In recent years there has been an increase in the number of children ...

In recent years there has been an increase in the number of children ...

Health, safety, security and contract management sectionAnaphylaxis inSchools-A Guide For TeachersBelfast Education and Library Board40 Academy Street Belfast BT1 2NQ

Anaphylaxis – A guide for teachersIntroductionIn recent years there has been an increase in the number of children whoare sensitised to foods such as peanuts, dairy products or seafood.Inadvertent ingestion, or in extreme cases exposure by handling, cancause a severe allergic reaction. Many schools have at least one child withone of the most common food triggers, peanuts. These are mostly normalhealthy 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 reactionrequiring immediate medical attention. It is caused by a confusedimmune system that mistakes a benign protein for a dangerous one. Theallergen triggers cells that release histamine. The whole body is affected,usually within minutes of exposure to the allergen but sometimes afterhours.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 painand vomiting. This may be followed by oral oedema and swelling of theface, generalised rash, hypotension, difficulty in breathing andanaphylaxis.ReactionsMild reactions are treated with oral antihistamine. Typical symptomsinclude itching and urticaria. The child should be observed and theirparents contacted.Moderate or severe reactions will need either inhaled or injectedadrenaline depending on the child’s protocol. A paramedic ambulanceHealth, safety, security, and contract management section 1

Anaphylaxis – A guide for teachersshould be called, these carry the equipment necessary to deal with asevere reaction, and it should be stated at the time that the child issuffering from anaphylaxis. The child must go to hospital for observation,even if recovered, in case of relapse.MedicationAll children at risk of anaphylaxis will be prescribed medication for use inthe event of an allergic reaction. These may include antihistamines, anadrenaline inhaler or an adrenaline injector. The adrenaline injectionthat is most commonly supplied is the EpiPen. These devices arepreloaded with a single pre-measured dose. It is the responsibility of thechild’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 theparents should be asked to replace it.Storage of medicationMedication should be stored under secure conditions, clearly marked foruse and easily accessible by designated school staff or qualified personneland showing an expiry date. The EpiPen should be kept at roomtemperature. If exposed to extreme heat or sunlight the adrenaline turnsbrown. Looking through the viewing window can check this. It isrecommended that two EpiPens are kept in school, both because of thepotential need for a second dose and in case there is a problem such asfaulty technique or damage to equipment.Administration of adrenaline injectionAs soon as a severe reaction is suspected an adrenaline injection must begiven. Do not wait to be sure. The administration of this medication issafe. It will not harm the child. A paramedic ambulance must be calledand it should be stated that the child is suffering from anaphylactic shock.The EpiPen is a disposable pen with a concealed needle that delivers asingle 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, (thereshould be a click). Hold in place for 10 seconds. Remove the EpiPen and massage the area. The time of administration should be noted, as the paramedics willneed this information.Health, safety, security, and contract management section 2

Anaphylaxis – A guide for teachersPrevention of a reactionWith thoughtful prevention the chances of a child suffering a severereaction requiring the administration of an injection are very small.Consideration should be given to banning peanuts and peanut butter fromthe school by explaining the situation to other parents by letter and askingfor their co-operation.School meals/snacksBeing a high-energy source of protein, peanuts are the basis of manychildren’s snacks and a common ingredient in a wide range of foods. Theycan be hidden in breakfast cereals, spaghetti sauces, oriental dishes,pastries, sweets, ice creams, puddings and garnishes. It is therefore vitalthat there should be prior consultation with regard to the provision ofmeals/snacks when a child with a peanut allergy enrols in the school.It is very important to bring to the attention of the school mealsdepartment any specific diets that your pupils require. You shouldprovide a copy of the diet sheet along with the name and telephonenumber of the pupil to the relevant area manager within the school mealsdepartment. If the pupil is in the free meals register the board has a legalobligation to provide a meal and will do so, working in close liaison withthe pupil’s parent or guardian and school.Where the board has no legal obligation it would be preferable if theparent/guardian provided the child with a packed lunch and also suitablesweets/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 theingredients.Outdoor activities/school tripsArrangements should be discussed in advance with the parents. Anemergency kit should be carried at all times and a trained member of staffshould accompany the group on school trips. Potential problems incontacting emergency services must be addressed by the school prior toundertaking any trips or outdoor activities.School activitiesThere are also hidden dangers in everyday school activities for childrenaffected by allergens. For example:Health, safety, security, and contract management section 4

Anaphylaxis – A guide for teachers Cookery and science experiments with food may present difficulties fora child at risk of anaphylaxis. Art works often include nuts and nutshells in collage work, especiallyin Nursery schools. The food provided for pets that are kept in the classroom may be of anut or other allergen variety. There is the possibility that children may come into contact with wildbird feeders if they are located in the playground for example.ConclusionAs with any other medical condition privacy and the need for prompt andeffective care need to be balanced with sensitivity. Supervision andobservation should be discreet. However, although anaphylaxis is apotentially life threatening condition, with the co-operation of parents andschool it is possible for an affected child to continue to receive mainstreamschooling.Health, safety, security, and contract management section 5

Anaphylaxis – A guide for teachersIf 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 inorder to agree appropriate provision and safe handling of his medication.Whenever the planned curriculum involves cookery or experimentationwith food items, prior discussions will be held between the school andparents 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 personneland showing an expiry date.A bottle of Triludan medicine, an adrenaline inhaler and two EpiPens areto be held in the head-teacher’s office. The parents accept responsibilityfor maintaining appropriate up-to-date medication.3. Allergic reactionIn the event of John showing physical symptoms for which there is noobvious alternative explanation, his condition will be reported to the headteacher/teacherin charge. Do not leave John alone.On receipt of such a report, the person in charge, if agreeing that hiscondition is cause for concern, will:Instruct a staff member to contact in direct order of priority: AMBULANCE - EMERGENCY SERVICES 999 G.P - 4447 5894 / 447 689 LOCAL HEALTH CENTRE - 447 889 MESSAGES TO BE GIVEN - JOHN SMITH, ANAPHYLACTIC REACTONAnd then his parents in the following order:1. Mother - 447 6652. Father - 343 6753. Grandparents - 656 7874. Mrs Jones (neighbour) - 447 434Whilst awaiting medical assistance the head-teacher and designated staffwill assess John’s condition and administer medication in line withperceived symptoms and following closely the instructions given by thepaediatrician during the staff training session.Health, safety, security, and contract management section 7

Anaphylaxis – A guide for teachersThe following procedure will be followed:1. Bad tummy ache…itchiness…irritated…distressed…ticklythroat…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 puffsevery few minutes…. Up to a maximum of 15 puffs.3. Pale…drowsiness…difficulty breathing…blue lips…unable to takepuffs…losing consciousness…John will be given the EpiPen auto-injection into the outer side ofthe thigh, midway between knee and hip (through clothing ifnecessary).The administration of this medication is safe for John and even if it isgiven through a misdiagnosis it will do him no harm.4. Check pulse in the neck – if absent with no sign of spontaneousbreathing start cardio pulmonary resuscitation (CPR).On the arrival of the qualified medical staff the teacher in charge willappraise them of the medication given to John. All medication will behanded 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 ofstaff involved.Parents will replace any used medication.4. Transfer of medical skillsVolunteers from the school staff have undertaken to administer themedication in the unlikely event of John having an allergic reaction.Seven members of the school staff attended a training session. Doctor TFox, the community paediatrician, explained in detail John’s condition,the symptoms of the anaphylactic reaction and the stages and proceduresfor the administration of medication.Health, safety, security, and contract management section 8

Anaphylaxis – A guide for teachersFurther advice is available to the school staff at any point in the futurewhere they feel the need for further assistance. The medical training willbe repeated at the beginning of the next academic year.The Belfast Education and Library Board provides a staff indemnity forany school staff who agree to administer medication to a child in schoolgiven the full agreement of parents and school.5. Staff indemnityThe Belfast Education and Library Board and the Council for CatholicMaintained Schools indemnify their staff against claims for allegednegligence, providing they are acting within the scope of employment. Forthe purpose of indemnity, the administration of medicine falls within thisdefinition and hence staff can be reassured about the protection theiremployer provides.6. Agreement and conclusionThe school and parents will hold a copy of these notes. A copy will be sentto the local health centre, Dr Fox, the GP, Belfast Education and LibraryBoard and the Catholic Council for Maintained Schools for information.Any necessary revisions will be the subject of further discussions betweenthe school and parents.During each term any changes in routine will be noted and circulated.Agreed and signedOn behalf of the school_____________________Head-teacher_______________Date_____________________ChairmanBoard of Governors________________DateHealth, safety, security, and contract management section 9

Anaphylaxis – A guide for teachersParents of John Smith________________________________________Date________________________________________DateHealth, safety, security, and contract management section 10

Anaphylaxis – A guide for teachersUseful addressesAnaphylaxisThe Anaphylaxis CampaignPO Box 275FarnboroughGU14 6SXTel: 01252 546100Helpline: 01252 542029Fax: 01252 377140E-mail: healthNorth and West BelfastBelfast Health and Social Care TrustCupar Street Clinic91 Cupar StreetBelfastBT13 2LJTel No 028 9032 7613 Fax No 028 9024 0362South and EastBelfast Health and Social Care TrustKnockbracken Healthcare ParkSaintfield RoadBelfastBT8 8BHTel No 028 9056 5900 or 028 9056 5916Belfast Education and Library BoardMr B O’Reilly, Health, safety, and security managerTel No 028 9056 4162 Fax No 028 9056 4374Health, safety, security, and contract management section 11

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