker). Know where your single dose, single use auto-injector is kept if not on your person or if it is your back up dose. Wear a Medical Alert bracelet or necklace at all times. Inform your teachers, coaches, supervising adults and friends about your allergy and be sure they know where your single dose, single-use auto-injector is kept. Wash hands before and after eating. If you have food allergies Eat only food and drinks brought from home Do not share utensils, cups or straws Do not share lipsticks or lip moisturizers Review your school s avoidance strategies document Work with Public Health Nurse to develop and provide allergy awareness education to your classmates if age appropriate. For secondary students: Encourage your friends to learn how to administer a single dose, single use auto-injector If you carry a cell phone, pre-program it to dial 911 and inform your friends September

11 3.3 PARENT RESPONSIBILITIES CHECKLIST Ensure school staff, classroom teacher(s), coaches and supervising adults are informed of your child s medical alert condition. Ensure your child is aware of his/her medical alert and/or allergy. Ensure your child knows to avoid allergens to avoid anaphylactic reactions. Ensure your child is aware of signs and symptoms of his/her medical alert. Encourage your child to tell an adult if he/she is experiencing any signs or symptoms. In conjunction with your physician, complete the Medical Forms. Return completed Medical Forms to the principal as soon as possible. Set up a time to meet with designated school staff to develop the AP. For anaphylaxis, provide two current single dose, single-use auto-injectors for school use. Inform school staff of your child s ability to carry his/her single dose, single-use auto-injector on his/her person (if they have demonstrated maturity). If your child is not able to carry his/her single dose, single-use auto-injector on his/her person, in consultation with teacher/principal, determine where the primary single dose, single-use autoinjector should be located. Children with anaphylaxis, age dependent, should know how to administer his/her own single dose, single-use auto-injector For diabetic students, provide school with juice and protein snacks for emergencies. Provide consent which allows school staff to provide emergency medication in the event of an incident. Ensure your child knows where his/her emergency medication is kept. Ensure your child wears a Medical Alert bracelet or necklace. In consultation with classroom teacher and public health nurse determine your role in providing allergy awareness education for classmates. Notify the principal if there is a change in your child s medical alert condition or treatment. September

12 If your child has a food allergy: Ensure your child knows to only eat food and drinks brought from home. Provide the school with non-perishable foods (in case child s lunch is forgotten at home) and safe snacks for special occasions (this goes for diabetic students as well). Be informed of strategies in place for developing an allergy safe classroom. Communicate with school staff about any specific field trip arrangements. Meet with food service staff to inquire about allergen management policies and menu items, if their child is to eat foods prepared at school. If your child has a dual diagnosis of anaphylaxis and asthma, ensure they are educated to: Learn the importance of keeping their asthma under control and what triggers their asthma. Always carry their asthma medication. If they are unclear as to whether they are experiencing an anaphylactic reaction or an asthma attack, the single dose, single-use auto-injector should be used first. September

13 3.4 RESPONSIBILITY OF PUBLIC HEALTH NURSE Promote the parent/guardian s role in providing up-dated health information to school staff. Support the school community in providing a safe environment for children and youth who may require emergency medical management at school (medical alert conditions). This includes providing information/resources about specific medical conditions, health education on emergency procedures, use of medications and consultation regarding emergency medical management. This also includes providing educational material for parents, students and school staff. September

14 4.0 PROCEDURE FOR COMPILING MEDICAL ALERT LIST 4.1 Identify Students to be Included on the Emergency Medical Management (Medical Alert) List 1. Administrator to determine which school staff member will be responsible for compiling the emergency medical management list (medical alert list) on an annual basis. 2. Review emergency medical management list (medical alert) from previous year. 3. Review ALL new registrations for life-threatening medical conditions (as defined under section 2.0). 4. Special needs students with medical alert conditions will be identified by the Nursing Support Services Coordinators; information to be added to the list will be sent to the school. 4.2 Contact Parent/Guardian 1. For new students, the Medical Alert Information Sheet (Appendix B-1) or the Anaphylactic Student Emergency Procedure Plan (Appendix B-2) should be provided at the time of registration. 2. Returning students up-date information from existing list. 3. Complete the Medical Alert Information Sheet (Appendix B-1) or the Anaphylactic Student Emergency Procedure Plan (Appendix B-2) with parent/guardian, student and physician if applicable. This can be done through a family interview, telephone/fax or by sending the form home (attach Appendix B to Appendix B-1 or B-2). Older students should be encouraged to complete the medical alert information sheet with input from parent/guardian as needed. 4. Provide parent with the Parent and Student Responsibility checklist. 4.3 Develop Medical Alert List 1. Transcribe information from medical alert information sheet (Appendix B-1 or B-2) to Emergency Medical Alert List (Appendix C) to ensure clarity and consistency of information. 4.4 Organize Emergency Medications 1. It is recommended that all emergency medications and medical alert lists be kept in one central, secure location in a transportable container (e.g. main office). 2. Each medication must be clearly labelled with pharmacy label, student name and expiry date. Food for diabetic students also to be clearly labelled with student name. September

15 3. Label a clear zip-lock bag (or large envelope) for each medical alert student, including: Copy of completed Medical Alert Information specific to that child with Signature of prescribing physician Labelled emergency medication (if applicable) = pharmacy label 4. Organize envelopes/zip lock bags in container by alphabetical order by children s last name. 5. A copy of the complete medical alert list should be in the front of the container. NOTE: Emergency medical management plans and medications should be taken on field trips and school evacuations. Medication is for prescribed student only. For those students who carry their own medication, or keep it in the classroom, it is recommended that there be a back-up dose in the main office as well. If not, the medical alert list must clearly state where the student s emergency medication is located in the school. 4.5 Distribute Medical Alert List 1. Have a distribution plan to get the list out to all school staff (include support staff if there is shared playground/gym/lunch-hour monitoring). List must also be available to the teacher on call (TOC). 2. A reference copy should kept in the medical room, main office, and staff room. 4.6 Staff Education and Training At the beginning of each school year, a training session on medical alerts will be held for all school staff and persons reasonably expected to have supervisory responsibility of schoolage students and preschool age children participating in early learning programs (e.g. food service staff, volunteers, bus drivers, custodians). Efforts shall be made to include the parents, and students (where appropriate), in the training. Experts (e.g. public health nurses, trained school district occupational health & safety staff) will be consulted in the development of training policies and the implementation of training. For Anaphylaxis: Training will be provided by individuals trained to teach anaphylaxis management. The training sessions will include: Signs and symptoms of anaphylaxis Common allergens Avoidance strategies Emergengy protocols Use of single dose, single use epinephrine auto-injectors September

16 Identification of at risk students Emergency Plans Method of communication and strategies to education and raise awareness of parents, students, employees and volunteers about anaphylaxis and medical alerts Best Practice to educate: Distinction between the needs of younger and older anaphylactic students. Participants during the training will have an opportunity to practice using an auto-injector trainer (i.e. device used for training purposes) and are encouraged to practice with the auto-injector trainers throughout the year, especially if they have a student at risk in their care. Training on medical alerts will also include: 1. Diabetes Management and Seizure Management: where appropriate. 2. Reinforcement of confidentiality 3. Posters which describe signs and symptoms of anaphylaxis and how to administer a single dose, single-use auto-injector. These should be placed in relevant areas. which may include classrooms, office, staff room, lunch room and/or the cafeteria, library, computer room or gym. September

17 5.0 MATERIALS 1. Epipen and Twinject trainers, posters. 2. Emergency Medical Management: Guidelines for North Shore Schools Revised Emergency Medical Management at Schools Resource List, Vancouver Coastal Health, North Shore. July Kids with Diabetes in Your Care. A Practical Guide. Canadian Diabetes Association. September 1998 (revised). 5. Awareness of Chronic Health Conditions. Ministry of Education. 6. Life-threatening Food Allergies in School and Childcare Settings; A practical resource for parents, care providers and staff. (1999) BC Ministry for Children and Families. 7. Medical alert identification (bracelet/necklace), order forms. 6.0 REFERENCES 1. B.C. Ministry of Education. British Columbia Anaphylactic and Child Safety Framework. September B.C. Ministry of Education. Anaphylaxis Protection Order. October B.C. Ministry of Education. Core Anaphylaxis Resources. January B.C. Ministry of Health. Public Health Nursing Policy, Standards, and Guidelines. Volume 5 Child and Youth (school-age) Health. Oct Canadian School Boards Association and Health Canada. ANAPHYLAXIS: A Handbook for School Boards Revised Government of British Columbia. Freedom of Information and Protection of Privacy Act and Public Health Nursing Policy Health Act. 7. West Vancouver School District #45. Medical Alert Conditions, Policy March Ministry of Education Special Feature. Services: A Manual of Policies, Procedures and Guidelines Provincial Document: Public Health Nursing Guidelines for School Age Children and Youth (1994). 9. Vancouver Health Board - Burrard Health Unit. Recommended Strategies in the Prevention and Management of Anaphylaxis in the School Setting. September Government of British Columbia. School Act and Ministerial Orders: Inter- Ministerial Protocols for the Provision of Support Services to Schools (1990). 11. Summary of research findings: The Public Health Nurse and the Medical Alert System in B.C. Elementary Schools: Is It Working, (1995). September

18 7.0 RESOURCES For more information: Allergy Safe Communities BC Health Files: Severe Food Allergies in Children Dial-A-Dietitian: (Greater Vancouver), (toll free) September

19 8.0 APPENDIX A-NEWSLETTER INSERT Promoting a Safe and Healthy School Environment for Children with Medically Diagnosed Life Threatening Conditions Ensuring a safe and health school environment is a responsibility shared by students, parents and staff. It is important that all members of the school community are aware of their role in promoting that child s safety. Individuals at risk of anaphylaxis must learn to avoid specific triggers. While the key responsibility lies with the students at risk and their families, the school community must participate in creating an allergy-aware environment. Special care is taken to avoid exposure to allergy-causing substances. ALL parents are asked to consult with the teacher before sending food to classrooms where there are food-allergic children. The risk of accidental exposure to a food allergen can be significantly diminished by means of such measures. Please notify the school if your child has any or all of the following: - A MEDICALLY DIAGNOSED health condition/s, which may require emergency care at school. - This includes anaphylaxis, diabetes, severe asthma, seizure disorder, blood clotting disorders or serious heart conditions. Please contact the school office to complete the appropriate Medical Alert Forms. September

20 9.0 APPENDIX B-LETTER TO PARENT Date: SCHOOL LETTER HEAD HREE Emergency Medical Management at School Dear Parent/Guardian of: Your child is currently on/or requires being on, the medical alert list at school. The purpose of the medical alert list is to communicate a student s life threatening condition and their needs to school staff to ensure their safety should a medical emergency arise. The primary responsibility for ensuring a safe school environment for each child with a life threatening condition is with the parent, student and school staff. The Public Health Nurse acts as a resource. In order to ensure a safe school environment we ask the parents and students to agree to the following responsibilities: Parent/Guardian Student Complete the appropriate medical alert information sheet Provide the school with doctor instructions and signatures if needed (see attached forms) Supply the school with medication and replace when expired or depleted Provide your child with a medic alert bracelet Review medical alert information with school staff annually (especially classroom teachers) Notify the school staff of any changes in the student s health status during the school year Participate in educating staff/students regarding your child s medical alert condition Ensure that your child has emergency medication with him/her on field trips Participate in self-care activities as appropriate for age Wear a medic alert identification bracelet/necklace Inform school staff and friends of medical alert condition Avoid allergy triggers or other potentially harmful situations Inform school staff or friends if feeling unwell A complete list of responsibilities can be found on the parent and student responsibilities checklist which are attached. Principal s Signature: October 2006 rev

21 10.0 APPENDIX B-1-INFORMATION SHEET SCHOOL LETTER HEAD HERE School: Name of Student: Parent/Guardian: Medical Alert Information Sheet Date: Date of Birth: (Parent) Signature: Home Tel #: Bus. Tel #: Physician: Tel: PHN / Care Card: To Be Completed by Parent: Emergency Action Plan Student Information Medical Condition Symptoms Child s Name: Grade: Class/home room Teacher: Diabetes Seizure Disorder Severe Asthma Blood Clotting Disorder Heart Condition Plan of Action (Number in order of priority: 1=Most important 5 Least important) Administer Medication Call 911 Call Parents Provide juice/snack (if appropriate for diabetes. etc.) Other To be completed by prescribing Physician if emergency medication is required at school (e.g. rescue inhalers, seizure medication, and food for diabetic students): (Please Print) Medication Dose Route Frequency Directions Physician s Name: Signature: October 2006 rev

22 11.0 APPENDIX B-2 ANAPHYLAXIS INFORMATION FORMS 22

23 Anaphylactic Student Emergency Procedure Plan SCHOOL LETTER HEAD HERE School: Date: Personal Health Number: Student Name: Grade: Parent/Guardian: Home Telephone: Physician: Date of Birth: Classroom Teacher: Signature: Business Telephone: Telephone: Emergency Action Plan -To be Completed in Consultation with Physician CHILD S ANAPHYLAXIS TRIGGERS ARE: (do not include antibiotics or other drugs) peanuts nuts milk all diary eggs shellfish fish Food allergies (list): Insect stings (list): Latex Other: ANAPHLYAXIS SYMPTOMS: Swelling (eyes, lips, face, tongues) Hives or itchy skin Cold, clammy, sweaty skin Fainting or loss of consciousness Stomach cramps/diarrhea/vomiting Difficulty breathing/swallowing, shortness of breath, wheezing Other (list) Tingling of lips/mouth, trouble swallowing Coughing or choking Flushed face or body Dizziness, confusion, pale/blue color,weak pulse,shock Change of voice Heart rate changes (fast/slow) Anxiety, feeling of impending doom, headache EMERGENCY TREATMENT: Administer single dose, singe use auto-injector Call 911 Administer 2 nd single dose, singe use auto-injector in minutes, or sooner, if symptoms do not improve Transport student to hospital by ambulance To be completed by prescribing Physician if emergency medication required at school Emergency Medication must be a single dose, single use auto-injector for school setting. Oral antihistamines will not be administered by school personnel. Medication Dose Route Frequency Directions Physician s Name: Signature:

24 Anaphylactic Student Emergency Procedure Plan SCHOOL LETTER HEAD HERE Parent/Guardian Please Complete Discussed and reviewed Anaphylaxis Procedure Plan? Yes No Discussed and reviewed Anaphylaxis Action Plan with principal? Yes No Two single dose, singe use auto-injectors provided to schools? Yes No Student Aware of how to administer? Yes No Auto injector locations: Your child s personal information is collected under the authority of the School Act and the Freedom of information and Protection of Privacy Act. The Board of Education may use your child s personal information for the purposes of: Health, safety, treatment and protection Emergency care and response If you have any questions about the collection of your child s personal information, please contact the school principal directly. By signing this form, you give your consent to the Board of Education to disclose your child s personal information to school staff and persons reasonably expected to have supervisory responsibility of schoolage students and preschool age children participating in early learning programs (as outlined in the BC Anaphylactic and Child Safety Framework 2007) for the above purposes. This consent is valid and in effect until it is revoked in writing by you. Parent/Guardian Signature Date (YY/MM/DD) 24

25 Anaphylaxis Action Plan SCHOOL LETTER HEAD HERE For Date This plan is required to establish what measures can be taken to limit the child s risk of exposure to an allergen to an appropriate level. The principal (or designate) in a meeting with the parent(s)/guardian(s) of the student with anaphylaxis will complete the Anaphylaxis Action Plan form. The management measures required will be communicated to staff and other parents (if necessary) by the principal (or designate). General Measures to be Discussed (Check Required Measures): Designate a safe eating area in the classroom that has good ventilation. Establish a hand-washing and desk-top washing routine after eating, particularly for younger students Encourage the anaphylactic child to place waxed paper or a napkin on the desktop, remove only one item at a time from lunch kit and not to leave food unattended. Labelling of stored food with the anaphylactic student's name Discourage sharing of food, utensils or containers Discourage sharing of lipstick and lip moisturizers Limit the anaphylactic child to food brought from his or her home or provided by the parent for the entire class If foods come from other homes into the classroom, remind parents of the anaphylactic child s allergens and insist on ingredient lists. Consider measures for holidays and special celebrations Consider allergens in school activities (composting, gardening, school fund-raisers, vending machine options, yard clean-up art projects, science projects, toys, seasonal activities, crafts and cooking) Describe specific plans: If the food cannot be eliminated or there is lower risk of accidental exposure (such as milk anaphylaxis) the above measures may be adequate. Increased Avoidance Measures Create allergen aware areas of the school: If possible, avoid using the classroom of an anaphylactic child as a lunchroom. If the classroom must be used as a lunchroom, establish it as an allergen-aware area, using a cooperative approach with students and parents in the class. Develop strategies for identifying high-risk areas for anaphylactic students (such as the library, computer room, music room and gym). Establish these as allergen-aware areas. Discourage eating/drinking (other than water) in these areas. Describe allergen aware area plan: It is recommended the parent share information in a meeting with other parents in the affected classroom, in consultation with the principal, to explain the seriousness of the situation. Describe plan Principal (or designate) will send a letter to parents in the classroom requesting they not send the allergen food or foods that may contain that ingredient. Provide parents with a listing of ways the offending food may be found in ingredient labels. Describe plan Epinephrine Auto-injector (single dose, single use) Management Anaphylactic children who have demonstrated maturity (as deemed by their parents) should carry at least one single dose, single use auto-injector with them at all times and the school will keep at least 1 extra one in the office, in case of an emergency. Ensure that auto-injectors are stored in a safe (unlocked) but easily accessible location and that staff has been informed of the location. Describe plan 25

26 12.0 APPENDIX C-MEDICAL ALERT LIST SCHOOL LETTER HEAD HERE Emergency Medical Alert List School: Date: REFER TO FRONT OFFICE FOR STUDENTS INDIVIDUAL CARE PROTOCOL Picture ID Medical Alert Symptoms Plan of Action Name Grade Room Teacher Name Grade Room Teacher Name Grade Room Teacher 26

27 13.0 APPENDIX D-COVER SHEET SCHOOL LETTER HEAD HERE MEDICAL ALERTS School Name: Year: To: All Staff From: Principal Date: The students on this list have a medical condition that requires an immediate response at school. This list is as complete as possible at the time of printing. If additional information is received, an addendum will be sent to you. PLEASE FAMILIARIZE YOURSELF WITH THE HEALTH CONDITIONS AND CARE REQUIRED FOR THESE STUDENTS ESPECIALLY THOSE STUDENTS IN YOUR CLASS. In the event of an emergency, please follow the directions provided in the Plan of Action column. Medications for students are located in the main office unless otherwise indicated. All students medications and food (e.g. juice for diabetics) are clearly labelled and are to be administered to that individual student only. Diabetic snacks are in the main office and in the student s classroom. THIS INFORMATION IS STRICTLY CONFIDENTIAL and is not to be released to anyone outside of the staff. It should be kept in a place that is easily accessible to teachers on call (TOCs). Please destroy any previous list(s). 27

28 14.0 APPENDIX E-NO RESPONSE LETTER TO PARENT SCHOOL LETTER HEAD HERE Date: Dear Parent It has come to my attention that you have not returned the school s phone calls regarding your child s medical alert condition and his/her possible need for medication should a medical emergency arise. It is imperative that we speak with you to ensure a safe school setting for your child. This letter is to let you know that if we do not hear from you, your child will be on the medical alert list; however, if he requires emergency medical attention our course of action will be to call 911. A supply of his/her medication, if needed, would be appreciated with the appropriate completed paperwork. This can be obtained at our main office. Your prompt attention to this matter is appreciated. Please do not hesitate to call if you have any questions. Sincerely, Principal 28

29 15.0 APPENDIX E-CHILD IN CLASSROOM WITH ANAPHYLAXIS LETTER September SCHOOL LETTER HEAD HERE Dear Parents of Students in Insert Name of Teacher Class We have a child attending insert grade that has a life-threatening allergy to NUTS (put in other food allergens if necessary) and exposure could result in severe sickness or death. To help reduce the risk of accidental exposure, we need your cooperation in order to provide a safe and secure learning environment. The following are respectfully requested: 1. Students in this class do not bring food to school that contain peanuts or nut products (i.e. peanut butter, muffins/cookies with nuts, granola bars). Please read the list of ingredients on food packages. The Allergy Aware and Lunches to Go handouts from Vancouver Coastal Health can help parents plan lunches and snacks. 2. If your child enjoys peanut/nut containing products at home, please ensure that your child adds handwashing to their routine before coming to school. Even a small amount of peanut oil or dust from a friend s hand can easily be transferred to crayons, books or playground equipment that can pose a risk for the allergic child. 3. Discuss with your child the importance of not trading or sharing food. The above items will also be discussed with all the students in the classroom setting along with ways to help their allergic friend stay safe. We hope you will appreciate the seriousness of this condition and that you will assist us in our efforts to create as safe an environment as possible for this student. Thank you for your understanding and cooperation. If you have any questions or suggestions, please feel free to call me at the school or our Community Health Nurse at Sincerely, Principal Community Health Nurse Classroom Teacher 29

30 16.0 APPENDIX F-MEDICATION AT SCHOOL REMINDER SCHOOL LETTER HEAD HEREDear Parent: This is a reminder regarding your child s emergency medical management at school. Your child currently has the following medications at school: The emergency medication for your child is EXPIRED Please make arrangements to pick-up these medications and provide the school with new medications for emergency use at school. School Year End All medications MUST be picked up from school office on the last day of school. If the medication continues to be required at school in September, please do the following: Return the medication at the start of the school year Be sure all medication has a current expiration date, is in its original container, and is clearly labelled with the student s name. Include a new medical/parental authorization form only if: There is a change of medication There is a change in directions for use Parents are reminded that emergency medications cannot be given at school without written medical and parental authorization. Please check with the school office staff to ensure the consent form is on file. If necessary, review medication directions with school personnel. Your cooperation is appreciated and will assist the school in providing a safe environment for your child. Sincerely, School name or Principal 30

31 17.0 APPENDIX G-RESOURCES 31

32 Anaphylaxis A sudden and severe allergic reaction, which can be fatal, requiring immediate medical emergency measures be taken Signs and symptoms of a severe allergic reaction can occur within minutes of exposure to an offending substance. Reactions usually occur within two hours of exposure, but in rarer cases can develop hours later. Specific symptoms can vary from person to person and sometimes from attack to attack in the same person. COMMON SYMPTOMS Skin hives, swelling, itching, warmth, redness, rash Respiratory (breathing) wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhea Cardiovascular (heart): pale/blue colour, weak pulse, passing out, dizzy/light-headed, shock Other: anxiety, feeling of impending doom, headache, uterine cramps in females Treatment GIVE AUTO-INJECTOR (single dose, single-use) CALL 911 Emergency Medical Care CALL child's parent/guardian GIVE second auto-injector within 10 to 15 minutes, or sooner, if symptoms have not improved or recur. TRANSPORT to hospital If child has had a reaction and does not have any medication, call 911 Emergency Medical Care 32

33 Preventing Bee, Wasp and Insect Stings Wear shoes when outside Check food and drink containers for insects Keep lids on sweet drinks and use a straw Wear a cap on warm sunny days to prevent insects from getting caught in your hair If a bee is buzzing around your head, hold your hands up on each side of your face, and walk calmly into a treed area. Even a few branches will disorientate the bee and it will fly off. DO NOT swat at bees, wasps, flying insects or destroy nests DO NOT drink sweet drinks outside DO NOT sit close to garbage cans DO NOT wear perfume, bright clothes or floral prints DO NOT pick flowers June

34 School Activities and Food Allergens Resource Document The following sections are designed to provide awareness as to how food allergens may turn up in craft activities, science and social studies projects, field trips and other school activities. It is not possible to list all of the ways allergens may turn up in schools but the information outlined in this document can help create awareness and provide an opportunity to explore alternatives. Communication with parents and/or students and being proactive in the planning and preparation of school activities can allow school personnel to address the individual nature of each student s triggers for anaphylaxis, allergy and asthma. This material has been provided by the Allergy/Asthma Information Association. June

35 School Craft Activities and Food Allergens The following are some examples of craft activities that could pose a risk to students with the following life-threatening food allergies. Egg Allergy Using egg cartons in crafts Coloring or decorating Easter eggs. Plastic eggs could be substituted and covered with tissue paper and diluted glue (decoupage). This would also create a more lasting craft. Wooden eggs are an option but may be expensive. Using crushed egg shells to cover a bottle (e.g., making a vase) Egg shell mosaic (crushed eggshells are dried and used to make mosaic pictures) Crushed egg shells are sometimes used in paint to give it a crackle effect Making Christmas cookie ornaments and brushing with egg white to glaze Using dried fruit in wreaths and ornaments and brushing with egg white to keep from going brown Eggs are blown out and brought to class or this is done in the class Sugar cookies may be decorated with a mixture of food coloring and egg yolk Easter egg hunts (use plastic eggs instead of real eggs). Egg white icing for gingerbread houses Homemade playdough recipes Some tempera paints may contain egg. The old technique for making tempera paints uses egg. The powdered paint used in elementary schools may not. The egg and spoon race is a potential risk for students with egg allergy (golf balls may be substituted for eggs). Milk Allergy Making bird houses out of milk cartons Used popsicle sticks could be contaminated with milk Blowing bubbles in chocolate milk until it overflows over the glass onto the paper to make designs Taking a bucket of milk, adding food coloring and swooshing paper through for a neat design Peanut and/or Nut Allergy Crafts using bird seed can pose a risk of peanut/nut exposure Pine cone bird feeders covered with peanut butter so that dried fruit, etc. will stick to it. Mesh plastic bags that house shelled peanuts are often used in crafts Used popsicle sticks may be contaminated with peanut or nut Using nuts in making wreaths Candies used to decorate gingerbread houses may contain peanuts (e.g. M&M s) Halves of walnut shells are often used to make Christmas tree ornaments. Use small sea shells instead. They can be purchased at craft or dollar stores or gathered at the beach. Peanut butter playdough Making bean bags Acorns and walnuts are sometimes used in collage activities Wheat Allergy Using wheat in making wreath decorations June

36 Science Projects and Food Allergens The following are some examples of science projects that could pose a risk to students with the following life-threatening food allergies. Egg Allergy Egg flotation to demonstrate buoyancy Demonstrating how an egg can be sucked into a bottle by creating a vacuum Make an egg go soft via immersion in vinegar Packing eggs so they will not break when dropped from heights to see the effect of force of gravity Bringing in an incubator and hatching baby chicks Peanut/Nut Allergy Celebrate a legume day. Peanuts along with other legumes are brought in to study (note that peanuts are a legume). Burning a peanut to demonstrate heat producing substances (Diffusion Grade 9) Collections of seeds. Ensure peanuts and nuts are not included in this if there are students with these allergies. Other Tasting and/or sniffing white powders to determine their identity. Allergic students should not be required to participate. Avoid using latex balloons or other latex products in class IF you have students with latex allergy Social Studies Projects and Food Allergens The following are some examples of social studies projects that could pose a risk to students with lifethreatening food allergies. Tasting foods from around the world. Food allergens should not be permitted in the classroom. Note that foreign foods may use peanut oil in cooking as well as other nuts, shellfish, fish and egg. Visiting ethnic restaurants to sample various foods. It is very difficult to fully ascertain ingredients in these restaurants and food may be cross-contaminated. Food allergic students should not be required to participate. June

37 Field trips and Food Allergens The following are some examples of school field trips that could pose a risk to students with food allergies such as egg, dairy, peanut/nut, wheat or fish. Many situations can be avoided by planning ahead and being prepared for the unexpected. A visit to a farm and a young egg allergic student is handed an egg Touring a bakery, restaurant or grocery store many food allergens present A visit to a farm and milk allergic students are shown cows being milked Students are singing at a senior s home and the residents serve peanut butter cookies to the students (consider that cookies may also contain egg, wheat or dairy IF either of those are a problem for any students in attendance). Many field trips include handing out goodies at the end that may contain student allergens. Zoos and animal parks can expose children to food allergens (e.g. nuts) and asthma triggers. Sports activities (many peanuts/nuts are consumed in arenas and playing fields) Water parks or the beach where will the single dose, single-use auto-injectors (e.g.,epipen) be kept. They must not be left sitting in the sun or stored in vehicle glove compartments. Heat will affect the medication. Hand wipes are needed as well as allergen-safe lunches. There may not be sinks to wash hands. When planning a trip to a fish hatchery, are there students who are allergic to fish. Track and field or sports trips where will the students be eating and where will the autoinjectors be kept. Skiing trips Single dose, single-use auto-injectors must not freeze as that could cause the injector to malfunction. Traveling long distances on school buses where students are eating on the bus. Classmates should not for example, bring peanut/nut products on a bus trip when there is a student with these allergies. Also consider other life-threatening allergies and ask students not to bring foods containing those allergens. It is helpful if school staff pack juice boxes, water and allergy friendly snacks. On out-of-town field trips be prepared in case the school bus breaks down, or the possibility of delays in airports. Allergic students should carry extra safe non-perishable food. They may not be able to safely eat at a restaurant, fast food outlet or corner store. School-wide picnics at city parks. Plan how will you monitor the whereabouts of allergic students and where the single dose, single-use auto-injectors will be kept. Some field trips may also present problems for children with asthma, i.e. a hay maze, petting zoo, farm. Talking with parents of the anaphylactic student ahead of time can help ensure the student takes asthma medication along. Visiting a chocolate or candy factory may expose allergic students to nuts, peanuts, milk, egg (cream centres in chocolates) or wheat. Restaurants can pose risk for allergic students. Parental input of allergy friendly chain restaurants can help reduce risks. June