RATIONALE Anaphylaxis is a severe, rapidly progressive allergic reaction that is potentially life threatening. The most common allergens in school aged children are peanuts, eggs, tree nuts (e.g. cashews), cow s milk, fish and shellfish, wheat, soy, sesame and certain insect stings (particularly bee stings). The key to prevention of anaphylaxis in schools is knowledge of the student who has been diagnosed as at risk, awareness of allergens, and prevention of exposure to those allergens. Partnerships between schools and parents/guardians are important in helping the student avoid exposure. Adrenaline given through an adrenaline autoinjector (such as an EpiPen or Anapen ) into the muscle of the outer mid-thigh is the most effective first aid treatment for anaphylaxis. POLICY St James Anglican School aims to: provide, as far as practicable, a safe and supportive environment in which students at risk of anaphylaxis can participate equally in all aspects of the student s schooling. raise awareness about anaphylaxis and the school s anaphylaxis management policy/guidelines in the school community. engage with parents/guardians of each student at risk of anaphylaxis in assessing risks, developing risk minimisation strategies for the student. ensure that staff have knowledge about allergies, anaphylaxis and the school s guidelines and procedures in responding to an anaphylactic reaction. St James Anglican School is an allergy aware school with strategies in place to promote awareness. It is not a nut free school as it is not possible to guarantee this position. P A G E n 1
What is anaphylaxis? Anaphylaxis is a severe and sudden allergic reaction. It occurs when a person is exposed to an allergen (such as a food or insect bite). Although death is rare, an anaphylactic reaction always requires an emergency response. Prompt treatment with injected adrenaline is required to halt progression and can be lifesaving. Fortunately, anaphylactic reactions are usually preventable by implementing strategies for avoiding allergens. Common allergens for anaphylaxis are: foods (e.g. peanuts and nuts, shellfish and fish, milk and egg); insect bites (e.g. bee, wasp, jumper ants); medications (e.g. antibiotics, aspirin); latex (e.g. rubber gloves, balloons, swimming caps). The severity of an anaphylactic reaction is influenced by a number of factors, such as exercise, hot weather and in the case of food allergens, the amount eaten. In the case of severe food allergies, an anaphylactic reaction is usually triggered by ingestion of the food. How can you recognise an anaphylactic reaction? Reactions usually begin within minutes of exposure and can progress rapidly at any time over a period of two hours. A student at risk of anaphylaxis will often recognise the early symptoms of an allergic reaction before any other signs are observable. Common symptoms are: flushing and/or swelling of the face itching and/or swelling of the lips, tongue or mouth itching and/or a sense of tightness in the throat, hoarseness, difficulty breathing and/or swallowing hives, itchy rash and/or swelling about the face, body or extremities nausea, abdominal cramps, vomiting shortness of breath, repetitive coughing and/or wheezing faint, light headedness, rapid pulse, low blood pressure, collapse distress, anxiety and/or a sense of dread. P A G E n 2
Peanut & nut allergy: Peanuts and nuts are the most likely foods to cause anaphylaxis. Foods that contain peanuts and nuts (even trace amounts) can trigger a reaction in an allergic child. PROCEDURES Student Responsibilities All students need to be aware that they must eat only from their own lunchbox. Students must understand the importance of washing hands before and after eating Educating a student s peers about anaphylaxis is important as a way to gain their support for preventing exposure to allergens. Education is also important to ensure that the affected student is protected from any teasing or provocation that may result in risk taking associated with allergens eg. nuts. Parent Responsibilities It is the responsibility of the parent to notify the school that their child is at risk of an anaphylactic reaction either at the time of enrolment or, if the student is enrolled, as soon after diagnosis as possible. As with other health conditions, St James Anglican School provides support to assist the parent in the management of their child s health. For this support to be effective it is important that: a partnership is established between the parent and the school to share information and clarify expectations ensure that an Individual Anaphylaxis Health Care Plan and the relevant Action Plan are completed every reasonable effort is made to minimise the exposure of students at risk of an allergic reaction to known allergens within the school environment parents must supply an adrenaline auto injector e.g. Epipen and/or other medications to the school and are responsible to check the expiry dates as well as keeping the medications current. parents are to remind the class teacher of medications that must accompany the student on class excursions. All diagnosed anaphylactic students must be made aware of their condition and the processes involved if an allergic reaction occurs at school. P A G E n 3
Staff Responsibilities If a child has been diagnosed with an allergy, the school will organise a meeting between the Principal or delegate, the child's Teacher/Form Teacher and the parents to discuss the child's needs further. At this meeting: ensure that they complete and return relevant forms for the administration of medication at school discuss strategies to avoid potential exposure to allergens in the student's routine and issues to be addressed in implementing an emergency response plan in these situations. Consider: routine classroom activities, including lessons in other locations around the school non-routine classroom activities and non-routine school activities before school, recess, lunchtime, other break or play times sport or other programmed out of school activities and excursions. Regularly remind all parents: The school has an allergy awareness policy and provide information about allergies and anaphylaxis. Parents need to be reminded to refrain from sending peanut and nut products to school in lunches and snacks. It is most important that parents impress upon their children the importance of following this request. 1. Discuss the allergy awareness policy with the class. With the permission of the parent/guardian, plan an information sheet including a recent head & shoulders photograph of the child in the classroom. Place a copy of this information sheet and Action Plan in: the student's file, the classroom, the Front Office/Sick Bay and the staff room the class roll so that Relief Teachers are made aware of the child's condition electronically on SEQTA with the class roll 2. Ensure that medications (e.g. EpiPen) are clearly marked with the student's name and kept alongside their personal information in Sick Bay and their classroom along with accompanying anti-histamine medication (e.g Clarantyne). P A G E n 4
3. Review Anaphylaxis Policy annually at a specified time (e.g. beginning of the school year) and at any other time where there are changes in: the student's health needs staff (e.g. class teacher) other factors that affect the plan, for example, when an anaphylactic event occurs. 4. Ensure all staff attend a First Aid training course, covering allergy awareness, anaphylaxis and the use of an EpiPen 5. In case of any incident do not wait for allergy symptoms to present themselves- phone for an ambulance immediately and be ready to administer the Epi-Pen if necessary Individual Anaphylaxis Health Care Plans The principal, in conjunction with the relevant staff members, will ensure that an Individual Anaphylaxis Health Care Plan is developed in consultation with the student s parents/guardians, for any student who has been diagnosed by a medical practitioner as being at risk of anaphylaxis. The Individual Anaphylaxis Health Care Plan will be in place as soon as practicable after the student is enrolled and where possible before their first day of school. The student s Individual Anaphylaxis Health Care Plan will be reviewed, in consultation with the student s parents/guardians: annually, and as applicable, if the student s condition changes, immediately after the student has an anaphylactic reaction. It is the responsibility of the parent/guardian to: provide an Australian Society of Clinical Immunology and Allergy (ASCIA) Action Plan completed by the child s medical practitioner with a current photo, inform the school if their child s medical condition changes, and if relevant provide an updated ASCIA Action Plan. P A G E n 5
Communication The Principal, or his / her delegate (e.g. Head of Primary) will be responsible for providing information to all staff, students and parents/guardians about anaphylaxis and development of the school s anaphylaxis management strategies. Volunteers and casual relief staff will be informed on arrival at the school if they are caring for a student at risk of anaphylaxis and their role in responding to an anaphylactic reaction. Staff training and emergency response Teachers and other school staff who have contact with the student at risk of anaphylaxis, are encouraged to undertake training in anaphylaxis management including how to respond in an emergency. At other times while the student is under the care or supervision of the school, including excursions, yard duty, camps and special event days, the principal must ensure that there is a sufficient number of staff present who have up to date training and know how to recognise, prevent and treat anaphylaxis. Training will be provided to these staff as soon as practicable after the student enrols. Wherever possible, training will take place before the student s first day at school. Where this is not possible, an interim plan will be developed in consultation with the student s parents/guardians. The school s first aid procedures and student s ASCIA Action Plan will be followed when responding to an anaphylactic reaction. Risk Minimisation The key to prevention of anaphylaxis is the identification of allergens and prevention of exposure to them. St James Anglican School follows a range of practical prevention strategies to minimise exposure to known allergens. P A G E n 6
Setting Considerations Classroom Display a copy of the students ASCIA Action Plan in the classroom and staffroom, with the permission of the parent/guardian. Liaise with parents/guardians about food related activities ahead of time. Inform other class members parents of trigger substances and request that these foods are avoided. Use non-food treats where possible. If food treats are used in class, it is recommended that parents/guardians provide a box of safe treats for the student at risk of anaphylaxis. Treat boxes should be clearly labelled. Treats for the other students in the class should be consistent with the school s allergen minimisation strategies Food for the allergic student should only be approved and provided by the student s parents. Never give food from outside sources to a student who is at risk of anaphylaxis. Be aware of the possibility of hidden allergens in cooking, food technology, science and art classes (e.g. egg or milk cartons, peanut butter containers). Have regular discussions with students about the importance of washing hands, eating their own food and not sharing food. Casual/relief teachers should be provided with a copy of the student s ASCIA Action Plan. This may be through familiarisation with SEQTA for the class roll. Canteen If the school uses an external/contracted food service provider, the provider should be able to demonstrate satisfactory training in the area of anaphylaxis and its implications on food handling. With permission from parents/guardians, canteen staff (including volunteers), should be briefed about students at risk of anaphylaxis, preventative strategies in place and the information in their ASCIA Action Plans. With permission from parents/guardians, the students name, photo and the foods they are allergic to will be displayed in the canteen as a reminder to staff. Liaise with parents/guardians about food for the student. Food banning is not recommended (see Step 4 of allergy awareness in schools), however some school communities may choose not to stock peanut and tree nut products (including nut spreads) as one of the school s risk minimisation strategies. Products labelled may contain traces of peanuts/tree nuts should not be served to the student known to be allergic to peanuts/tree nuts. Be aware of the potential for cross contamination when storing, preparing, handling or displaying food. Ensure tables and surfaces are wiped clean regularly. P A G E n 7
Yard The student with anaphylactic responses to insects should wear shoes at all times. Keep outdoor bins covered. The student should keep open drinks (e.g. drinks in cans) covered while outdoors. Specify play areas that are lowest risk to the student and encourage the student and his or her peers to play in this area. Staff trained to provide an emergency response to anaphylaxis should be readily available during non-class times (e.g. recess and lunch). The adrenaline auto injector should be easily accessible from the yard. It is advised that schools develop a communication strategy for the yard in the event of an anaphylactic emergency. Staff on duty need to be able to communicate that there is an anaphylactic emergency without leaving the child experiencing the reaction unattended. This could be achieved by any or all of the following actions: The teacher on duty should immediately send two students to the front office for help. They should gain the attention of a nearby staff member and / or use their mobile phone to get help On-site events (e.g. sporting events, in school activities, class parties) For special occasions, class teachers should consult parents/guardians in advance to either develop an alternative food menu or request the parents/guardians to send a meal for the student. Parents/guardians of other students should be informed in advance about foods that may cause allergic reactions in students at risk of anaphylaxis as well as being informed of the school s allergen minimisation strategies. Party balloons should not be used if a student is allergic to latex. Latex swimming caps should not be used by a student who is allergic to latex. Staff must know where the adrenaline auto injector is located and how to access if it required. Staff should avoid using food in activities or games, including rewards. For sporting events, it may be appropriate to take the student s adrenaline auto injector to the playing fields. If the weather is warm, the auto injector should be stored in an esky to protect it from the heat. Off-site school settings field trips, excursions The student s adrenaline auto injector, ASCIA Action Plan and means of contacting emergency assistance must be taken on all field trips/excursions. One or more staff members who have been trained in the recognition of anaphylaxis and the administration of the adrenaline auto injector should P A G E n 8
accompany the student on field trips or excursions. All staff present during the field trip or excursion need to be aware if there is a student at risk of anaphylaxis. Staff should develop an emergency procedure that sets out clear roles and responsibilities in the event of an anaphylactic reaction. The school should consult parents/guardians in advance to discuss issues that may arise, to develop an alternative food menu or request the parent/guardian to send a meal (if required). Parents/guardians may wish to accompany their child on field trips and/or excursions. This should be discussed with parents/guardians as another strategy for supporting the student. Consider the potential exposure to allergens when consuming food on buses. Off-site school settings camps and remote settings When planning school camps, a risk management plan for the student at risk of anaphylaxis should be developed in consultation with parents/guardians and camp managers. Campsites/accommodation providers and airlines should be advised in advance of any student with food allergies. Staff should liaise with parents/guardians to develop alternative menus or allow students to bring their own meals. Camp providers should avoid stocking peanut or tree nut products, including nut spreads. Products that may contain traces of peanuts/tree nuts may be served, but not to the student who is known to be allergic to peanuts/tree nuts. Use of other substances containing allergens (e.g. soaps, lotions or sunscreens containing nut oils) should be avoided. The student s adrenaline auto injector and ASCIA Action Plan and a mobile phone must be taken on camp. A team of staff who have been trained in the recognition of anaphylaxis and the administration of the adrenaline auto injector should accompany the student on camp. However, all staff present need to be aware if there is a student at risk of anaphylaxis. Staff should develop an emergency procedure that sets out clear roles and responsibilities in the event of an anaphylactic reaction. Be aware of what local emergency services are in the area and how to access them. Liaise with them before the camp. The adrenaline auto injector should remain close to the student at risk of anaphylaxis and staff must be aware of its location at all times. It may be carried in the school first aid kit, although schools can consider allowing students, particularly adolescents, to carry it on their person. Remember, staff P A G E n 9
members still have a duty of care towards the student even if they carry their own adrenaline auto injector. The student with allergies to insect venoms should always wear closed shoes when outdoors. Cooking and art and craft games should not involve the use of known allergens. Consider the potential exposure to allergens when consuming food on buses/airlines and in cabins. STEP BY STEP APPROACH IN CASE OF INCIDENT 1. Check student s condition, analyse situation, remove food responsible for incident if possible [but do not dispose of, as medical staff may require] 2. Immediately contact front office with child's name to confirm ASCIA Action Plan and get adult help. 3. Duty teacher to administer medicine as necessary, in line with instructions and training. (e.g. antihistamine or EpiPen. These will be found in the duty bag.) 4. Front Office to immediately call an Ambulance, send additional staff assistance to help duty teacher and then attempt to contact parents. 5. If necessary, continue to use medicines in line with instructions. 6. Ensure staff member at front of school to meet ambulance and is aware of location of affected student. 7. Ensure that student does not walk to the ambulance after an adrenaline auto-injector is given, even if the student is recovering. The ambulance should put the student on a stretcher and place them in the ambulance. P A G E n 10
Attachment 1: Sample :Individual Anaphylaxis Health Care Plan http://www.health.wa.gov.au/anaphylaxis/docs/schools/11289%20sk15%20health%20car e%20plan.pdf Attachment 2: General ASCIA Action Plan for Anaphylaxis for use with EpiPen http://www.allergy.org.au/images/stories/anaphylaxis/2014/ascia_action_plan_anaphyla xis_epipen_general_2014.pdf Attachment 3 Personal ASCIA Action Plan for Anaphylaxis for use with EpiPen http://www.allergy.org.au/images/stories/anaphylaxis/2014/ascia_action_plan_anaphyla xis_epipen_personal_2014.pdf Attachment 4 General ASCIA Action Plan for Anaphylaxis for use with Anapen http://www.allergy.org.au/images/stories/anaphylaxis/2014/ascia_action_plan_anaphyla xis_anapen_general_2014.pdf Attachment 5 Personal ASCIA Action Plan for Anaphylaxis for use with Anapen http://www.allergy.org.au/images/stories/anaphylaxis/2014/ascia_action_plan_anaphyla xis_anapen_personal_2014.pdf Attachment 6 Personal Action Plan for Allergic Reactions http://www.allergy.org.au/images/stories/anaphylaxis/2014/ascia_action_plan_allergic_ Reactions_2014.pdf Attachment 7 Personal Travel Plan http://www.allergy.org.au/images/stories/anaphylaxis/2013/ascia_travel_plan_anaphyla xis_2013.pdf Attachment 8 Travelling with allergy, asthma and anaphylaxis: checklist http://www.allergy.org.au/images/stories/anaphylaxis/2013/ascia_travel_checklist_2013. pdf P A G E n 11
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