Anaphylaxis

10. Adrenaline autoinjectors for general use

Clause 10 of Ministerial Order 706 (PDF) provides that a school’s anaphylaxis management policy must prescribe the purchase of adrenaline autoinjectors for general use.

Purchasing adrenaline autoinjectors

The principal of the school is responsible for arranging the purchase of additional adrenaline autoinjector(s) for general use, as a back-up to adrenaline autoinjectors supplied by parents of students who have been diagnosed as being at risk of anaphylaxis. The additional adrenaline autoinjector(s) for general use can also be used on other students previously undiagnosed for anaphylaxis, where they have a first time reaction.

Adrenaline autoinjectors for general use are available for purchase at any chemist. No prescription is necessary. These devices are to be purchased by a school at its own expense, in the same way that supplies for school first aid kits are purchased.

The principal will need to determine the type of adrenaline autoinjector to purchase for general use. In doing so, it is important to note the following:

• there are currently 2 adrenaline autoinjector devices available in Australia, these are the EpiPen and the Anapen
• the different doses of each device include:
  • EpiPen (300 microgram) is prescribed for adults and children over 20 kg (aged around 5 years or over)
  • EpiPen Jr (150 microgram) is prescribed for children 7.5 to 20 kg (aged around 1 to 5 years)
  • Anapen 500 (500 microgram) is prescribed for adults and children over 50 kg (aged around 12 or over)
  • Anapen 300 (300 microgram) is prescribed for adults and children over 20 kg (aged around 5 years or over)
  • Anapen Jr.) (150 microgram) is prescribed for children 7.5 to 20 kg (aged around 1 to 5 years).

Number of back up adrenaline autoinjectors to purchase

The principal will also need to determine the number of additional adrenaline autoinjector(s) required to be purchased by the school. In doing so, the principal should take into account the following relevant considerations:

• the number of students enrolled at the school who have been diagnosed as being at risk of anaphylaxis
• the weight of the students at risk of anaphylaxis to determine the correct dosage of adrenaline autoinjector/s to purchase
• the accessibility of adrenaline autoinjectors that have been provided by parents of students who have been diagnosed as being at risk of anaphylaxis
• the availability and sufficient supply of adrenaline autoinjectors for general use in specified locations at the school including in the school yard, and at excursions, camps and special events conducted, organised or attended by the school
• the adrenaline autoinjectors for general use have a limited life, and will usually expire within 12 to 18 months, and will need to be replaced at the school’s expense either at the time of use or expiry, whichever is first
• the expiry date of adrenaline autoinjectors should be checked regularly to ensure they are ready for use.

Note: Even when a school has no students enrolled with a diagnosed risk of anaphylaxis, the principal should consider purchasing an autoinjector for general use as some students may experience their first anaphylactic reaction while at school.

When to use adrenaline autoinjectors for general use

It is recommended that adrenaline autoinjectors for general use be used when:

• a student's prescribed adrenaline autoinjector does not work, is misplaced, out of date or has already been used or
• a student is having a suspected first time anaphylactic reaction and does not have a medical diagnosis for anaphylaxis or
• when instructed by a medical officer after calling 000.

Schools can use either the EpiPen and Anapen on any student suspected to be experiencing an anaphylactic reaction, regardless of the device prescribed in their Australasian Society of Clinical Immunology and Allergy (ASCIA ) Action Plan.

Where possible, schools should use the correct dose of adrenaline autoinjector depending on the weight of the student. However, in an emergency if there is no other option available, any device should be administered to the student.

ASCIA advises that no serious harm is likely to occur from mistakenly administering adrenaline to an individual who is not experiencing anaphylaxis.

Further information is available from ASCIA at adrenaline (epinephrine) autoinjectors for general use and frequently asked questions.

Storage of adrenaline autoinjectors

The ASCIA recommends adrenaline autoinjector devices be stored in a cool dark place at room temperature, which they define as 15 and 25 degrees Celsius. If these temperatures cannot be maintained, ASCIA recommends storing the device in an insulated wallet. For more information visit the ASCIA website.

The school principal is responsible for determining the storage location of all student owned adrenaline autoinjector and the school adrenaline autoinjectors for general within the school environment after undertaking a risk assessment. School anaphylaxis supervisors are responsible for informing school staff of the location for use in the event of an emergency.