Page 16 - Anaphylaxis in Schools & Other Settings, 3rd Edition Revised

6. No person experiencing anaphylaxis should be expected to be fully responsible for self-administration of an epinephrine auto-injector.
Individuals may not physically be able to self-administer epinephrine when they are suffering from a reaction. They may be anxious about using a needle, may downplay the seriousness of a reaction, or may not want to draw attention to themselves. They may also be confused. Assistance from others, especially in the case of children or teens, is crucial in these circumstances.
Location of Epinephrine Auto-injectors (“auto-injectors”)
Auto-injectors must be kept in locations which are easily accessible (e.g. not in locked cupboards
or drawers) but out of reach of young children. They should not be exposed to extreme cold (fridge/ freezer) or heat (glove box in a vehicle). The locations should be known to all staff members and caregivers. Individuals at risk of anaphylaxis are advised to carry an auto-injector at all times and tell others where the device is kept, in case of an emergency. Auto-injector expiry dates must be checked regularly to ensure that devices have not expired.
Children who have demonstrated maturity (usually by the age of 6 or 7) should carry their own epinephrine. Many children learn to carry their auto-injector in a waist-pack by the time they are in grade one or two. This will vary depending on the child’s development and skill level, level of support provided and education of peers and caregivers. In the case of younger children, staff may have to carry the auto-injector or have it available in the classroom. Classmates and friends should be taught not to play with an auto-injector.
Back-up Auto-injectors
It is suggested that a back-up dose of epinephrine (auto-injector) be available as a precautionary measure. In some situations, a second injection may be required to treat an allergic reaction. It is beneficial for schools to have an epinephrine auto-injector as a standard item in their emergency or first-aid kit. Note that auto-injectors contain one of two specific dosages of epinephrine, i.e. 0.15 mg and 0.30 mg, and are not necessarily interchangeable. (See Appendix A for more information about auto-injectors.)
Some school boards and schools have taken different steps to ensure that back-up devices are available.
ƒ Many school administrators ask parents to provide a back-up epinephrine auto-injector that is kept in a central, unlocked area such as the school office. Some schools consider seeking financial assistance from their boards to ensure that medication is available if families have difficulty providing the school with an adequate supply.
ƒ Some school boards and schools purchase stock epinephrine auto-injectors (i.e. not prescribed for a specific person) for use in an emergency situation.
ƒ Many private day camps and some high schools strategically place spare auto-injectors in common areas such as cafeterias and sports areas.
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Anaphylaxis in Schools & Other Settings
© 2005-2016 Canadian Society of Allergy and Clinical Immunology
Consensus Statement