Guidelines for the Safe Management of Pupils with Severe Allergies ...

CLINICAL GUIDELINES
Guidelines for the Safe Management of Pupils with Severe
Allergies (including Anaphylaxis) in Education Settings in the
St Helens Borough
For use in:
St Helens Borough
Target Audience:
School Nursing Service staff across Halton and
St Helens and staff in education
establishments in St Helens
Purpose:
To provide a supportive and structured
approach to staff, to enable the safe
management of children and young people at
risk of anaphylaxis
Document Owner:
Julie Broughton
Approved by:
Clinical Guidelines Group or Equivalent
Ratified by:
Policy Sub-Committee (PSC)
Policy Indexed No:
HStHCL289
Version Number: 5.0
Effective From: March 2011
Review Date: March 2014
Statutory and legal requirements
Implementation Lead
Guidelines based on Managing Medicines in
School and Early Years Settings DFES/DH
(2005) Healthy Child Programme DFES
(2010)
Julie Broughton
The Trust is committed to creating an environment that promotes equality and embraces
diversity, both within our workforce and in service delivery. This document should be
implemented with due regard to this commitment
This document seeks to uphold the duties and principles contained within the Human Rights
Act. All Staff within the PCT should be aware of its implications
This policy is due for review by March 2014. After this date, this policy and associated process
documents may become invalid. All users should ensure that they are consulting the current
version of this document.

Key individuals involved in developing the document (Internal Staff Only)
Name(s)
Designation
Julie Broughton
Louise Gettings
Margaret Gorst
Team Co-ordinator School Nursing
School Nurse
School Nurse
Distributed to the following for approvals and comments
Committee(s)
Members of the Policy Sub Committee (PSC)
Members of the Clinical Policies Guidelines
Group (CPG)
Individual(s) (Include email address of external
individuals (NON NHS))
Designation
Lesley Brownlow
Roslyn Connolly
Dr Laweh Amegavie
Michele Harrop
Dot Keates
Susan Richardson –
Susan.Richardson@sthelens.gov.uk
Christine Williams
Christine.Williams@sthelens.gov.uk
Stuart Pennington –
Stuart.Pennington@sthelens.gov.uk
Stephen McDowell
Gill Clare
Debbie Fairclough
Catherine Clegg – www.hilldickinson.com
School Nurse Lead
Assistant Director Child and Family Health
Consultant Paediatritian (Respiratory Lead)
Whiston Hospital
Paediatric Respiratory Nurse Specialist
Whiston Hospital
Professional Development Lead
Director of Children and Young People’s
Service St Helens
Senior Assistant Director of Children and
Families
Risk Assessment Manager St Helens
Council
CPR/First Aid Training Manager
Senior Pharmacist ( Medicines Governance)
Assistant Chief Executive Halton and St
Helens PCT
Hill Dickinson LLP
Page 2 of 26

Revision History and Version Control
Revision
Date
Reason for Change Version No. By Who Version No.
October
2008
January
2009
First Issue 1.0 Julie
Broughton
Document review 2.0 Julie
Broughton
May 2009 Document review 3.0 Julie
Broughton
March 2010 Document review 4.0 Julie
Broughton
March 2011 Document review 5.0 Julie
Broughton
1.0
2.0
3.0
4.0
5.0
Page 3 of 26

Table of Contents
Introduction ..................................................................................................................................5
Purpose........................................................................................................................................5
Objectives .................................................................................................................................5
Outcomes..................................................................................................................................6
Scope...........................................................................................................................................6
Background..................................................................................................................................6
Duties and Responsibilities ..........................................................................................................7
Duties within the Organisation...................................................................................................7
Document Storage and Filing.....................................................................................................12
References.................................................................................................................................13
Appendix 1 .................................................................................................................................15
Anaphylaxis Management in Schools and Education Settings................................................15
Appendix 2 .................................................................................................................................16
School Health Care Plan For Allergic Reactions Including Anaphylaxis..................................16
Appendix 3 .................................................................................................................................21
Emergency Measures to be taken in the event of a Severe (Life Threatening) Allergic Reaction
(Anaphylaxis)...........................................................................................................................21
Appendix 4 .................................................................................................................................22
Post Anaphylaxis De-Brief Form .............................................................................................22
Appendix 5 .................................................................................................................................24
Equality Impact Assessment Tool ...........................................................................................24
Appendix 6 .................................................................................................................................25
Dissemination and Training Plan.............................................................................................25
Page 4 of 26

INTRODUCTION
The School Nursing Service, acknowledges that whilst at school, the safety and well being of
children and young people with severe allergies who are at risk of anaphylaxis, is a joint
responsibility shared between the PCT and the Local Authority. The services are committed to:
Providing, as far as practicable, a safe and healthy environment in which children at risk of
anaphylaxis can participate in all aspects of school life, both within the curriculum and extracurricular
activities and experiences.
Raising awareness about allergies and anaphylaxis with staff in a variety of educational
settings.
Actively involving the parents/guardians of each child at risk of anaphylaxis in developing
allergen avoidance and management strategies for their child.
Encouraging all staff members (irrelevant to ‘grade’ or position), to receive training from
appropriate health professionals, to enhance their knowledge of allergies, allergen avoidance,
anaphylaxis and emergency procedures.
Facilitating communication to ensure the safety and well being of children at risk of anaphylaxis.
Develop a pathway of integrated working between agencies to ensure the safe management of
anaphylaxis in schools and education settings. (Appendix 1)
PURPOSE
The purpose of this document is to provide a supportive and structured approach to education
staff, in order to initiate and maintain the safe management of children and young people with
severe allergies who are at risk of anaphylaxis.
Objectives
To highlight that anaphylaxis is potentially life-threatening, particularly if ill managed or
misunderstood.
To ensure staff are aware of their duty of care to children and young people in the event
of an emergency.
To ensure these guidelines are understood and supported by the School Nursing Service
and the Local Authority.
Page 5 of 26

Outcomes
Minimised risk of an anaphylactic reaction occurring while the child or young person is in
the care of education staff.
Staff members know how to respond to an anaphylactic reaction by initiating appropriate
treatment, including the correct administration of essential medication via an adrenaline
auto-injector device, as prescribed by a qualified Medical/Health Professional.
Raised awareness of anaphylaxis and its management through education and policy
implementation.
SCOPE
This document is intended to provide guidelines to safely manage children and young people
with severe allergies in St Helens schools. It can also be used in pre-school and further
education establishments.
A framework is included which clearly defines the roles and responsibilities of staff across both
health and education agencies (as well as parental and pupil responsibility) in order to ensure
effective partnership working.
The document also includes specific actions to follow in the event of an allergic reaction in
school.
BACKGROUND
Anaphylaxis is a severe, life threatening generalised or systemic hypersensitivity reaction. This
is characterised by rapidly developing life-threatening airway and /or breathing and/or circulation
problems usually associated with skin and mucosal changes (Resuscitation Council (UK) 2008).
Common triggers include food, stinging insects and medication. In young children triggers can
be eggs, cow’s milk, fruit, tree nuts, bee or wasp venom, and some medications. The most
common cause of anaphylaxis in school age children however, is peanuts. Research by Grundy
et al (2002) showed that 1 in 70 school age children have a peanut allergy. However the
Anaphylaxis Campaign (2007) suggests that it is more likely that 1 in 50 school age children
have a nut allergy, when including other nuts.
A reaction usually develops within minutes of exposure to the allergen, but with the presence of
a comprehensive individual anaphylaxis care plan for each child and regular evidence based
training, a reaction can be treated effectively by using an adrenaline auto- injector without delay
Page 6 of 26

and summoning emergency medical help as soon as possible. Young children may not be able
to verbalise or alert staff to the symptoms of anaphylaxis.
Treatment varies on an individual basis, therefore some children/young people are prescribed
oral antihistamines only, or a combination of oral antihistamine and adrenaline auto-injector.
Staff therefore, need to be able to recognise the differences in symptoms between mild,
moderate and severe and know how to act accordingly.
All staff responsible for children at risk of anaphylaxis should attend training on at least an
annual basis, provided by the School Nursing Service. The training includes preventative
measures to reduce the risk of anaphylactic reaction, recognition of the signs and symptoms of
anaphylaxis and emergency treatment. A demonstration in the use of an adrenaline autoinjector
device is also provided. Training should be updated as necessary on the basis of
additional or updated guidance and/or relevant information.
Staff and parents/guardians should be made aware that it is unrealistic to expect to achieve a
completely allergen free environment in any public settings including schools. However, staff
should recognise the need to be ‘allergen aware’ and to adopt a range of procedures and risk
minimisation strategies to reduce the chance of a child having an anaphylactic reaction,
including plans to minimise the presence of the allergen in a specific building.
As with any long-term condition, self-management is key to avoid, control, or treat symptoms as
and when they appear. Therefore it is important that once diagnosed with a life-threatening
allergy, children are made aware of and understand what their ‘triggers’ or allergens are and
how they can avoid them. As the child grows and becomes more independent, they should be
encouraged to carry their own adrenaline auto-injector at all times.
DUTIES AND RESPONSIBILITIES
Duties within the Organisation
Duties and accountabilities of directors, committees, specialist staff, and authors with
responsibility for procedural documents must be included within the document.
Chief Executive
The Chief Executive is responsible for ensuring compliance with the Policies and Guidelines,
legislation, NHS guidance and for ensuring the policy is effective.
Trust Board
The Trust board is responsible for overall responsibility for ensuring the provision of effective
clinical services within the organisation, and to ensure that the Trust complies with its statutory
obligations.
All organisations providing a service to children must work together to support every child to
achieve the five outcomes as set out in Every Child Matters (2003): 1) Be healthy, 2) Stay safe,
3) Enjoy and achieve, 4) Make a positive contribution and 5) Achieve economic wellbeing.
Page 7 of 26

Therefore both St Helens Local Authority and the local community NHS provider, together with
parents/carers, have a duty to ensure the safety of any child/young person, who is in their care
and has been identified as being diagnosed with a potentially life-threatening allergy.
Whilst there is no contractual duty on education staff to administer medication or supervise a
child taking it, they do have a common law duty of care to the child.
Duty of care
“Anyone caring for children including teachers, other school staff and daycare staff in charge of
children have a common law duty of care to act like any reasonably prudent parent. Staff need
to make sure that children are healthy and safe. In exceptional circumstances the duty of care
could extend to administering medicine and/or taking action in an emergency. This duty also
extends to staff leading activities taking place off site, such as visits, outings or field trips”.
(section 7 Managing Medicines in Schools and Early Years Settings 2005)
This document also highlights that although it is support staff who usually provide medical
assistance, prompt action needs to be taken by any member of staff to assist any child in an
emergency. Employers therefore should ensure that their insurance policies provide appropriate
cover.
Medicines act 1968
This stipulates that “anyone may administer a prescribed medicine, with consent, to a third
party, so long as it is in accordance with the prescriber’s instructions. This indicates that a
medicine may only be administered to the person for whom it has been prescribed, labelled and
supplied. No-one other than the prescriber can vary the dose and directions for administration.
The administration of prescription- only medicine by injection may be performed by any
individual but must be in accordance with directions made available by a doctor or
pharmaceutical prescriber for a named patient.
The Children Act 1989
Part III of this act confirms that local authority should ‘do what is reasonable’, ‘to safeguard and
promote the welfare of children within their area’, ‘by providing a range and level of services
appropriate to children’s needs’.
It is important that responsibility for the safety of a child or young person at risk of anaphylaxis is
clearly defined and that each person involved (directly or indirectly) with these children is aware
of what is expected of them. Thus, close co-operation between parents, schools and other
educational settings, health professionals and other agencies is important to provide a safe
environment for children at risk of anaphylaxis.
Page 8 of 26

Responsibilities of the School Nursing Service
When the Named School Nurse is notified of a child or young person with a severe
allergy, a referral should be made to a designated School Nurse who is responsible for
children’s asthma and allergies.
On receipt of a completed anaphylaxis care plan (Appendix 2) the Named School Nurse
reads and files the care plan in a child’s school health records.
Responsibilities of the School Nurse for Children’s Asthma and Allergy
Contact the parent/guardian to introduce a service and arrange a face-to-face visit to
complete individual anaphylaxis care plan for school.
An Anaphylaxis care plan to be completed and signed by the parent/guardian and health
professional; an explanation of anaphylaxis training provided to schools is to be given to
the parent/guardian, ensuring transparency and clarity of responsibilities.
Further information, advice and support regarding the child’s allergy should be offered
and provided to the family and school as necessary, with contact details of the School
Nurses responsible for children’s asthma and allergy.
Ensure the anaphylaxis care plan includes the name of the Designated School Contact
(whose name should be provided by the school).
Ensure signed copies of anaphylaxis care plan are provided to the parent/guardian,
school, Named School Nurse.
Contact the school to arrange allergy and anaphylaxis awareness training, which is
current and evidence based.
Provide an Anaphylaxis Flowchart (Appendix 3), which is to be kept updated in line with
current research. Request that the school nominates a person to photocopy the flowchart
and advise that one should be attached to each classroom door. (see section 4.3 bullet
point 5).
Provide updated training to the school on an annual basis or more frequently if
requested.
Ensure anaphylaxis care plans are updated annually, or more frequently, as appropriate.
Provide support to young people, parents/guardians regarding self-administration of an
adrenaline auto-injector. The parent/guardian, young person, as appropriate, will
determine when to carry their own adrenaline auto-injector at school.
Ensure each member of staff within the service adheres to the NMC (Nursing and
Midwifery Council) code of conduct at all times, including record keeping as per trust
policy and maintaining that all training and advice provided is in line with current research
and local, national and international guidelines concerning allergy and anaphylaxis.
Members of staff must be provided with training to deal appropriately with emergency
situations as necessary.
Page 9 of 26

Responsibilities of Education Services
Obtain consent from parents/guardians to share medical information with the School
Nursing Service by completing the appropriate referral form.
Once a child is identified with a diagnosis of a potentially life threatening allergy and a
care plan has been completed, it is the responsibility of each individual member of staff
to know which pupils have an anaphylaxis care plan in place and where the care plan
and emergency kit are situated.
Inform the Named School Nurse or the School Nurses with responsibility for children’s
asthma and allergies of details of any child or young person, they are aware of, with a life
threatening allergy whether an adrenaline auto-injector is prescribed or not. (This could
occur throughout the academic year).
Identify a member of staff to be a Designated School Contact. This person’s name will be
recorded on the anaphylaxis care plan and have the responsibility of ensuring the care
plan is kept with the emergency kit (this comprises of medication which has been
prescribed by a suitably qualified health professional, in the event of an allergic reaction).
They will also inform all staff as to where the care plan and emergency kit are situated.
Ensure a copy of the anaphylaxis care plan is readily available to all staff who may be in
contact with the child.
It is the responsibility of each school to request allergy/anaphylaxis training from the
School Nursing Service (annual training is recommended).
Ensure the Anaphylaxis Flowchart is easily visible; there should be one on every
classroom wall or door (preferably door).
ALL staff should be aware of how to recognise symptoms of anaphylaxis and how to
take emergency action. It is important therefore, that ALL staff are provided with training
and advice from an appropriate health professional.
Follow the child’s anaphylaxis care plan in the event of an allergic reaction, which may
progress to anaphylaxis.
In a situation where a child or young person has not been diagnosed with an allergy but who
appears to be having an anaphylactic reaction:
Call an ambulance immediately by dialling 999 or 112.
Commence first aid measures as per school policy.
Contact the parent/guardian.
Contact the person to be notified in the event of illness if the
parent/guardian cannot be contacted.
Ask all parents/guardians as part of the enrolment procedure, prior to their child’s
attendance at the school or other education setting, whether the child or young person
Page 10 of 26

Ensure that parents/guardians provide a prescribed anaphylaxis emergency kit which is
within the expiry date and clearly labelled with the child’s name and date of birth.
Ensure the emergency kit is stored in a location that is known to ALL staff, including
relief staff; easily accessible to adults (not locked away); inaccessible to children; and
away from direct sources of heat. Older children are encouraged to carry an adrenaline
auto-injector on their person. School staff should be aware of this and support the young
person. A second adrenaline auto-injector together with any other emergency medication
for the same individual should be kept by school, and stored as above.
Ensure that an adult, who has received anaphylaxis training, is present on
trips/excursions attended by a child or young adult at risk of anaphylaxis. This adult must
carry the emergency kit and be confident and competent to administer an adrenaline
auto-injector device if needed.
It is advised that each term a nominated person will check the expiry dates of all allergy
medication, including oral antihistamine, blue inhaler (if coexisting asthma is present) and
the adrenaline auto-injector/s and notify parent if out of date.
In the event of an anaphylactic reaction and the need to use the adrenaline auto-injector
the Post Anaphylaxis De-Brief Form, should be completed (Appendix 4) in conjunction
with a separate Incident Report Form, and sent to Risk Management.
If a child refuses to take medicine, staff should not force them to do so, but should note
this in the child’s records and follow agreed procedures. Procedures should be set out in
the policy or an individual child’s Care Plan. Parents should be informed of a refusal on
the same day. If a refusal results in an emergency, established emergency procedures
should be followed.
Responsibilities of Parents/Guardians of a child or young person at risk of anaphylaxis.
Inform education staff, either on enrolment or on diagnosis of the child’s allergies.
Provide staff with an anaphylaxis emergency kit which is within the expiry date and
clearly labelled with the child’s name and date of birth.
In conjunction with the School Nurse responsible for children’s asthma and allergies
complete an individual anaphylaxis care plan which incorporates parent/guardian’s
written consent to use the adrenaline auto-injector in line with this care plan.
Ensure child’s emergency medication is always replaced before the expiry date of the
adrenaline auto-injector (see section 4.3 bullet point 14).
Assist education staff by offering information and answering any questions regarding
their child’s allergies.
Notify the staff of any changes to their child’s allergy status to allow the School Nurse to
provide a new anaphylaxis care plan in accordance with these changes.
Communicate all relevant information and concerns to staff, for example, any matter
relating to the health of the child or young person.
Page 11 of 26

To ensure compliance with this policy no child or young person who has been prescribed
an adrenaline auto-injector should be permitted to attend school, nursery, or other
education establishments (including school trips), without their emergency kit, in
conjunction with suitably trained staff to deal with any emergency arising.
Responsibilities of Young Person carrying own adrenaline auto-injector, (if deemed
competent; to be decided on an individual basis)
To carry emergency medication safely and appropriately.
To immediately notify a member of staff at the onset of any symptoms.
Avoid eating anything with unknown ingredients.
Be proactive in the care and management of his/her food allergies and reactions (based
on age level)
All Halton & St Helens Staff
All Staff are responsible for adhering to and complying with the requirements of the policies,
guidelines, protocols and standard operating procedures (SOPs) contained within and
applicable to their area of operation.
Temporary and Agency Staff, Contractors and Subcontractors
All Staff are responsible for adhering to and complying with the requirements of the policies,
guidelines, protocols and standard operating procedures (SOPs) contained within and
applicable to their area of operation.
DOCUMENT STORAGE AND FILING
The approved and ratified corporate document will be uploaded to the document portal. Follow
the link below to view the policy document and its related pages:
http://sharepointcompliance/default.aspx
Page 12 of 26

REFERENCES
Reference
Allergy (2007) House of Lords Science and
Technology Committee. 6 th Report of Session
2006-2007. Volume 1: Report. London: The
Stationary Office Ltd
Anaphylaxis Campaign (2007) Medical
Conditions at School. A Policy Resource
Pack
Baral V.R and Hourihane J. O’B (2005) food
allergy in children. Postgrad Medical
Journal. 81: 693-701
Clarke A.T (2008) Food Allergy in Childhood.
British Journal of Primary Care Nursing.
Vol 2; (4) pg 19-21
Department of Education and Skills (2003)
Every Child Matters. DfES Publications,
London
Department of Health (2004) Choosing
Health: Making healthy choices easier. DH
Publications, London
Department for Education and Skills and
Department of Health (2005) Managing
Medicines in Schools and Early Years
Settings. DfES Publications, London
Grundy J. et al (2002) Rising prevalence of
allergy to peanuts in children: Data from 2
sequential cohorts. Journal of Allergy and
Clinical Immunology. 110 (5): 784-789
Hayman G., Bansal J., Bansal A (2003)
Knowledge about using auto-injectable
adrenaline: review of patient’s case notes
and interviews with general practitioners.
British Medical Journal. 327 (7427) : 1328
McLean-Tooke A.P.C., Bethune C.A., Fay
A.C., Spickett G.P (2003) Adrenaline in the
treatment of anaphylaxis: what is the
evidence? British Medical Journal. 327:
1332-1335
Pumphrey R.S.H (2003) Fatal posture in
anaphylactic shock. Journal of Allergy and
Relevance (whole
document or
section, please
state)
4.3
Background
Background
4
Appendix 1
Whole Document
Whole Document
Whole Document
Whole Document
Background
4
Background
Objective
Background
Appendix 3
Evidence Grade
Government Document
Third Sector
Organisation Publication
Medical Journal
Medical Journal
Government Document
Government Document
Government Document
Medical Journal
Medical Journal
Medical Journal
Medical Journal
Page 13 of 26

Clinical Immunology. 451-452
Resuscitation Council (UK) (2008)
Emergency treatment of anaphylactic
reactions. Guidelines for healthcare
professionals.
Royal College of Physicians (2003) Allergy:
the unmet need. A blueprint for better patient
care. London. The Stationary Office
Watura J.C (2002) Nut allergy in
schoolchildren: a survey of schools in the
Severn NHS Trust. Archives of Childhood
Diseases. 86: 240-4
Background
Appendix 3
Whole Document
Whole Document
Clinical Publication
Government Document
Medical Journal
Page 14 of 26

APPENDIX 1
Anaphylaxis Management in Schools and Education Settings
Child with allergy
registers at school
A Newchild
Child School New seek 1 consent
from parents to share
information
Consent
sought from
Parental consent obtained
School inform Named
School Nurse
Named School Nurse refers to
School Nurse responsible for
children’s asthma and allergies
Allergy
Referral
Form
Visit arranged by School Nurse
with parents, and Anaphylaxis
Care Plan devised for Child
Anaphylaxis Care Plan signed by
Designated School Contact and
Head Teacher - copied to:
Parents/School/School Nurse
Training provided by School Nurse for ALL staff to
attend, to ensure ALL staff are aware of allergy
management and are able to provide a safe
environment for pupils.
A. Newchild
Anaphylaxis Care Plan
Parent
A. Newchild
School
Anaphylaxis Care Plan
A. Newchild
School Health
Anaphylaxis Care Plan
A. Newchild
Anaphylaxis Care Plan
School Nurse responsible for children’s asthma and allergy to continue to provide yearly update
training for school, update the Anaphylaxis Care Plan yearly or sooner if required. Provide support,
advice and information to school and family in allergy management as required on an ongoing basis.
Page 15 of 26

APPENDIX 2
School Health Care Plan For Allergic Reactions Including
Anaphylaxis
Date
Name:
………………………….
…………………………………………………………………………..
Address: ......................................................................................................
D.O.B. ...................................... Tel. No. …………………………
School
………………………………………..
Allergy to:
1. ………………………………… 2. ………………………………….
3. ………………………………… 4. ………………………………….
Asthma
Yes/No
Emergency - Contact 999 or 112 (Numbers listed by priority)
1. ………………………………… 2. …………………………………..
3. ………………………………… 4 …………………………………..
Designated School Contact
…………………………………………..
School Health Practitioner
…………………………………………..
Page 16 of 26

Medication/contents of emergency kit include:
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
Does pupil carry his/her own medication? Yes/No
(If yes please indicate above which medication is carried by the pupil. A spare emergency kit
should also be held in a central area on the school premises with this care plan. ALL members
of staff should know where the emergency kit is held)
Parent’s description of previous symptoms:
………………………………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….
Key points
Anaphylaxis is a severe, life-threatening generalised or systemic hypersensitivity reaction. This
is characterised by rapidly developing life-threatening airway and/or breathing and/or circulation
problems usually associated with skin and mucosal changes (Resuscitation Council (UK) 2008)
Symptoms may appear within seconds or minutes after exposure to the allergen (what the
person is allergic to), therefore avoidance wherever possible is the primary objective.
Anaphylaxis requires urgent medical treatment without delay.
Page 17 of 26

EMERGENCY MEASURES TO BE TAKEN IN THE EVENT OF
SEVERE ALLERGIC REACTION (ANAPHYLAXIS)
Call for help from other member of staff ASAP to obtain the emergency kit
AN ADULT MUST STAY WITH THE CHILD AT ALL TIMES
Severe Allergic Reaction (Airway and/or Breathing and/or Circulation
problems)
Call 999, state the child is having Anaphylaxis (ana-fil-ak-sis)
GIVE Adrenaline Injector ………………………into the thigh as shown in your training. (No
need to remove light clothing)
The child with Airway and/or Breathing problems may prefer to sit up as this may ease
breathing.
If faint or collapsed (Circulation problems) lay the child flat, raise the legs, turn head to
the side in case of vomiting. DO NOT sit or stand them up Keep child in this position
until Paramedics arrive.
If the child becomes unconscious and is breathing normally, place them on their side
(recovery position)
If the child is not responding to the first Adrenaline Injector after 5 minutes, deteriorating
and ambulance has not arrived, GIVE second Adrenaline Injector (preferably in the
opposite thigh)
If the child stops breathing initiate Paediatric Resuscitation
Page 18 of 26

EMERGENCY MEASURES TO BE TAKEN IN THE EVENT OF
MILD TO MODERATE ALLERGIC REACTION
Call for help from other member of staff ASAP to obtain the emergency kit
AN ADULT MUST STAY WITH THE CHILD AT ALL TIMES
Mild to Moderate Allergic Reaction
Remove the allergen if visible. If it is food, get the child to spit the item out
Give Oral Antihistamine as prescribed on page 2 of care plan
Contact parents/carers to come and collect the child so he/she can be observed at home
If in doubt or symptoms worsening, follow severe management guidelines
Signatures of Agreement to the above School Health Care Plan
Page 19 of 26

This school health care plan has been completed by a School Nurse and parent/carer of (name
of child) _____________________________
Parental and Pupil Agreement
‣I agree that the medical information contained in this plan may be shared with individuals
involved with my child’s care and education (this includes emergency services). I understand
that I must notify the school of any changes in writing.
‣I agree that I/my child can be administered my/their medication by a member of staff in an
emergency.
‣I agree that the information I have provided is accurate and up to date.
Parent/Carer:
Signed…………………………………….
Print name…………………………………
Date…………………..
Pupil (if wish to sign):
Signed…………………………………….
Print name…………………………………
Date…………………..
Head Teacher Agreement
‣It is agreed that (name of child) __________________________________ will receive the
listed medication in an emergency by a member of staff who has received/attended up to date
anaphylaxis training by the School Nursing Service.
‣The school will notify School Nursing Service of any changes they are made aware of by the
parent.
Signed…………………………………….
Print name…………………………………
Date…………………..
Healthcare Professional Agreement
‣I agree that the information provided is accurate and up to date on completion of this school
health care plan.
Signed………………………………… Print name……………………………
Job Title………………………………………………….. Date…………………..
Protocol of Emergency Measures – Anaphylaxis Julie Broughton/Louise Gettings/AC Nov 2009
Page 20 of 26

APPENDIX 3
Emergency Measures to be taken in the event of a Severe (Life Threatening) Allergic
Reaction (Anaphylaxis)
Anaphylactic Reaction?
Airway, Breathing, Circulation
Diagnosis – look for:
Acute onset of illness
Life-threatening Airway and/or Breathing and/or Circulation problems 1
And usually skin changes
Call for help- 999, state child
having (ana-fil-ak-sis)
Lie child flat, head to side
Raise the child’s legs ²
Adrenaline Injector (if prescribed) ³
1. Life-threatening problems:
Airway: swelling, hoarseness.
Breathing: rapid breathing, wheeze, fatigue, confusion.
Circulation: pale, clammy, feeling faint (dizziness), drowsy/collapse.
2. Positioning of the child (DO NOT LEAVE THE CHILD ALONE)
The child should be placed in a comfortable position. The following factors should be
considered:
• The child with Airway and Breathing problems may prefer to sit up as this will make
breathing easier.
• Lying flat with or without leg elevation is helpful for patients with a low blood pressure
(Circulation problem). If the child feels faint, do not sit or stand them up - this can cause
cardiac arrest.
• The child who is unconscious and breathing normally should be placed on their side
3. Intramuscular Adrenaline
Administer the child’s prescribed Adrenaline Injector. This can be repeated after 5
minutes if no better and ambulance has not arrived (preferably in the opposite thigh).
If required commence with resuscitation
Adapted (with permission) for use in a school from the Resuscitation Council (UK)
Page 21 of 26

APPENDIX 4
Post Anaphylaxis De-Brief Form
(For use within the school setting)
The occurrence of Anaphylaxis can be distressing not only to the child and their family but also to staff
involved with the care of the child experiencing Anaphylaxis at school.
This form is designed to assist staff to reflect upon their actions taken during an episode of Anaphylaxis
at school. The aim of the de-brief is to identify any areas for improvement and to raise any training
issues or concerns that staff may have.
Q1 Age of child ……………………………………………………………………………………
Q2 Was there a definite ‘trigger’ to the reaction?...............................................................
Q3 If so what was the trigger…………………………………………………………………… .
Q4 Does the child have an Adrenaline Injector?
………………………………………………………………………………………………………….
Q5 Was the Adrenaline Injector used ?…………………………………………………………….
Q6 Was an ambulance called? …………………………………………………………………..
Page 22 of 26

Q7 Did the child go to hospital?...........................................................................................
a If yes did a member of staff accompany the child to hospital? …………………………..
Q8 Was the child’s medication easy to locate in school? …………………………………………..
Q9 Overall do staff feel that the incident was managed well?..............................................
Q10 What could have made the incident more manageable?………………………………..
…………………………………………………………………………………………………………………………………
………………………………………………………………………………………
Q11 Do staff feel more training is required in the management of Anaphylaxis?................
Q12 Are there any factors that staff can highlight following this incident?............................
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
……………………………………………
Following completion of this form, should any training issues be raised please contact the Children’s
Community Asthma and Anaphylaxis Service to further discuss your needs.
Page 23 of 26

APPENDIX 5
Equality Impact Assessment Tool
To be completed and attached to any corporate document when submitted to the appropriate
committee for consideration and approval.
1. Does the policy/guidance affect one group less or
more favourably than another on the basis of:
Yes/No
Race No
Ethnic origins (including gypsies and travellers) No
Nationality No
Gender No
Culture No
Religion or belief No
Sexual orientation including lesbian, gay and
bisexual people
No
Comments
Age Yes Aimed at children and
young people
Disability - learning disabilities, physical disability,
sensory impairment and mental health problems
2. Is there any evidence that some groups are affected
differently?
3. If you have identified potential discrimination, are
there any exceptions valid, legal and/or justifiable?
4. Is the impact of the policy/guidance likely to be
negative?
No
Yes
N/A
5. If so can the impact be avoided? N/A
6. What alternative are there to achieving the
policy/guidance without the impact?
7. Can we reduce the impact by taking different
action?
No
N/A
N/A
As above
Page 24 of 26

APPENDIX 6
Dissemination and Training Plan
To be completed with the corporate document when submitted to the appropriate committee for
consideration, approval and ratification. The status column must be given a Red, Amber or
Green rating with evidence to demonstrate an action has been completed.
DISSEMINATION PLAN
Title of document:
Guidelines for the safe management of
pupils with severe allergies (including
anaphylaxis) in education settings in the
St Helens Borough
Dissemination Lead: (Print name and
contact details)
Julie Broughton
Proposed action to retrieve out-of-date
copies of the document:
Date finalised: 17 th March 2011
Previous document already being used? No
If yes, in what format and where? Electronic/Intranet
Withdraw from the internet/intranet/portal
To be disseminated to:
School Nursing Service St Helens
?Halton
St Helens LSCB
Disseminated
by whom?
Timescale
(Date)
Status
R A G
Paper
or
Electronic
Comments
Trust Times
Team Brief
Training sessions (Give Details Below)
Other (Give Details Below)
Red
IMPLEMENTATION PLAN
Training Timescale Owner Status
R A G
Training Event (Please provide details of available training venues/dates
to educate staff about this document)
Training Plan Lead (Please provide details of staff who will be
responsible for overseeing this training)
Compliance Monitoring Timescale Owner Status
R A G
Methodology to be used for monitoring/audit (please include PCT
Audit Proposal Form)
Responsibilities for conducting monitoring/audit
Frequency of monitoring/audit (e.g. annually, 6 monthly etc)
Process for reviewing/reporting results
Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided.
Page 25 of 26

Denotes: Action partially implemented.
Denotes: Action complete.
Page 26 of 26