1 WORKING DOCUMENT YORK REGION DISTRICT SCHOOL BOARD Policy and Procedure #661.0, Anaphylactic Reactions The Anaphylactic Reactions policy and procedure address staff responsibilities with regard to providing a safe environment for staff, students and members of the community. What has changed? Major Changes to the Document parent(s)/guardian(s) should provide at least one epinephrine auto-injector; principals shall purchase one back-up epinephrine auto-injector as needed; parents signature is no longer required to authorize staff administration to use an epinephrine auto-injector; inclusion of strategies to reduce risk of exposure to anaphylactic causative agents; emphasis on communication processes; steps to be followed if parents refuse to; let child carry an epinephrine auto-injector, provide an epinephrine auto-injector to the school but allow the child to carry one, and provide an epinephrine auto-injector to the school or allow the child to carry one; what must be contained in the file for student at risk of anaphylaxis; and parent(s)/guardian(s) responsibilities. Who is affected by these changes and Principals, staff members, parent(s)/guardian(s) and students what is the impact on current practice? Implementation Timelines Immediately. Lead Superintendents/Subject Matter Expert Superintendent of Curriculum and Instructional Services Superintendent of Schools, Operations Curriculum Coordinator Health and Physical Education K-12, Healthy Schools & Positive Climates for Learning Who has responsibilities? Board of Trustees Director of Education Superintendents Principals Teachers Outdoor Education Centre Staff Student Transportation Services Cafeteria Food Service Providers (Secondary Schools) All school staff Parents Students How is this policy and/or procedure related to Board priorities? The Anaphylactic Reactions policy and procedure promote student achievement and well-being by ensuring that physical environments in schools and workplaces are inviting, safe and supportive. They also ensure student and staff well-being.
2 What are the timelines and next steps? This policy was adopted as a working document for six school months at the December 15, 2015 Board Meeting. Comments will be scheduled for consideration at the appropriate committee meetings in October How do I find out more or provide feedback? Questions about this policy and/or procedure should be raised with your principal, manager or supervisor. If additional clarification is required, principals, managers and supervisors may contact the lead superintendent and/or subject matter expert. In accordance with Board Policy #285.0, Board Policies, Procedures and Supporting Documents, the Board welcomes all comments and suggestions on Board policy. Input is an important component of the review process. If you feel a policy and/or procedure needs to be revised, it is most helpful if you: outline clearly the specific section(s) of the policy and/or procedure in which you are not comfortable; the reason(s) for your concern(s); and suggest specific alternate wording to reflect your position. Specific recommendations or questions about the policy and procedure review process should be submitted via to or to the attention of the Assistant Manager, Board and Trustee Services at or extension 2217 or mailed to The Education Centre Aurora. It is the expectation of the York Region District School Board that all employees, students and persons invited to or visiting Board property; or partaking/volunteering in Board or school-sponsored events and activities will respect the policies and procedures of the Board. The term parents refers to both biological/adoptive parents and guardians in all Board policies and procedures.
3 WORKING DOCUMENT Board Policy #661.0 Anaphylactic Reactions Policy Statement The York Region District School Board believes that all students and staff members are entitled to safe and healthy learning and working environments. It is important that students and staff members with a potentially life-threatening allergy (anaphylaxis) develop independence to advocate for themselves within their school community. Application The Board recognizes that there can be major challenges for students or staff members who are at risk of anaphylaxis. This policy applies to anyone at risk who has been diagnosed by an allergist or a physician responsible for prescribing treatment and outlines strategies to reduce risk of a potential reaction. Strategies to Reduce Risk of Exposure to Anaphylactic Causative Agents The four categories to consider when providing a safe environment for staff members, students and members of the community at risk of anaphylaxis are: 1. information and awareness for the entire school community or workplace; 2. avoidance of the allergen that causes anaphylactic reactions wherever possible and acknowledging that it is impossible to ensure the elimination of all allergens in schools and workplaces; 3. emergency response procedures in case of accidental exposure; and 4. fostering a safe, caring and supportive environment for those at risk of anaphylaxis. More information is available in the Best Practices for Avoiding Anaphylactic Reactions document. Responsibilities The Board of Trustees is responsible for: reviewing the Anaphylactic Reactions policy in accordance with the priorities in the Trustees Multi-Year Plan and the approved review cycle; and understanding and communicating with members of the community about the Anaphylactic Reactions policy, as required. The Director of Education is responsible for: implementing and operationalizing the Anaphylactic Reactions policy. Superintendents are responsible for: supporting the application of this policy at each school; and ensuring all staff members are trained annually. Principals are responsible for: ensuring that parent(s)/guardian(s) and students are asked to supply information, if any, on anaphylaxis when registering;
4 ensuring that information about the Anaphylactic Reactions policy and procedure is shared with parent(s)/guardian(s) and students at the beginning of the school year and throughout the year, including informing parent(s)/guardian(s) of the need to let the school know if their child is at risk of anaphylaxis; including the Anaphylactic Reactions policy and procedure in the school s Emergency Response/Action Plan and medical care plan; ensuring that the school purchases at least one back-up epinephrine auto-injector if no auto-injectors are stored in the school; ensuring that all staff members are made aware of students who could require immediate medication due to anaphylaxis and the location of their prescribed epinephrine auto-injector; maintaining a file for each anaphylactic student outlining; their allergies, current treatment, a copy of any prescriptions, instructions from the student s physician or nurse practitioner, if provided, a current emergency contact list, and strategies to support the student; creating an action plan for anaphylactic emergencies; ensuring an accessible area in the school has been designated for storing prescribed epinephrine auto-injector, if provided by parents, and the school-purchased epinephrine auto-injector(s); ensuring that any epinephrine auto-injector carried by a student is prescribed by a physician, nurse practitioner or allergist; ensuring appropriate communications to parent(s)/guardian(s), staff members and students, as outlined in the procedure; ensuring that the parent(s)/guardian(s) are informed about the risks associated with not carrying and/or providing the school with an in-date epinephrine auto-injector; providing regular and current training on anaphylaxis for all staff members; and fostering a caring, safe, supportive and inclusive environment to those with life-threatening allergies. All staff members are responsible for: participating in annual training for anaphylactic reactions; reviewing the Policy and Procedures, Anaphylactic Reactions and Best Practices for Avoiding Anaphylactic Reactions documents annually; taking appropriate action in the event of an emergency, in accordance with the policy and procedure; practicing allergen avoidance measures within the school, at school or work-related events and out-of-school or workplace activities; and fostering a caring, safe, supportive and inclusive environment for those at risk of life-threatening allergies. Parent(s)/guardian(s) are responsible for: informing the school if their child has a diagnosis of anaphylaxis; completing the required documents and providing the required signatures necessary to ensure that the school has the most up-to-date information on their child; providing the school with at least one in-date epinephrine auto-injector, and preferably two, to be used in the event of an anaphylactic reaction; ensuring that their child, where age and/or developmentally appropriate, carries the epinephrine auto-injector with him/her at all times; and practicing allergen avoidance measures at all times.
5 Students are responsible for: carrying their epinephrine auto-injectors with them at all times, where age and/or developmentally appropriate; being aware of and acting on the preventative measures necessary to avoid contact with allergens; and informing staff immediately if they have been in contact with a known allergen or have any concerns related to potential allergens. The responsibilities above will be assessed based on the student s age and capability to understand their life-threatening condition. Students with special education needs would require additional assistance and advocacy by staff members and parents. Legislative Context Sabrina s Law Education Act Good Samaritan Act Definitions Age and/or Developmentally Appropriate Students in Junior Kindergarten to Grade 12 are required to carry their epinephrine auto-injector with them at all times. However, it is recognized that age and/or developmental concerns for individual students will need to be considered by the superintendent of schools and principal in consultation with the parent(s)/guardian(s). Allergens For the purpose of this policy, allergens are any substance or condition that can bring on an allergic reaction leading to a life-threatening allergic reaction known as anaphylaxis. Anaphylaxis Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Anaphylactic Reaction Signs and symptoms of anaphylaxis can occur within minutes of exposure to an allergen. In rarer cases, the time frame can vary up to several hours after exposure. The ways symptoms appear can vary from person to person and from episode to episode in the same person. Symptoms of anaphylaxis generally include two or more of the following body systems: skin, respiratory, gastrointestinal and/or cardiovascular. However, low blood pressure alone, in the absence of other symptoms, can also represent anaphylaxis. Skin - hives, swelling (face, lips, tongue), itching, warmth, redness; Respiratory (breathing) - coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing; Gastrointestinal (stomach) - nausea, pain or cramps, vomiting, diarrhea; Cardiovascular (heart) - paler than normal skin colour/blue colour, weak pulse, passing out, dizziness or lightheadedness, shock; Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, metallic taste.
6 Epinephrine Auto-injector A medical device that is used to deliver a pre-measured dose (or doses) of epinephrine. Epinephrine Epinephrine is a synthetic version of the hormone adrenaline that is used in the treatment of anaphylaxis and life-threatening asthma attacks. A second dose of epinephrine may be administered as early as 5 minutes after the first dose if there is no improvement in symptoms. Risk Reducing Strategies Strategies to reduce risk of exposure include, but are not limited to: making reasonable efforts to limit the student s exposure to the life-threatening allergen in foods, craft materials and insect stings; avoiding the cross-contamination of food allergens; establishing lunchroom/classroom eating area practices that limit allergen contact for the at-risk student or staff member; encouraging parent(s)/guardian(s) to avoid the use of substitute peanut butter products; taking special precautions in planning field trips, extra-curricular events, special celebrations and fundraising events; and inviting the student at risk to identify a buddy who is able to recognize symptoms of an anaphylactic reaction and to alert an adult. More information on risk reducing strategies is available in the Best Practices for Avoiding Anaphylactic Reactions document. Related Policies Policy # 240.0, Respectful Workplace and Learning Environments Policy # 261.0, Equity and Inclusive Education Policy # 668.0, Caring and Safe Schools Department Education and Community Services Policy History Approved 2006 Working Document February 2013 Revised March 2013 Working Document December 2015
7 WORKING DOCUMENT Board Procedure #661.0 Anaphylactic Reactions This procedure outlines the process for managing anaphylactic reactions of students and the administration of medication by the principal and/or staff members in the event of an anaphylactic reaction. Responsibilities The Director of Education shall: allocate staff and resources to support the Anaphylactic Reactions procedure. Superintendents of Schools shall: ensure schools are meeting the responsibilities of the Anaphylactic Reactions policy and procedure on an annual basis; and support schools in implementing a caring, safe and inclusive environment for those with anaphylaxis. Principals shall: ask parent(s)/guardian(s) to inform the school if their child is at risk of anaphylaxis; establish a file for each student identified with anaphylaxis; communicate the Anaphylactic Reactions policy and procedure with staff members and the school community at the beginning of the school year and throughout the year, as outlined in the Anaphylactic Reactions Communication Protocol for Principals; ensure that an Anaphylactic Reactions Protocol form is completed and updated annually, including necessary signatures, a recent photo of the student and an emergency action plan as agreed upon with parent(s)/guardian(s); ensure that parent(s)/guardian(s) of a student who has been diagnosed, and it has been reported to the school that the child has the potential to have an anaphylactic reaction, are aware that; signed authorization for a staff member to administer an epinephrine auto-injector is not required, and any staff member may administer epinephrine; at the time of registration and then again each September annually; ensure that occasional staff members and volunteers are informed of any students with anaphylaxis, provide Student Transportation Services and cafeteria food service providers with a current copy of the Anaphylactic Reactions Protocol form upon receipt from the parent/guardian, maintain open communication with parent(s)/guardian(s), staff members and students, and in cases of financial difficulty, encourage parent(s)/guardian(s) to contact Food Allergy Canada for support to purchase the epinephrine auto-injector; recommend to parent(s)/guardian(s) that they should provide at least one in-date epinephrine auto-injector to the school; additionally, encourage parents to provide a second epinephrine auto-injector to the school, when a second epinephrine auto-injector is provided, store it in an accessible location known to all staff along with documentation as outlined in the Anaphylactic Reactions Protocol form, and where it is age and/or developmentally appropriate, ensure the student keeps one epinephrine auto-injector with them at all times; ensure at least one school-purchased, back-up epinephrine auto-injector is in the school if no back-up epinephrine auto-injectors have been provided; if required, purchase back-up stock epinephrine auto-injector(s) using school funds;
8 if an anaphylactic reaction occurs and no epinephrine auto-injector is available for the student, ensure that either another student s back-up epinephrine auto-injector or a school-purchased auto-injector is used, and replace the auto-injector using school funds as soon as possible; ensure staff members bring epinephrine auto-injectors on field trips, as required; encourage the student to wear a MedicAlert bracelet or necklace; meet with the parent(s)/guardian(s) when necessary, to discuss; the student s level of responsibility, the consequences of not having the epinephrine auto-injector close to the child, an alternate plan, that will allow efficient response, if it is determined that it is in the best interest of the child not to carry the epinephrine auto-injector, if parent(s)/guardian(s) refuse to allow their child to carry the epinephrine auto-injector at school, include a notation in the student s Emergency Response/Action Plan, if parent(s)/guardian(s) refuse to provide the school with an epinephrine auto-injector and refuse to allow the student to carry an epinephrine auto-injector, suggest the parent(s)/guardian(s) contact Food Allergy Canada to discuss the refusal, seek permission of parent(s)/guardian(s) to discuss the refusal with the child s doctor or nurse practitioner, invite a public health nurse to discuss the refusal with the child s parent(s)/guardian(s), consult with the Superintendent of Schools regarding next steps, and use professional judgment to determine whether or not to contact the Children s Aid Society, if necessary; if attempts to resolve non-compliance persist; send a letter including a non compliance waiver to the student s parent(s)/guardian(s) outlining the risk to their child that is associated with this decision and have the waiver signed and returned to the school, ensure the letter provided to parents includes a disclaimer for the Board; identify individual students at risk of anaphylaxis to all school staff each September; post this information in common staff areas; and inform teachers and others who have contact with this student that they will not be carrying their epinephrine auto-injector; provide annual in-service training each September for all school staff in; anaphylaxis prevention, recognition of allergic reactions and appropriate responses, proactive communication of a caring and safe environment, Board policy and procedure related to students at risk of anaphylaxis, and use and location of epinephrine auto-injectors; invite before and after school program staff and volunteers to the annual in-service training each September; encourage/request that the entire school community assist in managing exposure to identified allergens, by periodically communicating identified allergies and avoidance strategies, as outlined in the Best Practices for Avoiding Anaphylactic Reactions documental celebrations and observances; communicate to the school community the need to share information about known allergies; if a student is experiencing an anaphylactic reaction follow the Anaphylactic Reactions Protocol; if a student is known to be at risk of anaphylaxis and is experiencing a perceived anaphylactic reaction, staff members are required to assist in the administration of epinephrine with the assurance that they will not be held responsible for any adverse reaction resulting from such administration, have the individual transferred to hospital to seek immediate medical attention preferably by ambulance, and ensure that the used epinephrine auto-injector and the Anaphylactic Reactions Protocol form accompany the student to the hospital as long as no delay is caused in the transporting of the student.
9 Teachers shall: if asked, meet with the parent(s)/guardian(s) of an identified student to discuss and record; the student s needs, and the school procedure in case of emergency and the Anaphylactic Reactions Protocol; ensure that epinephrine auto-injectors, as required, and the student s Anaphylactic Reactions Protocol form are taken on excursions and/or activities outside of the school; include the student s Anaphylactic Reactions Protocol form in teacher planning records; create, practice and enforce allergen avoidance strategies within the school, at school events and out-of-school activities following the Best Practices for Avoiding Anaphylactic Reactions document; communicate to students and staff members about how to help avoid allergens and reduce risks; communicate health or safety concerns to an administrator or supervisor; ensure that occasional staff in the classroom are aware of students at risk of anaphylaxis by including a communication on daily plans about emergency procedures; foster a caring, safe and inclusive environment for those at risk; and inform their supervisor of their own potentially life-threatening allergies. School caretakers, office and support staff shall: create, practice and enforce allergen avoidance strategies within the school, at school events and out-of-school activities following the Best Practices for Avoiding Anaphylactic Reactions document; communicate health or safety concerns to an administrator or supervisor; foster a caring, safe and inclusive environment for those at risk of anaphylaxis; and inform their supervisor of their own potentially life-threatening allergies. Outdoor Education Centre staff members and teachers planning remote field trips shall: when students have potentially life-threatening allergies, ensure awareness of the estimated time to reach the nearest hospital or medical facility; and provide school staff with the availability of two-way communication. Student Transportation Services (STS) shall: ensure that the current Anaphylactic Reactions Protocol form received from the principal is available on file in the STS office, in the appropriate service provider s dispatch office, and in the appropriate school vehicle(s); require the service provider to ensure all regular and substitute drivers who transport students with anaphylaxis have received training, including, but not limited to, recognition of symptoms of anaphylactic reactions, proper administration of epinephrine auto-injector, and how to contact emergency services; ensure that service providers have developed an emergency plan to respond to anaphylactic reactions; work with the principal and the service provider to assign a specific seat to a student with anaphylaxis, if required; and advise bus drivers to enforce the no food or beverage consumption rule on school buses. Cafeteria Food Service Provider (Secondary Schools) shall: ensure that the current Anaphylaxis Reactions Protocol form received from the principal is available on file in their office; ensure that all personnel are trained to reduce the risk of cross-contamination through purchasing, handling, preparation and serving of food; ensure that the contents of all foods served in school cafeterias and brought in for special events are clearly identified; participate in the school s anaphylaxis training on how to recognize the symptoms of an anaphylactic reaction and how to respond.
10 Parent(s)/guardian(s) shall: inform the school to their child s anaphylactic allergies by completing the Anaphylactic Reactions Protocol form upon registration and each September; call the school to schedule a meeting with the teacher/principal to discuss their child s Anaphylactic Reactions Protocol form if they choose; ensure that their child, where age and/or developmentally appropriate, carries the epinephrine auto-injector with him/her at all times; sign the waiver if they choose not to provide the school or their child with an epinephrine auto-injector; where possible, provide their child with identification, for example, MedicAlert, which should be carried by the student specifying the nature of the problem and the procedure to be followed in an emergency; provide the school with at least one in-date epinephrine auto-injector to be carried by the student; replace the epinephrine auto-injectors before the listed expiry date; and encourage the child to practice allergen avoidance measures. Students shall: carry their epinephrine auto-injectors at all times, where age and/or developmentally appropriate; practice allergen avoidance measures; refrain from sharing food or items that could include an allergen; and alert staff if they believe they have been accidentally exposed to an allergen. The responsibilities above will be assessed based on the student s age and capability to understand their life-threatening condition. Students with special education needs would require additional assistance and advocacy by staff and parents. Procedure History Approved January 2006 (formerly part of Procedure 662, Provision of Health Support Services in School Settings) Revised May 2008 Working Document May 2012 Revised March 2013 Working Document December 2015 It is the expectation of the York Region District School Board that all employees, students and persons invited to or visiting Board property; or partaking/volunteering in Board or school-sponsored events and activities will respect the policies and procedures of the Board. The term parents refers to both biological/adoptive parents and guardians in all Board policies and procedures.