Anaphylaxis

9. School planning and emergency response

A school’s anaphylaxis management policy must include emergency response procedures for students at risk of anaphylaxis.

What should schools do to plan for an anaphylaxis emergency?

A school’s anaphylaxis management policy must include details of how the policy integrates with the school’s general first aid and emergency response procedures.

The school’s anaphylaxis management policy must include emergency response procedures relating to anaphylactic reactions including:

• a complete and up to date list of students identified as being at risk of anaphylaxis
• details of individual anaphylaxis management plans and ASCIA Action Plans for Anaphylaxis and where these are located within the school and during school excursions, school camps and special events conducted, organised or attended by the school
• an outline of the storage and accessibility of adrenaline autoinjectors, including those for general use
• how appropriate communication with school staff, students and parents is to occur in accordance with a communication plan that complies with Ministerial Order 706 (PDF) (refer to Chapter 11).

The school’s anaphylaxis management policy must state that when a student at of a risk of an anaphylactic reaction is under the care or supervision of the school outside normal class activities, including in the school yard, at camps and excursions, or at special events conducted, organised or attended by the school, the principal must ensure that there are a sufficient number of school staff present who have been trained in accordance with the Ministerial Order (refer to Chapter 5).

The school’s anaphylaxis management policy must state that in the event of an anaphylactic reaction, the student’s ASCIA Action Plan for Anaphylaxis, the emergency response procedures for anaphylaxis and general first aid procedures must all be followed.

Role and responsibilities of principals

School principals have overall responsibility for implementing strategies and processes for ensuring a safe and supportive environment for students at risk of anaphylaxis. To assist principals in meeting their responsibilities and discharging their duty of care to students, a summary of some of the key obligations under the Order and suggested risk minimisation strategies are set out below. This is a guide only, and is not intended to be an exhaustive list:

1. Ensure that the school develops, implements and routinely reviews its school anaphylaxis management policy in accordance with the Order and these Guidelines.
2. Actively seek information to identify students with severe life-threatening allergies or those who have been diagnosed as being at risk of anaphylaxis, either at enrolment or at the time of diagnosis (whichever is earlier).
3. Ensure that parents provide an ASCIA Action Plan for Anaphylaxis which has been completed and signed by the student's medical practitioner and contains an up-to-date photograph of the student.
4. Ensure that an individual anaphylaxis management plan is developed in consultation with the student’s parents for any student that has been diagnosed by a medical practitioner with a medical condition relating to allergy and the potential for an anaphylactic reaction, where the school has been notified of that diagnosis.
   This includes ensuring the documentation of practical strategies for activities in both in-school and out-of-school settings to minimise the risk of exposure to allergens, and the nomination of staff who are responsible for implementing those strategies. The risk minimisation plan should be customised to each particular student for participation in normal school activities (for example, during cooking and art classes) and at external events (for example, swimming sports, camps, excursions and interstate/overseas trips). Ensure students’ individual anaphylaxis management plans are appropriately communicated to all relevant staff.
5. Ensure that the canteen provider and all of its employees can demonstrate satisfactory training in the area of food allergy and anaphylaxis and its implications for food-handling practices. This includes careful label reading, and an understanding of the major food allergens that trigger anaphylaxis and cross-contamination issues specific to food allergies. School staff involved in food preparation can complete All about Allergens training for food service to gain knowledge about food allergens and develop best practice procedures to ensure safe food provision to students and staff with a food allergy. Further information on food service management is available at the All about Allergens resource hub.
6. Ensure that parents provide the school with an adrenaline autoinjector for their child that is not out-of-date and a replacement adrenaline autoinjector when requested to do so.
7. Ensure that an appropriate communication plan is developed to provide information to all school staff, students and parents about anaphylaxis and the school's anaphylaxis management policy.

8. Ensure there are procedures in place for providing information to school volunteers and casual relief staff about:

   • students who are at risk of anaphylaxis, and
   • their role in responding to an anaphylactic reaction of a student in their care.

   Casual relief staff regularly employed at the school should be encouraged to undertake the ASCIA anaphylaxis e-training for Victorian schools.

9. Ensure that relevant school staff have successfully completed an approved anaphylaxis management training course in the prior 3 years (for face-to-face training in 22300VIC or 10313NAT), or 2 years (for the ASCIA e-training).
10. Ensure that school staff who are appointed as school anaphylaxis supervisor(s) are appropriately trained in the Course in Verifying the Correct Use of Adrenaline Autoinjector Devices 22303VIC (every 3 years).
11. Ensure that all school staff are briefed at least twice a year by the school anaphylaxis supervisor (or other appropriately trained member of the school staff). Information to be covered should include:
    • the school's anaphylaxis management policy
    • the causes, symptoms and treatment of anaphylaxis
    • the identities of students diagnosed as being at risk of anaphylaxis and the location of their medication
    • how to use an adrenaline autoinjector, including hands-on practice with an adrenaline autoinjector trainer device (which does not contain adrenaline)
    • the school's general first aid and emergency procedures
    • the location of adrenaline autoinjector devices prescribed for individual students that have been purchased by their family
    • the location of adrenaline autoinjector devices that have been purchased by the school for general use
12. Allocate time, such as during staff meetings, to discuss, practise and review the school's anaphylaxis management policy. Practise using the adrenaline autoinjector trainer devices as a group and undertake drills to test the effectiveness of the school’s general first aid procedures.
13. Encourage regular and ongoing communication between parents and school staff about the current status of the student's allergies, the school's policies and their implementation.
14. Ensure that the student's individual anaphylaxis management plan is reviewed in consultation with parents annually at the beginning of each school year, when the student's medical condition changes, as soon as practicable after a student has an anaphylactic reaction at school, and whenever a student is to participate in an off-site activity such as camps or excursions or at special events conducted, organised or attended by the school.
15. Ensure the risk management checklist for anaphylaxis is completed and reviewed annually.
16. Arrange to purchase and maintain an appropriate number of adrenaline autoinjectors for general use to be part of the school's first aid kit, stored with a copy of the general ASCIA Action Plan for Anaphylaxis (orange).

Role and responsibilities of school staff

All school staff have a duty of care to take reasonable steps to avoid reasonably foreseeable risks of injury to students. This includes administrators, canteen staff, casual relief staff, specialist staff, sessional teachers and volunteers.

To assist school staff who conduct classes attended by students at risk of anaphylaxis, and other school staff where relevant, a summary of some of the key obligations under the Order and suggested risk minimisation strategies are set out below. This is a guide only, and is not intended to be an exhaustive list to be relied upon by school staff when seeking to discharge their duty of care:

1. Know and understand the school’s anaphylaxis management policy.
2. Know the identity of students who are at risk of anaphylaxis. Know the students by face and, if possible, know what their specific allergy is.
3. Understand the causes, symptoms, and treatment of anaphylaxis.
4. Obtain regular training in how to recognise and respond to an anaphylactic reaction, including administering an adrenaline autoinjector. Refer to Chapter 5 for more details.
5. Know where to find a copy of each student’s ASCIA Action Plan for Anaphylaxis quickly, and follow it in the event of an allergic reaction.
6. Know the school's general first aid and emergency response procedures, and understand their role in relation to responding to an anaphylactic reaction.
7. Know where students' adrenaline autoinjectors and the adrenaline autoinjectors for general use are kept. (Remember that the adrenaline autoinjector is designed so that anyone can administer it in an emergency).
8. Know and follow the risk minimisation strategies in the student's individual anaphylaxis management plan.
9. Plan ahead for special class activities (for example, cooking, art and science classes), or special occasions (for example, excursions, incursions, sport days, camp, cultural days, fetes and parties), either at school, or away from school. Work with parents to provide appropriate food for their child if the food the school/class is providing may present an allergy risk for him or her.
10. Avoid the use of food treats in class or as rewards, as these may contain allergens. Consider the alternative strategies provided in this document (refer to Chapter 8 and the Resources tab). Work with parents to provide appropriate treats for students at risk of anaphylaxis.
11. Be aware of the possibility of hidden allergens in foods and of traces of allergens when using items such as egg or milk cartons in art or cooking classes.
12. Be aware of the risk of cross-contamination when preparing, handling and displaying food.
13. Make sure that tables and surfaces are wiped down regularly and that students wash their hands before and after handling food.
14. Raise student awareness about allergies and anaphylaxis, and the importance of each student’s role in fostering a school environment that is safe and supportive for their peers.

Role and responsibilities of the school anaphylaxis supervisor

The principal is responsible for appointing appropriate members of staff to take on the role of school anaphylaxis supervisor. If available at the school, a first aid coordinator or school-employed nurse may be an appropriate person to become the school anaphylaxis supervisor and take a lead role in supporting the principal and other school staff to implement the school’s anaphylaxis management policy. A health and wellbeing coordinator or leading teacher may also be appropriate.

Set out below are some suggested areas where the school anaphylaxis supervisor may provide assistance and advice. This is a guide only, and is not intended to be an exhaustive list:

1. Work with principals to develop, implement and regularly review the school's anaphylaxis management policy.
2. Obtain regular training in how to recognise and respond to an anaphylactic reaction, including administering an adrenaline autoinjector (for example, an EpiPen and an Anapen). At a minimum, have currency in the Course in Verifying the Correct Use of Adrenaline Autoinjector Devices 22579VIC (every 3 years) and the ASCIA Anaphylaxis e-training for Victorian Schools (every 2 years).
3. Verify the correct use of adrenaline autoinjector (trainer) devices by other school staff undertaking the ASCIA Anaphylaxis e-training for Victorian Schools.
4. Provide access to the adrenaline autoinjector (trainer) device for practice by school staff.
5. Send reminders to staff or information to new staff about anaphylaxis training requirements and liaise with the principal to maintain records of training undertaken by staff at the school.
6. Lead the twice-yearly anaphylaxis school briefing.
7. Develop school-specific scenarios to be discussed at the twice-yearly briefing to familiarise staff with responding to an emergency situation requiring anaphylaxis treatment for example:
   • a bee sting occurs on school grounds and the student is conscious
   • an allergic reaction where the child has collapsed on school grounds and the student is not conscious
     Similar scenarios will also be used when staff are demonstrating the correct use of the adrenaline autoinjector (trainer) device.
8. Keep an up-to-date register of students at risk of anaphylaxis.
9. Keep a register of adrenaline autoinjectors, including a record of when they are ‘in’ and ‘out’ from the central storage point. For instance, when they have been taken on excursions, camps.
10. Work with principals, parents and students to develop, implement and review each individual anaphylaxis management plan to:
    • ensure that the student’s emergency contact details are up-to-date
    • ensure that the student’s ASCIA Action Plan for Anaphylaxis matches the student’s supplied adrenaline autoinjector
    • regularly check that the student’s adrenaline autoinjector is not out-of-date, such as at the beginning or end of each term, and record this information in the register of adrenaline autoinjectors
    • inform parents in writing that the adrenaline autoinjector needs to be replaced one month prior to the expiry date, and follow up with parents if the autoinjector is not replaced
    • ensure that the student’s adrenaline autoinjector is stored correctly (at room temperature and away from light) in an unlocked, easily accessible place
    • ensure that a copy of each student’s ASCIA Action Plan for Anaphylaxis is stored with that student's adrenaline autoinjector
11. Provide advice and guidance to school staff about anaphylaxis management in the school, and undertake regular risk identification and implement appropriate minimisation strategies.
12. Work with school staff to develop strategies to raise their own, students and school community awareness about severe allergies.
13. Provide or arrange post-incident support (for example, counselling) to students and school staff, if appropriate.

Role and responsibilities of parents of a student at risk of anaphylaxis

Parents have an important role in working with the school to minimise the risk of anaphylaxis. Set out below is a summary of some of the key obligations for parents under the Order, and some suggested areas where they may actively assist the school. This is a guide only, and is not intended to be an exhaustive list:

1. Inform the school in writing, either at enrolment or diagnosis, of the student's allergies, and whether the student has been diagnosed as being at risk of anaphylaxis.
2. Obtain and provide the school with an ASCIA Action Plan for Anaphylaxis from the student's medical practitioner that details their condition, any medications to be administered, and any other relevant emergency procedures.
3. Immediately inform school staff in writing of any changes to the student’s medical condition and if necessary, obtain and provide an updated ASCIA Action Plan for Anaphylaxis.
4. Provide the school with an up to date photo for the student’s ASCIA Action Plan for Anaphylaxis when the plan is reviewed.
5. Meet with and assist the school to develop the student's individual anaphylaxis management plan, including risk minimisation and management strategies.
6. Provide the school with an adrenaline autoinjector and any other medications that are current and not expired.
7. Replace the student’s adrenaline autoinjector and any other medication as needed, before their expiry date or when used.
8. Assist school staff in planning and preparation for the student prior to camps, field trips, incursions, excursions or special events (for example, class parties, cultural days, fetes or sport days).
9. If requested by school staff, assist in identifying and/or providing alternative food options for the student when needed.
10. Inform school staff in writing of any changes to the student's emergency contact details.
11. Participate in reviews of the student's individual anaphylaxis management plan:
    • when there is a change to the student's condition
    • as soon as practicable after the student has an anaphylactic reaction at school
    • annually
    • prior to the student participating in an off-site activity such as camps and excursions, or at special events conducted, organised or attended by the school.

What should we do if someone has an anaphylactic reaction?

It is important for schools to have in place clear and comprehensive first aid and emergency response procedures that allow staff to react quickly if an anaphylactic reaction occurs, for both in-school and out-of-school settings. Drills to test the effectiveness of these procedures should be undertaken regularly.

Self-administration of the adrenaline autoinjector

The decision as to whether a student can carry their own adrenaline autoinjector should be made when developing the student’s individual anaphylaxis management plan, in consultation with the student, the student’s parents and the student’s medical practitioner.

It is important to note that students who could ordinarily self-administer their adrenaline autoinjector may sometimes not physically be able to self-administer due to the effects of a reaction. In these circumstances, school staff must administer an adrenaline autoinjector to the student, as part of discharging their duty of care to that student.

If a student self-administers an adrenaline autoinjector, one member of the school staff should supervise and monitor the student at all times, and another member of the school staff should immediately contact an ambulance (on emergency number 000).

If a student carries their own adrenaline autoinjector, it may be prudent to keep a second adrenaline autoinjector (provided by the parent) on-site in an easily accessible, unlocked location that is known to all school staff.

Responding to an incident

A member of the school staff should remain with the student who is displaying symptoms of anaphylaxis at all times. As per instructions on the ASCIA Action Plan for Anaphylaxis:

‘Lay the person flat. Do not allow them to stand or walk. If breathing is difficult allow them to sit.’

Another member of the school staff should immediately locate the student's adrenaline autoinjector and the student’s ASCIA Action Plan for Anaphylaxis.

The adrenaline autoinjector should then be administered following the instructions in the student's ASCIA Action Plan for Anaphylaxis. Where possible, only school staff with training in the administration of an adrenaline autoinjector should administer the student’s adrenaline autoinjector. However, it is imperative that an adrenaline autoinjector is administered as soon as signs of anaphylaxis are recognised. If required, the adrenaline autoinjector can be administered by any person following the instructions in the student’s ASCIA Action Plan for Anaphylaxis.

It is important that in responding to an incident, the student does not stand and is not moved unless in further danger (for example, the anaphylactic reaction was caused by a bee sting and the bee hive is close by). The ambulance should transport the student by stretcher to the ambulance, even if symptoms appear to have improved or resolved. The student must be taken to the ambulance on a stretcher if adrenaline has been administered.

In the school environment

• Classrooms – schools may use classroom phones/personal mobile phones to raise the alarm that a reaction has occurred. Some schools may decide to utilise an emergency card system (laminated card stating anaphylaxis emergency), whereby students go to the nearest teacher, office or other predetermined point to raise an alarm which triggers getting an adrenaline autoinjector to the child and other emergency response protocols.
• Yard – schools may use mobile phones, walkie talkies or a card system while on yard duty. Consideration needs to be given to the size of the campus, the number and age of students at risk, where first aiders will be stationed during lunch breaks and so on.

In addition to planning for how to get an adrenaline autoinjector to a student as quickly as possible, plans also need to be in place for:

• a nominated staff member to call an ambulance
• a nominated staff member to wait for the ambulance at a designated school entrance
• a second adrenaline autoinjector to be sent to the emergency just in case a further device is required to be administered (this may be the school adrenaline autoinjector for general use or the family purchased device).

Out-of-school environments

Excursions and camps – each individual camp and excursion requires a risk assessment for each individual student attending who is at risk of anaphylaxis. Therefore, emergency procedures will vary accordingly. A team of school staff trained in anaphylaxis needs to attend each event, and appropriate methods of communication need to be discussed, depending on the size of excursion/camp/venue. It is imperative that the process also addresses:

• the location of adrenaline autoinjectors, for example, who will be carrying them? Is there a second medical kit? Who has it?
• how to get the adrenaline autoinjector to a student as quickly as possible in case of an allergic reaction
• who will call for ambulance response, including giving detailed location address, for example, Melway reference if city excursion, and best access point or camp address/GPS location.

Always call an ambulance as soon as possible (000)

When using a standard phone call 000 (triple zero) for an ambulance. If calling from a mobile phone which is out of range, call 112.

First-time reactions

If a student appears to be having a severe allergic reaction, but has not been previously diagnosed with an allergy or being at risk of anaphylaxis, the school staff should follow the school's first aid procedures.

This should include immediately:

• locating and administering an adrenaline autoinjector for general use
• following instructions on the ASCIA Action Plan for Anaphylaxis general use (which should be stored with the general use adrenaline autoinjector).

Followed by calling the ambulance (000).

Post-incident support

An anaphylactic reaction can be a very traumatic experience for the student, staff, parents, students and others witnessing the reaction. In the event of an anaphylactic reaction, students and school staff may benefit from post-incident counselling, provided by the school nurse, guidance officer, student welfare coordinator or school psychologist.

Review

After an anaphylactic reaction has taken place that has involved a student in the school's care and supervision, it is important that the following review processes take place:

1. The adrenaline autoinjector must be replaced by the parent as soon as possible.
2. In the meantime, the principal should ensure that there is an interim individual anaphylaxis management plan should another anaphylactic reaction occur prior to the replacement adrenaline autoinjector being provided by the parents.
3. If the adrenaline autoinjector for general use has been used this should be replaced as soon as possible.
4. In the meantime, the principal should ensure that there is an interim plan in place should another anaphylactic reaction occur prior to the replacement adrenaline autoinjector for general use being provided.
5. The student's individual anaphylaxis management plan should be reviewed in consultation with the student's parents.
6. The school's anaphylaxis management policy should be reviewed to ascertain whether there are any issues requiring clarification or modification in the policy. This will help the school to continue to meet its ongoing duty of care to students.