Anaphylaxis in Schools -A Guide For Teachers

Transcription

1 Health, safety, security and contract management section Belfast Region Anaphylaxis in Schools -A Guide For Teachers Health, safety, security, and contract management section 1

2 Introduction In recent years there has been an increase in the number of children who are sensitised to foods such as peanuts, dairy products or seafood. Inadvertent ingestion, or in extreme cases exposure by handling, can cause a severe allergic reaction. Many schools have at least one child with one of the most common food triggers, peanuts. These are mostly normal healthy children except for their life threatening reaction to these foods. Fortunately a severe reaction is rare. What is anaphylaxis? Anaphylaxis, pronounced ana-fill-axis, is an acute, severe allergic reaction requiring immediate medical attention. It is caused by a confused immune system that mistakes a benign protein for a dangerous one. The allergen triggers cells that release histamine. The whole body is affected, usually within minutes of exposure to the allergen but sometimes after hours. What are the symptoms? Any or all of the following symptoms may be present: Itching or a strange metallic taste in the mouth; Swelling of the throat and tongue; Difficulty in swallowing; Hives anywhere on the body; Generalised flushing of the skin; Abdominal cramps and nausea; Increased heart rate; Sudden feeling of weakness of floppiness; Difficulty in breathing due to swelling of throat/airway; Collapse and unconsciousness. The most common symptoms in the very young are acute abdominal pain and vomiting. This may be followed by oral oedema and swelling of the face, generalised rash, hypotension, difficulty in breathing and anaphylaxis. Reactions Mild reactions are treated with oral antihistamine. Typical symptoms include itching and urticaria. The child should be observed and their parents contacted. Health, safety, security, and contract management section 2

3 Moderate or severe reactions will need either inhaled or injected adrenaline depending on the child s protocol. A paramedic ambulance should be called, these carry the equipment necessary to deal with a severe reaction, and it should be stated at the time that the child is suffering from anaphylaxis. The child must go to hospital for observation, even if recovered, in case of relapse. Medication All children at risk of anaphylaxis will be prescribed medication for use in the event of an allergic reaction. These may include antihistamines, an adrenaline inhaler or an adrenaline injector. The adrenaline injection that is most commonly supplied is the EpiPen. These devices are preloaded with a single pre-measured dose. It is the responsibility of the child s parents to supply the school with the necessary medication, labelled with the child s name and marked for use by trained school staff, to use in an emergency. If the medication is used or out of date the parents should be asked to replace it. Storage of medication Medication should be stored under secure conditions, clearly marked for use and easily accessible by designated school staff or qualified personnel and showing an expiry date. The EpiPen should be kept at room temperature. If exposed to extreme heat or sunlight the adrenaline turns brown. Looking through the viewing window can check this. It is recommended that two EpiPens are kept in school, both because of the potential need for a second dose and in case there is a problem such as faulty technique or damage to equipment. Administration of adrenaline injection As soon as a severe reaction is suspected an adrenaline injection must be given. Do not wait to be sure. The administration of this medication is safe. It will not harm the child. A paramedic ambulance must be called and it should be stated that the child is suffering from anaphylactic shock. The EpiPen is a disposable pen with a concealed needle that delivers a single pre-measured dose. The following steps should be taken: Place the child in the recovery position. Remove the grey safety cap. Hold the EpiPen with the black top at right angles to the outer thigh. Press hard until the auto-injector mechanism functions, 3-4mm, (there should be a click). Hold in place for 10 seconds. Remove the EpiPen and massage the area. Health, safety, security, and contract management section 3

4 The time of administration should be noted, as the paramedics will need this information. Check pulse in neck, if absent with no sign of spontaneous breathing start C.P.R. Place auto-injector into plastic case and give to emergency services that will dispose of it safely. The child, even if recovered, must go to hospital in case of relapse. A second EpiPen may be administered minutes after the first if symptoms do not improve or get worse. The emergency services should be in attendance by then. Training The School health team will arrange training. It is essential that all staff who have received training know where the emergency kit containing medication and instructions is kept. Office staff may also be involved, either being asked to bring the emergency kit or phone for assistance. It is essential that they are familiar with emergency telephone procedures. Protocol It is recommended that schools, which manage a child at risk of anaphylaxis, should draw up an individual protocol, agreed by the parents, the treating doctor and the school. The protocol should deal with all the important issues, including: Anaphylaxis; Emergency procedure; Medication; Food management; Staff training; Precautionary measures; Professional indemnity; and Consent and agreement. This agreement will ensure that the best possible support is in place for both the child and the school staff. The partnership of parents, school and medical practitioner is crucial in formulating such an agreement. A sample protocol is attached. It is stressed that this is a guide only. Children can be assessed as being mild, moderate or severely allergic with subsequently differing treatment plans. For example, not all children will be prescribed adrenaline. It is therefore essential that protocols should be individualised. Health, safety, security, and contract management section 4

5 Prevention of a reaction With thoughtful prevention the chances of a child suffering a severe reaction requiring the administration of an injection are very small. Consideration should be given to banning peanuts and peanut butter from the school by explaining the situation to other parents by letter and asking for their co-operation. School meals/snacks Being a high-energy source of protein, peanuts are the basis of many children s snacks and a common ingredient in a wide range of foods. They can be hidden in breakfast cereals, spaghetti sauces, oriental dishes, pastries, sweets, ice creams, puddings and garnishes. It is therefore vital that there should be prior consultation with regard to the provision of meals/snacks when a child with a peanut allergy enrols in the school. It is very important to bring to the attention of the school meals department any specific diets that your pupils require. You should provide a copy of the diet sheet along with the name and telephone number of the pupil to the relevant area manager within the school meals department. If the pupil is in the free meals register the Education Authority (EA) has a legal obligation to provide a meal and will do so, working in close liaison with the pupil s parent or guardian and school. Where EA has no legal obligation it would be preferable if the parent/guardian provided the child with a packed lunch and also suitable sweets/treats if the school s policy allows such items. Children should be dissuaded from swapping foods at lunch breaks. Never offer the affected child any food if you are uncertain of the ingredients. Outdoor activities/school trips Arrangements should be discussed in advance with the parents. An emergency kit should be carried at all times and a trained member of staff should accompany the group on school trips. Potential problems in contacting emergency services must be addressed by the school prior to undertaking any trips or outdoor activities. School activities There are also hidden dangers in everyday school activities for children affected by allergens. For example: Health, safety, security, and contract management section 5

6 Cookery and science experiments with food may present difficulties for a child at risk of anaphylaxis. Art works often include nuts and nutshells in collage work, especially in Nursery schools. The food provided for pets that are kept in the classroom may be of a nut or other allergen variety. There is the possibility that children may come into contact with wild bird feeders if they are located in the playground for example. Conclusion As with any other medical condition privacy and the need for prompt and effective care need to be balanced with sensitivity. Supervision and observation should be discreet. However, although anaphylaxis is a potentially life threatening condition, with the co-operation of parents and school it is possible for an affected child to continue to receive mainstream schooling. Health, safety, security, and contract management section 6

7 Sample Protocol This sample protocol is for guidance only. An individual protocol for each child must be developed based on the clinical judgement of the child s GP or consultant. 1. Background It is thought possible that John may suffer an anaphylactic reaction if he eats nuts or products containing nuts. If this occurs he is likely to need medical attention and, in an extreme situation, his condition may be life threatening. However, medical advice is that attention to his diet, in particular the exclusion of nuts, together with the availability of his emergency medication, are all that is necessary. In all other respects, it is recommended by his consultant that his education should carry on as normal. John also suffers from a mild asthmatic condition and may therefore need occasional access to his inhaler. The arrangements set out below are intended to assist John, his parents and the school in achieving the least possible disruption to his education, but also to make appropriate provision for his medical requirements. 2. Details The head teacher will arrange for the teachers and other staff in the school to be briefed about John s condition and about other arrangements contained in this document. The school staff will take all reasonable steps to ensure that John does not eat any food items unless they have been prepared/approved by his parents. John s parents will remind him regularly of the need to refuse any food items that might be offered to him by other pupils. In particular, John s parents will provide for him; A suitable mid-morning snack. A suitable packed lunch. Suitable sweets to be considered as treats, and to be kept by the class teacher. Health, safety, security, and contract management section 7

8 If there are any proposals which mean that John may leave the school site, prior discussions will be held between the school and John s parents in order to agree appropriate provision and safe handling of his medication. Whenever the planned curriculum involves cookery or experimentation with food items, prior discussions will be held between the school and parents to agree measures and suitable alternatives. The school will hold, under secure conditions, appropriate medication, clearly marked for use by designated school staff or qualified personnel and showing an expiry date. A bottle of Triludan medicine, an adrenaline inhaler and two EpiPens are to be held in the head-teacher s office. The parents accept responsibility for maintaining appropriate up-to-date medication. 3. Allergic reaction In the event of John showing physical symptoms for which there is no obvious alternative explanation, his condition will be reported to the headteacher/teacher in charge. Do not leave John alone. On receipt of such a report, the person in charge, if agreeing that his condition is cause for concern, will: Instruct a staff member to contact in direct order of priority: AMBULANCE - EMERGENCY SERVICES 999 G.P / LOCAL HEALTH CENTRE MESSAGES TO BE GIVEN - JOHN SMITH, ANAPHYLACTIC REACTON And then his parents in the following order: 1. Mother Father Grandparents Mrs Jones (neighbour) Whilst awaiting medical assistance the head-teacher and designated staff will assess John s condition and administer medication in line with perceived symptoms and following closely the instructions given by the paediatrician during the staff training session. Health, safety, security, and contract management section 8

9 The following procedure will be followed: 1. Bad tummy ache itchiness irritated distressed tickly throat vomiting John will be given a spoonful of Triludan medicine. 2. Wheeziness blotchiness skin becoming raised and red John will be assisted with his adrenaline inhaler - 2 or 3 puffs every few minutes. Up to a maximum of 15 puffs. 3. Pale drowsiness difficulty breathing blue lips unable to take puffs losing consciousness John will be given the EpiPen auto-injection into the outer side of the thigh, midway between knee and hip (through clothing if necessary). The administration of this medication is safe for John and even if it is given through a misdiagnosis it will do him no harm. 4. Check pulse in the neck if absent with no sign of spontaneous breathing start cardio pulmonary resuscitation (CPR). On the arrival of the qualified medical staff the teacher in charge will appraise them of the medication given to John. All medication will be handed to the medical person. Even if recovered John will go to the hospital for 24 hours observation. After the incident a debriefing session will take place with all members of staff involved. Parents will replace any used medication. 4. Transfer of medical skills Volunteers from the school staff have undertaken to administer the medication in the unlikely event of John having an allergic reaction. Seven members of the school staff attended a training session. Doctor T Fox, the community paediatrician, explained in detail John s condition, the symptoms of the anaphylactic reaction and the stages and procedures for the administration of medication. Health, safety, security, and contract management section 9

10 Further advice is available to the school staff at any point in the future where they feel the need for further assistance. The medical training will be repeated at the beginning of the next academic year. The Education Authority Belfast Region provides a staff indemnity for any school staff who agree to administer medication to a child in school given the full agreement of parents and school. 5. Staff indemnity The Education Authority Belfast Region and the Council for Catholic Maintained Schools indemnify their staff against claims for alleged negligence, providing they are acting within the scope of employment. For the purpose of indemnity, the administration of medicine falls within this definition and hence staff can be reassured about the protection their employer provides. 6. Agreement and conclusion The school and parents will hold a copy of these notes. A copy will be sent to the local health centre, Dr Fox, the GP, The Education Authority Belfast Region and the Catholic Council for Maintained Schools for information. Any necessary revisions will be the subject of further discussions between the school and parents. During each term any changes in routine will be noted and circulated. Agreed and signed On behalf of the school Head-teacher Date Chairman Board of Governors Date Health, safety, security, and contract management section 10

11 Parents of John Smith Date Date Health, safety, security, and contract management section 11

12 Useful addresses Anaphylaxis The Anaphylaxis Campaign PO Box 275 Farnborough GU14 6SX Tel: Helpline: Fax: School health North and West Belfast Belfast Health and Social Care Trust Cupar Street Clinic 91 Cupar Street Belfast BT13 2LJ Tel No Fax No South and East Belfast Health and Social Care Trust Knockbracken Healthcare Park Saintfield Road Belfast BT8 8BH Tel No or The Education Authority Belfast Region Mr B O Reilly, Health, safety, and security manager Tel No Fax No Health, safety, security, and contract management section 12