Epinephrine Auto-Injector for Anaphylaxis School Training This presentation meets training criteria for school staff. Upon completion on the Western Region Public Health Training Center site, you will receive a certificate.
This presentation has been developed by the following collaborators to assist in teaching school staff about anaphylaxis and auto-injector epinephrine. Natalia Billias Health Service Administration MPH Candidate, University of Arizona Mel & Enid Zuckerman College of Public Health Senior Research Specialist, University of Arizona Asthma & Airway Disease Research Center Dr. Heather Cassell Clinical Associate Professor, University of Arizona College of Medicine Pediatric Allergy & Immunology, Banner University Medical Center Principal Investigator, University of Arizona Asthma & Airway Disease Research Center Dr. Lynn Gerald Professor, University of Arizona Mel & Enid Zuckerman College of Public Health Canyon Ranch Endowed Chair Director, Clinical Research, University of Arizona Asthma and Airway Disease Research Center Presentation is in collaboration with the following organizations:
Course Summary Increasing preparedness and confidence of school personnel to take proper action with their stock epinephrine when an event of anaphylaxis occurs. Introduction Learning Objectives – Recognizing Anaphylaxis – Identifying Symptoms – Administering Epinephrine – School Action Steps: • Following an Event • Year Round for Annual Training & Maintenance of Stock Epinephrine
Policy Review • Arizona Revised Statute § 15-341, A, 35 (a) – Permits pupils who have been diagnosed with anaphylaxis by a licensed health care provider to carry and self-administer emergency medications, including auto-injectable epinephrine, while at school and at school-sponsored activities. • Arizona Revised Statute § 15-157 Arizona Administrative Code R7-2-809 – Directs public school districts and charter schools to stock epinephrine by auto-injectors • 2 pediatric doses and 2 adult doses • Based on funding provided by the legislature – In addition to school nurses or athletic trainers, at each school there should be at least 2 other personnel trained in giving auto-injector epinephrine to children or adults who are showing symptoms of anaphylaxis. • Please note that authorized personnel are immune from civil liability with respect to all decisions made and actions taken that are based on good faith implementation of the requirements of ARS § 15-157, except in cases of wanton or willful neglect. R7-2-809, 2018.
Agenda Lesson 1: Anaphylaxis Basics Lesson 2: Recognizing Anaphylaxis Lesson 3: Administering Epinephrine Lesson 4: School Action Steps
• Definition ANAPHYLAXIS • Causes BASICS • Significance • Prevention & Treatment
What is Anaphylaxis? Anaphylaxis is a severe, life-threatening allergic reaction that is rapid in onset and requires immediate response and medical attention. Symptoms may include: The most dangerous symptoms of anaphylaxis include breathing difficulties and a drop in blood pressure or shock that are potentially fatal. Anaphylaxis & Treating Severe Allergic Reactions, 2018.
What causes Anaphylaxis? Anaphylaxis & Treating Severe Allergic Reactions, 2018.
Why this is important? Millions are constantly at risk Anaphylaxis can happen anywhere Only epinephrine can stop it FARE, 2018.
Food allergy is the most common cause of anaphylaxis Food Allergy Facts (FARE’s Facts and Statistics, 2018) U.S. Statistics (FARE’s Facts and Statistics, 2018) • Even ingesting a tiny amount of the food • 15 million Americans diagnosed with a known allergen may cause anaphylaxis food allergy, including 5.9 million children under 18 years old • Anaphylaxis may occur immediately after, or even up to 4 hours after ingestion • About 1 in 13 children have a food allergy, that is roughly about two in every classroom. • Teenagers and young adults with allergies are at the highest risk of fatal food- induced anaphylaxis • Not treating anaphylaxis promptly with epinephrine increases the risk of a fatal reaction.
Why this is important? U.S. Statistics on Anaphylaxis • Every three minutes, a food allergy reaction sends someone to the emergency room (FARE’s Facts and Statistics, 2018) • More than 15 % of school-aged children with food allergies have had a reaction in school (FARE’s Facts and Statistics, 2018) • Approximately 20-25 % of epinephrine administrations are in schools (Neighbors, 2018) • Peanut caused about 45 % of food-induced anaphylaxis admissions to PICUs, followed by tree nuts and seeds (19 %) and milk (10 %) (Ramsey et al., 2018) • Anaphylaxis is serious , but may be prevented and treated!
Other foods can also cause Common Food anaphylaxis. Please refer to the individual’s food allergy action Allergens plan for complete information. Anaphylaxis & Treating Severe Allergic Reactions, 2018.
Prevention & Treatment Prevention Treatment • • Epinephrine Auto-Injector Avoidance of known allergen, however, when an accidental – By making sure you are have exposure occurs, you will be all of the information you able to properly treat need and practicing with the training device, you will be anaphylaxis after completing well-prepared to use the this training. auto-injector when – This training is available to you, anaphylaxis occurs. because knowing that you are prepared for an emergency will give you peace of mind.
Treatment continued… Available Epinephrine Auto-Injectors Side effects: Doses: o Tremor o Adult (0.3 mg) for o Increase heart rate o Junior (0.15 mg) for o Headache adults and children o Paleness children weighing 33 o Nausea weighing 66 lbs or o Perspiration to 66 lbs more *Please note that other foods can also cause anaphylaxis. Please refer to the individual’s food allergy action plan for complete information Anaphylaxis & Treating Severe Allergic Reactions, 2018.
New Auto-Injector available for 2019 from Teva Generics
This additional section is available at no cost on the Western Region Public Health Training Center website: https://moodle.publichealth.arizona.edu/. After creating an account, type in the course title Epinephrine Auto-Injector for Anaphylaxis School Training on the search bar to directly access this course.
• What to do if someone is having an anaphylactic reaction? • Epinephrine Auto-Injector Instructions Administering • Epinephrine Auto-Injector Epinephrine Demonstration Videos • How to hold a child for administration This additional section is available at no cost on the Western Region Public Health Training Center website: https://moodle.publichealth.arizona.edu/. After creating an account, type in the course title Epinephrine Auto-Injector for Anaphylaxis School
School Supply Standing orders include directive and serve as a prescription. Use up-to-date standing orders Click here to obtain the template for Standing Orders for Auto-Injectable Epinephrine in a School Setting Purchase from pharmacy or pharmaceutical company. Prescription for epinephrine will need to be renewed annually or when signature changes. Send pharmacy copy of newly signed order, or physician can call in a verbal renewal order. Karen Kasmauski for The New York Times [Photograph]. Retrieved from https://nyti.ms/2Gany3A
Maintenance Storage • Stored in a secure, unlocked, easily accessible location at school district and charter schools. • A list of the people authorized to administer auto-injectable epinephrine stored next to the school’s supply auto-injectable epinephrine. – The list should also be maintained in the school’s administrative offices and made available upon request. • Store at room temperature between temperatures of 68°-77° F. (with an acceptable range of 59°-86° F). – Do not refrigerate auto-injectable epinephrine. – Keep epinephrine auto-injectors protected from excessive heat or cold. – The auto-injectors should be covered and protected from light. AAAAI, FARE, & Neighbors, 2018
Maintenance continued.. Storage • Each school should document monthly that they have checked to ensure the following: – auto-injector epinephrine is being properly stored, – epinephrine solution is clear, – no particles in the solution, and – expiration date has not been passed. Please note that the auto-injector should be replaced: • Before its expiration date • If the solution is discolored or if it contains a precipitate Disposal • Give the used auto-injectors to emergency response personnel with the time and date that they were used and the patient’s name written on the injector. • Do not discard auto-injectors into regular trash. Contact local waste management on proper disposal instructions.
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