ADMINISTRATIVE PROCEDURES

Transcription

1 PROCEDURE NO: A-SE ADMINISTRATIVE PROCEDURES SUBJECT: ANAPHYLAXIS INTRODUCTION Sabrina s Law: An Act to Protect Anaphylactic Pupils came into force January 1, This law helps to protect pupils with life-threatening allergies and to create a safe and healthy school environment. Sabrina s Law requires every school board to establish and maintain an anaphylaxis policy and every school principal to develop individual plans for any pupil with an anaphylactic allergy. BASIC UNDERSTANDING Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. While fatalities are rare, anaphylaxis must always be considered a medical emergency requiring immediate treatment. Signs and symptoms of a severe allergic reaction can occur within minutes of exposure to an allergen (a substance capable of causing an allergic reaction). The most common allergens include certain foods and insect stings. Less common allergens include medications, latex and exercise. Peanuts may be the most common allergen causing anaphylaxis in school children, and the most likely of all food allergens to trigger a full-blown anaphylactic reaction. This causes great difficulty in a school setting since peanut butter is a staple food for many children. The viscosity of peanut butter presents particular challenges in schools in terms of cross-contamination and cleaning. Symptoms of anaphylaxis generally include one or more of these four body systems: skin, respiratory, gastrointestinal and/or cardiovascular (Appendix 2). Breathing difficulties and low blood pressure are the most dangerous symptoms and both can lead to death if untreated. Anaphylaxis is an unpredictable condition as signs and symptoms can vary from one person to the next and from one episode to another in the same individual. Epinephrine is the first line treatment for anaphylaxis. This life-saving medication helps to reverse the symptoms of a severe allergic reaction by opening the airways, improving blood pressure and increasing the heart rate. It is recommended that epinephrine be given at the start of a known or suspected anaphylactic reaction. In normally healthy individuals, epinephrine will not cause harm if given unnecessarily. Schools must recognize and communicate to parents that, in spite of their best efforts, accidents may occur. However, once reasonable precautions have been taken, staff, parents, and/or other students should not feel responsible for accidental exposure. If accidental exposure does occur, appropriate emergency procedures must be in place, and acted upon immediately. Page 1 of 19

2 ADMINISTRATIVE PROCEDURES In accordance with Sabrina s Law: An Act to Protect Anaphylactic Pupils, the Lambton Kent District School Board is committed to providing a safe learning environment for all students (Policy P-AD- 110). In order to work towards this goal, it is necessary for school administrators and staff to take steps to safeguard students with life threatening allergies. The Lambton Kent District School Board supports principals in their efforts to reduce the possibility of student exposure to life threatening allergens. To that end, where there is a student with a lifethreatening allergy, the principal shall prepare a plan that clearly outlines procedures in three key areas: Communication Strategies to Reduce Risk Emergency Response 1.0 COMMUNICATION PLAN 1.1 Identification of Anaphylactic Students to School Authorities It is the responsibility of parents with anaphylactic children to identify their children to the school principal and provide: Information regarding foods which trigger an anaphylactic reaction. A current Emergency Response Plan signed by the parent and child s physician to the Principal for each school year and whenever the physician directs a modification of the prescribed medication (Appendix 1A and 1B). This includes a note from the parent/guardian confirming when administration of the medication is to end. Permission to post photographs and medical information in key locations such as the classroom, school bus, staff room, etc. (Appendix 3). Medication labeled with the child s name and the expiry date, (parents should provide at least two auto-injectors). Renewed medication prior to the expiry date. Guidance to their child in developing independent coping skills in the management of his or her medical condition (e.g. read food labels carefully: never share food, wash hands regularly, etc.). A medic-alert bracelet/necklace for their child which identifies specific allergens. It is recommended that identification of students, and student information updates are completed during the school registration process. Parents are also asked to participate in annual reviews of treatment plans. 1.2 Identification of Anaphylactic Students to School Personnel It is the principal s responsibility: To develop and maintain an Individual Emergency Response Plan (Appendix 1A and 1B) for each student with life-threatening allergies. To notify all personnel (including secretaries, custodians, supply teachers, educational assistants, bus drivers, etc.) regarding the presence of a student who is anaphylactic. Page 2 of 19

3 1.2 Identification of Anaphylactic Students to School Personnel (continued) It is the principal s responsibility: To distribute and familiarize staff with the individual emergency procedures to be followed for students with anaphylaxis. To arrange training sessions for all staff when there is a student with anaphylaxis in the school. It is advisable that general information be made available to all parents in the school (Appendix 4 or 5). (It is necessary that all information shared protects the privacy of the individuals involved.) To post in key locations an allergy alert form with photograph, description of the allergy, emergency response plan, and the location of the child s epinephrine auto-injector (Appendix 1 B). To consult parents about the decision to develop posters with their child s allergy information and the location of the posters (e.g. the child s classroom, staff room, school bus, etc.). Issues of personal privacy must be considered. To post in key locations instructions on the use of the epinephrine auto-injector, along with a list of symptoms and emergency procedures (Appendix 1A and 1B). To require the child s classroom teacher to keep a copy of each Individual Emergency Response Plan in a place where it will be highly visible and readily understood by occasional teachers. If not posted in the classroom, it should be kept with the teacher s daybook. 1.3 Further Roles and Responsibilities It is the teacher s responsibility: To be aware of the Emergency Response Plan for an individual student with anaphylaxis. To participate in annual training regarding signs, symptoms and emergency treatment of anaphylaxis. To discuss anaphylaxis with the class, in age appropriate terms. To encourage students not to share lunches or trade snacks. To encourage anaphylactic student to eat only what he/she brings from home. To communicate the importance of hand washing to the entire class. To facilitate ongoing communication with parents. To enforce school rules about bullying and threats. To leave medical information in an organized, prominent and accessible format for occasional teachers. To ensure that epinephrine and cell phones are taken on field trips. It is the student s responsibility: To have an age appropriate understanding of his/her allergy and its triggers. To comply with taking medications as required. To take responsibility as much as possible for avoiding allergens. To take responsibility for checking food labels and monitoring food intake. To wash hands before eating. To learn to recognize symptoms of an anaphylactic reaction. To inform an adult as soon as accidental exposure occurs or symptoms appear. To be aware of location of auto-injector. To know how to use an auto-injector. Page 3 of 19

4 1.3 Further Roles and Responsibilities (continued) Staff must recognize that an anaphylactic student may not be able to self-administer during an anaphylactic reaction. 1.4 In-Service for Teachers and Other School Staff Regular training is needed to ensure school staff and others who are in regular contact with students understand that anaphylaxis is a medical emergency which requires immediate treatment. The principal will ensure that: In-service is provided annually for school personnel, occasional teachers and volunteers (on: how to recognize and treat anaphylactic reactions, administration policies that deal with anaphylaxis and school protocol for responding to emergencies). Anaphylactic Resource Kit is up to date and available as a resource support to staff (Appendix 9). All staff and others in the school setting who are in direct contact with children with anaphylaxis receive training in the use of the epinephrine auto-injector. Where possible, parents participate in training staff in emergency response and the use of the epinephrine auto-injector. When needed, local health services, support groups or associations be consulted to assist in delivering in-service. 1.5 Sharing Information with Others The principal will: Consider, in consultation with the anaphylactic child s parents, identifying students suffering life-threatening allergies to all students in the school, in order to enlist their co-operation and support for the student. Share information about anaphylaxis with the school council. Seek the input of the school council in reviewing strategies to provide a safe environment for the anaphylactic child. Develop a communication strategy to inform parents of the presence of a student with life-threatening allergies in their child s school and the measures being taken to protect the student. Send home letters at the beginning of the year asking parents to send lunches and snacks that do not include the allergen (Appendix 4 and 5). Provide parents with suggestions for alternative foods when the allergen is a common item in school lunches, such as peanut butter. Send reminders or information articles in school newsletters about anaphylaxis (Appendix 6). Communicate through school newsletters, at the beginning of the year that information on medical consent forms will be shared with board bus operators to ensure the health and safety of all students in the case of an emergency. Medical information will be kept in strict confidence and will be made available in the event of an emergency when the health and safety of a student is in question. If a parent objects to or has questions relative to sharing information they should contact the principal at their earliest convenience. Identifying children with life-threatening allergies is more difficult in a secondary school setting. Although parents must still bear the burden of responsibility for reporting the condition to the school, schools may wish to explore ways of Page 4 of 19

5 encouraging and reminding them to do so, particularly with older students, those who have moved into the system, and those who have been recently diagnosed. 2.0 STRATEGIES TO REDUCE RISK The goal of the Board s policy is to provide a safe environment for all children. The key to preventing an anaphylactic emergency is absolute avoidance of the allergen. Unfortunately it is not possible for schools to reduce the risk to zero for children with anaphylaxis. School administrators need to review the environment in collaboration with their staff and determine if it can be altered to minimize the allergen, thereby reducing the risk of a reaction for the student. It should be noted that precautions might vary depending on the properties of the allergen, (i.e. peanut butter poses greater difficulties due to its particular viscosity; it can easily be transferred to a variety of surfaces and even minute amounts can trigger a severe reaction). Decisions on any actions taken by the school should be made in the context of the anaphylactic child s age and maturity. A secondary school student would be encouraged to assume more personal responsibility than an elementary student. The following strategies should be implemented as part of a school prevention and management plan: Where there is a child in an elementary school who is peanut allergic, peanuts, peanut butter or peanut-containing foods should not be brought to school. Where there is a student in a secondary school who is peanut allergic, complete avoidance policies, while desirable, may not be practical; therefore, allergy-aware classrooms may need to be instituted. Promote public education regarding the dangers of peanut allergies and request cooperation limiting peanut use at school. Provide visual supports (posters) as reminders of allergy sensitive environments Establish safe lunchroom and eating area procedures: o The anaphylactic child should eat only food that has been prepared specifically for him/her, usually at home. o There should be no sharing or trading of food, food utensils, or food containers. o Establish a hand washing routine before and after meals. o Ensure that tables and eating surfaces are cleaned before and after eating. o Ensure careful supervision of lunch rooms and food celebrations. o Food personnel should also be instructed about measures necessary to prevent cross contamination during the handling, preparation and serving of food. Ensure teachers are made aware of possible allergens present in curricular material (e.g. play dough, beanbags, toys stuffed with peanut shells etc.) and art and craft materials (e.g. food materials, seeds, etc.) (Appendix 2). Take extra caution during field trips to ensure avoidance of allergens. Take special caution during special celebrations and school festivities that involve food. Parents sending food for bake sales, class parties and festivities, and special treats should be reminded that foods must be allergen-free. In addition to the above strategies, two checklists have been prepared to further support schools in risk reduction (Appendix 7 and 8). 3.0 EMERGENCY RESPONSE Even when schools have taken every reasonable precaution, an anaphylactic student may accidentally come into contact with an allergen at school. The school must have in place an Individual Emergency Response Plan (Appendix 1A and 1B), and all staff must be aware of how to implement it. Anaphylactic children usually know when a reaction is taking place. It is important to encourage personnel to listen to what the student is saying. There is no danger in reacting too quickly, but there is grave danger in reacting too slowly. Page 5 of 19

6 Individual Emergency Response Plan (Appendix 1A and 1B): The six key recommendations in the emergency management of anaphylaxis include: 1. Epinephrine is the first line medication which should be used for the emergency management of a person having a potentially life-threatening allergic reaction. 2. Antihistamines and asthma medications should not be used as first line treatment for an anaphylactic reaction. 3. All individuals receiving emergency epinephrine must be transported to hospital immediately (ideally by ambulance) for evaluation and observation. 4. Additional epinephrine should be available during transport to hospital. A second dose of epinephrine may be administered within 5 to 15 minutes after the first dose IF symptoms have not improved. 5. Individuals with anaphylaxis who are feeling faint or dizzy because of impending shock should lie down unless they are vomiting or experiencing severe respiratory distress. 6. No person experiencing anaphylaxis should be expected to be fully responsible for selfadministration of an epinephrine auto-injector. Every emergency plan must include specific steps to follow in an emergency (A-C-T): A - Administer the auto-injector; This is done at the first sign of a known or suspected anaphylactic reaction. (Note: When a student self-administers an injection, it is essential that it be done under the direct supervision of an adult because symptoms may develop quickly and the stress of the situation can cause unconsciousness to occur.) C - Call 911 for an ambulance and report anaphylactic shock; Have a trained staff member stay with the student. Reassure the student, make the student comfortable, and lie the student on his/her side in case of vomiting. Be prepared to provide the paramedic with a copy of Individual Emergency Response Plan and the time and type of medication administered. T- Transport the child to the hospital at once if no ambulance service is available; Ideally this is by ambulance but if no ambulance service is available staff will need to assist as child must be transported immediately. If transporting by personal vehicle, take another trained adult and extra epinephrine auto-injectors with you. If breathing does not improve or if symptoms reoccur administer the second autoinjector (this would occur 5-15 minutes after first injection). Call parents as soon as reasonably possible informing them of their child s medical situation and the hospital that their child has been transported to. Page 6 of 19

7 Location of Epinephrine Auto-Injectors Epinephrine auto-injectors should be kept in a covered and secure area, but unlocked for quick access. (These easily accessible locations should be known to all staff members.) As soon as they are old enough, students should carry their own epinephrine autoinjectors. (Many young children carry an injection kit in a fanny pack around their waist at all times.) An up-to-date supply of epinephrine auto-injectors, provided by the parents, should be available in the school at all times. (Parents should provide at least two (2) autoinjectors in case one malfunctions or additional treatment is required.) Conditions of Storage for Epinephrine Auto-Injectors Epinephrine auto-injectors should be protected from light and stored at room temperature. Do not refrigerate and protect from freezing. Review Process School emergency response plans for each anaphylactic student should be reviewed annually with staff and parents. In the event of an emergency response, an immediate evaluation of the procedure should be undertaken. 4.0 LEGAL IMPLICATIONS Principals shall communicate to all staff the following facts as per Sabrina s Law: An Act to Protect Anaphylactic Students: If an employee has reason to believe that a pupil is experiencing an anaphylactic reaction, the employee may administer an epinephrine auto-injector or other medication prescribed to the pupil for the treatment of an anaphylactic reaction, even if there is no preauthorization to do so. No action for damages shall be instituted respecting any act done in good faith or for any neglect or default in good faith in response to an anaphylactic reaction in accordance with this Act, unless the damages are the result of an employee s gross negligence. Implementation Date: June 14, 2000 Revised: September, 2003 February, 2004 February, 2006 February, 2015 May, 2015 March, 2016 Reference: Policy and Regulations Sabrina s Law: An Act to Protect Anaphylactic Pupils Page 7 of 19

8 APPENDIX 1 A STUDENT SURNAME: INDIVIDUAL EMERGENCY RESPONSE PLAN FOR ANAPHYLACTIC STUDENTS GIVEN NAMES: Address: School: Grade: O.E.N.: Teacher: Bus Student: Yes If Yes, Route No. No Bus Driver: This person has a potentially life-threatening allergy to: PARENTS/GUARDIANS: EMERGENCY INFORMATION: MOTHER FATHER Name Doctor: Phone: Home Phone Ambulance: Phone: Work Phone Hospital Emerg. #: Cell Phone Fire Dept. #: Police #: STRATEGIES TO Peanut-containing foods/peanut butter have been restricted (should not be brought to school). REDUCE RISK: Allergy-aware classrooms. Safe lunch room and eating area procedures are in place/careful supervision of all eating areas. Teachers have taken precautions regarding allergens in curricular materials (i.e., bean bags). Extra caution taken on field trips, special celebrations, bake sales, etc. PERSONS INFORMED OF THE PLAN ANNUAL TRAINING IS REQUIRED FOR ALL INDIVIDUALS WHO WORK WITH ANAPHYLACTIC STUDENTS PERSON PERSON TRAINING COMPLETED Parent(s) ALL School Staff ALL School Staff Volunteers Volunteers Bus Driver/Operator Bus Driver/Operator This plan was developed in consultation with parent/ guardian on (date) and will be reviewed on an annual basis (or earlier if requested). Signature of Principal This information is collected in accordance with the Education Act. This medical information will be shared with individuals charged with transporting students in an effort to ensure health and safety in the event of an emergency. Page 8 of 19

9 APPENDIX 1 B Anaphylaxis Emergency Plan: (name) This person has a potentially life-threatening allergy (anaphylaxis) to: (Check the appropriate boxes.) D Peanut D Other: Tree nuts D Insect stings Egg Latex D Milk D Medication:. Food: The key to preventing an anaphylactic emergency is absolute avoidance of the allergen. People with food allergies should not share food or eat unmarked I bulk foods or products with a "may contain warning. PHOTO Epinephrine Auto-Injector: Expiry Date: ' Dosage: D EpiPen Jr 0.15 mg D Allerject mg D EpiPen 0.30 mg D Allerject mg Location of Auto-lnjector(s): Previous anaphylactic reaction: Person is at greater risk. D Asthmatic Person is at greater risk. If person is having a reaction and has difficulty breathing, give epinephrine auto-injector before asthma medication. A person having an anaphylactic reaction might have ANY of these signs and symptoms: Skin system: hives, swelling, itching, warmth, redness, rash Respiratory system (breathing): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing Gastrointestinal system (stomach): nausea, pain/cramps, vomiting, diarrhea cardiovascular system (heart): pale/blue colour. weak pulse, passing out. dizzy/lightheaded, shock Other: anxiety, feeling of "impending doom", headache, uterine cramps, metallic taste Early recognition of symptoms and immediate treatment could save a person's life. Act quickly. The first signs of a reaction can be mild, but symptoms can get worse very quickly. 1. Give epinephrine auto-injector (e.g., EpiPen or Allerjecti at the first sign of a known or suspected anaphylactic reaction. (See attached instruction sheet.) 2. can or local emergency medical services. Tell them someone is having a life-threatening allergic reaction. 3. Give a second dose of epinephrine in 5 to 15 minutes IF the reaction continues or worsens. 4. Go to the nearest hospital immediately (ideally by ambulance), even if symptoms are mild or have stopped. The reaction could worsen or come back, even after proper treatment. Stay in the hospital for an appropriate period of observation as decided by the emergency department physician (generally about 4 hours). 5. can emergency contact person (e.g. parent. guardian). Emergency Contact Information Name Relationship Home Phone Work Phone Cell Phone The undersigned patient, parent, or guardian authorizes any adult to administer epinephrine to the above-named person in the event of an anaphylactic reaction, as described above. This protocol has been recommended by the patient's physician. Patient/Parent/Guardian Signature Date Physician Signature D On file Date Anaphyla~ s Canada Canadl n Allefgy, Aattlm nd Immunology Foundation Page 9 of20 can.dlan Socl ty or AllerVJ' and Cllnlc.l lrnrnunofogy Page 9 of 19

10 How to use EpiPen and EpiPen Jr Auto-injectors. Remove the EpiPen Auto-Injector from the carrier tube and follow these 2 simple steps: Hold firmly with orange tip pointing downward. Remove blue safety cap by pulling straight up. Do not bend or twist. Swing and push orange tip firmly into mid-outer thigh until you hear a 'click~ Hold on thigh for several seconds. Built-in needle protection When the EpiPen Auto-injector is removed, the orange needle cover automatically extends to cover the injection needle, ensuring the needle is never exposed. After administration, patients should seek medical attention immediately or go to the emergency room. For the next 48 hours, patients must stay within close proximity to a heahhcare facility or where they can call 911. For more information visit EpiPen.ca. EpiPen and EpiPen Jr Auto-injectors are indicated for the emergency treatment of anaphylactic reactions in patients who are determined to be at increased risk for anaphylaxis, induding individuals with a history of anaphylactic reactions. Thi5,,...,..., not bo riglll.,... IMfs INI ond i>llowdlo ""*'* CJlllllllrCNllk,r.rlllld,l)ldllc 119JlMS illle H77-6'1PEN1 (W l61) E!f!no."""'"...,.i-...ct..,..,lltbn!ld"""""'""...,. lloyl'hlml,u!ctlllpi,caliluia;... llllrcnllk,r.rlllld,im!llr,llljlms llxxim1l97 Page 10 of 20 Trusted for over 25 years. Page 10 of 19

11 APPENDIX 2 SYMPTOMS OF ANAPHYLACTIC SHOCK The onset of anaphylaxis can begin within seconds of exposure or after several hours. Any combination of the following symptoms may signal the onset of a reaction: Face: itching, redness, swelling of face and tongue Airway: coughing, trouble breathing, difficulty swallowing, or difficulty speaking Stomach: stomach cramps or pain, vomiting, diarrhea Total Body: hives, rash, itching, swelling, weakness, paleness, sense of doom, dizziness, loss of consciousness The interval of time between onset of the first symptoms and death can be as short as a few minutes, if the reaction is not treated. Even when symptoms have subsided after initial treatment, they can return. ANAPHYLAXIS TRIGGERS Foods which are Sources of Anaphylactic Reaction: (It should be noted that any food could trigger an anaphylactic reaction. Cross contamination of foods is also a concern.) - Peanuts/peanut butter/peanut oil - Tree nuts: hazelnuts, walnuts, pecans, almonds, cashews - Sesame seeds and sesame oil - Cow s milk - Eggs - Fish, shellfish - Wheat - Soy - Bananas, avocados, kiwis and chestnuts for children with latex allergies Other Possible Sources in Prepared Foods: - Cookies, cakes - Cereals - Granola bars - Candies Non-Food Sources: - Play dough - Scented crayons, cosmetics and other products - Peanut-shell stuffing in bean bags and stuffed toys - Bird seed - Insect venom (bees, wasps, hornets, yellow-jackets) - Rubber latex (i.e. in gloves, balloons, erasers, rubber spatulas, craft supplies, koosh balls) - Vigorous exercise - Plants such as poinsettias, for children with latex allergies Page 11 of 19

12 APPENDIX 3 LAMBTON KENT DISTRICT SCHOOL BOARD CONSENT FOR RELEASE OF INFORMATION I give my permission for School Principal to share information regarding my child s,, life threatening allergy. Child s Name I recognize that sharing my child s picture and information about his/her allergy will assist the school in quickly responding to an emergency situation should my child come into accidental contact with the allergen. Date Signature of Parent or Guardian Page 12 of 19

13 APPENDIX 4 I. SAMPLE LETTER TO PARENTS Dear Parent: I am writing to you on behalf of our student and his parent(s)., is years old and is in Mr./Mrs. Grade class. He has a life-threatening reaction to peanuts and all types of nuts. If peanut butter or even the tiniest amount of peanut or any type of nut enters his body (through his eyes, nose or mouth), he experiences very strong reactions. His face swells and breaks out in hives, his throat swells and tightens. Without immediate medical treatment, he could die within minutes. After discussions with school staff, the school council, and other knowledgeable parties in the medical community, it has been suggested that the best way to provide a safe environment for would be to enlist the support of all parents to help make our school a peanut and nut-aware environment. This means that every child is asked to bring a peanut and nut-aware snack and lunch. Though it sounds simple, it means no peanut butter sandwiches or peanut butter cookies. Other foods like muffins, granola bars and cereals will require reading labels before being packed in your child s snack. Our concern is for foods where peanuts or other nuts might be a hidden ingredient. I realize this request poses an inconvenience for you when packing your child s snack and lunch, however, I wish to express sincere appreciation for your support and understanding of this potentially life-threatening allergy. I know that every parent would hope for the assistance of their school community if their child had a similar condition. In the very near future, the school will announce a parent meeting for you to become acquainted with this situation. Literature will be provided suggesting healthy and nutritional alternatives to nuts and their by-products. Sincerely, Principal THIS LETTER MAY ONLY BE SENT WITH THE WRITTEN CONSENT OF THE PARENTS OF THE CHILD WITH ALLERGIES. Page 13 of 19

14 APPENDIX 5 II. SAMPLE LETTER TO PARENTS Date Dear Parents and Guardians: One of our students has a life-threatening allergy to all nuts. The only way to ensure a safe environment for this child is to try to make our school NUT-AWARE. To do this, we need everyone s co-operation in sending snacks and lunches that are nut-free. Please check the ingredients of all foods your children bring to school. Coconut is not a nut and does not pose any risk. In a classroom setting, cross-contamination is the greatest risk from this type of allergy. Crosscontamination is when a few crumbs from one child s snack are dropped and then picked up by an allergic child. A small amount can kill. I hope you will appreciate the seriousness of this condition and that you will assist us at the school in our efforts to create as safe an environment as possible. With your co-operation we can minimize the risk of an allergic reaction. Thank you for your assistance with this issue. Sincerely, Principal Page 14 of 19

15 APPENDIX 6 Sample Item for Newsletters Watch out for Life-Threatening Allergies Many children have allergies; a few, however, are life-threatening. Some children, for example, are severely allergic to peanut butter. Even a tiny bit can be fatal within minutes. Nuts, shellfish, fish, eggs and milk are also known to cause severe reactions. Knowing that your child has allergies and knowing how to deal with them is your best defense. If your child is allergic to peanuts or peanut products, please tell us. With your help, we will do our best to prevent mishaps and to make sure that all of our students are safe, healthy, and able to concentrate on learning. If you would like further information about our policies and practices, please call the school. Page 15 of 19

16 APPENDIX 7 AN ELEMENTARY CHECKLIST FOR CREATING SAFE AND HEALTHY SCHOOLS FOR CHILDREN WITH FOOD ALLERGIES School staff and parents are responsible for creating safe and healthy environments for students. This is an extra challenge for schools attended by children with life-threatening food allergies. For some children, severe allergic reactions can be triggered not only by eating foods, but also by their touch and smell. This has implications for the whole school, not just for individual classrooms. It is important to review your school s use of foods. If foods pose health risks for some children, try not to make them the focus of all your special events. It will be safest to use non-food fundraisers. Discourage the use of food as a reward for good behaviour. Too often these rewards are unhealthy or unsafe food choices. When food is part of your school s activities, emphasize healthy food choices. Most children can safely enjoy them because they are easily identified and have no added ingredients. Highly processed foods contain hidden ingredients, which cannot be enjoyed freely by children with special dietary needs. While it is impossible to create a risk-free environment, school staff and parents can take important steps to minimize potentially fatal allergic reactions. Accurate records, written protocols, staff education, parental support, and classroom and school rules should all be considered. Use the following checklist to develop and implement your school plan. Have you received written notification from the allergic child s physician regarding specific foods to avoid, as well as authorization for emergency treatment? Have you established a written protocol with the parent of the allergic child which includes? A picture of the child Specific information on the child s food restrictions Use of a Medic Alert bracelet to identify the child s specific allergies Authorization and directions for administration of emergency medications At least two doses of the emergency medication, labeled with the child s name, and expiry date (children who are old enough can carry one dose with them at all times) Unlocked, safe and accessible storage of emergency medication, in locations which are known to all appropriate staff Plan for transportation to the hospital Telephone numbers for parents and alternate emergency contacts Posting of an Emergency Protocol, with parental consent, in an accessible location in the school (Appendix 1 B). Annual review of this protocol to ensure that it is still current Page 16 of 19

17 APPENDIX 7 (continued) Have you worked with the parent of the allergic child to educate and update your school staff, volunteers, bus drivers, and other students about: Food allergies and their potential severity Recognizing symptoms of an allergic reaction Administering emergency medications The Emergency Response Plan Have you gained the cooperation of other parents in the school by working with the parent of the allergic child to: Organize information sessions Set up information displays Send out letters explaining the presence of a student with life-threatening allergies (Appendix 4 and 5). Have you taken steps to ensure to create safe classrooms where: Allergic children are encouraged to eat the foods they bring from home Trading and sharing of food is discouraged The use of food in crafts and activities is reviewed Hand washing is encouraged before and after eating Clean desks or other eating surfaces are promoted The banning of food allergens from the classroom is considered Adequate controls are in place if food allergens are allowed in the classroom Parents are asked to provide detailed labeling on foods they send into the classroom for sharing There is appropriate training for older students who may be responsible for supervising classrooms Have you taken steps to create safe environments outside the classroom: Do you have plans in place to ensure safe field trips or extracurricular activities? Do your permission forms for off-site activities include information on food allergies? Can children take food outside at breaks? Are they encouraged to wash their hands after eating? What types are foods are available at special events? If foods are ordered in from commercial sources, do you ask for a list of ingredients? Are food preparation/handling areas kept clean? Are staff/parents reminded to use clean utensils when preparing foods for the allergic child? Is garbage disposal handled safely? Have you been sensitive to the needs of the child, as each child s needs are different? Make sure that you have taken all of the information you need about their specific food allergies, as well as their severity. Take realistic and practical actions, which will be well supported by everyone involved. Page 17 of 19

18 APPENDIX 8 A CHECKLIST FOR SECONDARY SCHOOLS Check registration forms for medical information Develop an Emergency Response Plan with the assistance of the parent and the student who has a severe allergy (Appendix 1). Work with the parent, allergic student and trained professionals, where possible, to ensure that the school personnel and other students are educated and updated regarding anaphylaxis and the Emergency Response Plan. Remind students with severe allergies to provide the office with information about their specific allergy early in the school year Include an article about allergies and anaphylaxis in your first newsletter to educate parents and students Review student emergency protocols every year for accuracy Establish an allergen-safe section in the cafeteria or other designated area Page 18 of 19

19 APPENDIX 9 Anaphylaxis Resource Kit Last Revised 2013 (Ministry) Each school should have an Anaphylaxis Resource Kit. This kit was developed by the Ministry of Education in collaboration with Anaphylaxis Canada. The kit contains resources to familiarize school staff with the basics of anaphylaxis, avoidance strategies and the appropriate emergency response. Contents of Kit: Case Binder with 2013 cover insert Auto-injector training devices (EpiPen) Awareness/Instructional Posters 4 GB memory stick of instructional videos, Anaphylaxis 101 Presentation and related materials Canadian Society of Allergy and Clinical Immunology s, Anaphylaxis in Schools and Other Settings, 2 nd Edition Revised OPHEA s, The Basics of Asthma, Allergies and Anaphylaxis Anaphylaxis Canada s, Why Risk It flyer To support training on anaphylaxis the Ministry has also provided an e-learning module that includes Ontario specific anaphylaxis training on Sabrina s Law. The module can be accessed at Page 19 of 19