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GET TRAINED©

Saving Lives at School:School Nurses Train Staff to Respond

to Anaphylactic Emergencies

This program is supported by an unrestrictedgrant from Mylan Specialty

The school nurse is the professionalresponsible to plan for a response to ahealth related emergency

The work of School Nurses helps tosave lives.

Emergencies happen at school . . .

Impacts students dailyin schoolStudent deaths dooccur –

7 year old in Virginia10 year old inWashington State

One death is too many

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Schools must be prepared to handle allergicreactions that require epinephrine

Need to be prepared:For students with a diagnosisFor students with unknown allergiesexperiencing their first episode ofanaphylaxis at school

Gregory, 2012

And the school nurse is the healthcare leaderin the best position to teach them!

School Staff need to know how tosave a child’s life

Participants will :Increase their knowledge base onanaphylaxis management, especially as itrelates to epinephrine administrationUnderstand the importance of trainingschool staff in epinephrine administrationIdentify the tools needed to train schoolstaff to administer epinephrine using anauto injector

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Anaphylaxis Issues and Concerns

Get Trained© Program

Small Group Scenarios

Training Tips for School Nurses

An overview of managing anaphylaxis in theschool setting

Anaphylaxis Issues and Concerns

LatexAllergies

InsectSting

Allergies

FoodAllergies

Most common allergies – food, insect sting, latexand medicationsNearly 8% of children have food allergies withyoung children affected most16 18% of school age children who have foodallergies have had a reaction in schoolIn an estimated 20 25% of the cases, the allergywas not known by the school at the time of thereaction

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Peanuts

Tree Nuts

Fish

Shellfish

Eggs

Milk

Soy

Wheat

Oftenoutgrown

Usuallylifelong –notoutgrown

Usuallylifelong –sometimesdevelopedinadulthood

• First time a food is eaten,the body producesimmunoglobulin E (IgE)which attaches to cells

• Often no symptoms areseen in initial exposure

• First time a food is eaten,the body producesimmunoglobulin E (IgE)which attaches to cells

• Often no symptoms areseen in initial exposure

•Food proteins interactwith IgE and the bodyreleases histamine

•Histamine causes theallergic reaction

•Food proteins interactwith IgE and the bodyreleases histamine

•Histamine causes theallergic reaction

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• Symptoms can appear inminutes or up to twohours later

• Reaction may be biphasic– “rebound effect”

• Symptoms can appear inminutes or up to twohours later

• Reaction may be biphasic– “rebound effect”

Information on Anaphylaxis:NASN Anaphylaxis ResourcesNASN Online Learning: Food Allergies in the SchoolSetting: A Best Practice Approach

Partner Resources:Food Allergy and Anaphylaxis Network

For School ProfessionalsAllergy & Asthma Network Mothers of AsthmaticsAANMA

Epi Everywhere! Every Day! School based Anaphylaxis PreparednessWebinarAnaphylaxis Community Experts (ACEs)

Information on Anaphylaxis:National Education Association – Health InformationNetwork

The Food Allergy Book: What School Employees Need to KnowAmerican College of Allergy, Asthma and Immunology– ACAAI

Anaphylaxis OverviewNational School Boards Association

Safe at School and Ready to Learn: A Comprehensive Policy Guide forProtection Students with Life Threatening Food Allergies

AllergyHome.orgSchools at AllergyHome.org

Links found on the “Get Trained” Webpage of theNASN website

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Universal standard for treatment of anaphylaxisDelayed administration associated withincreased morbidity & mortalityImpressive safety profile:No absolute contraindications to use ofepinephrineCases of cardiac arrhythmias only tend to occurin elderly patients with pre existingcardiovascular disease

National Association of EMS Physicians, 2011

Narrows the blood vessels and opens airwaysin lungsCan reverse:Severe low blood pressureWheezingSevere itchingHives and other allergy reactions

Adult dosing:0.1 – 0.5 mg SC or IM q 5 – 15 min. PRNAuto injectors: 0.3 mg

Pediatric dosing:15 – 30 kg – 0.15 mg IM x1 may repeat> 30 kg (~ 66 lbs) – 0.3 mg IM x1 may repeat

If no response to first dose of epinephrine,appropriate to allow for an additional dose in 5 to20 minutes

National Association of EMS Physicians, 2011

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Epi PenAdult: 0.3 mgEpiPen Jr.: 0.15 mgIM injection intothigh

Auvi QAdult: 0.3 mgAvailable in 0.15 mgas well

People with a prescription for epinephrine donot always carry an auto injectorStudies show that they carry themapproximately 55% of the time

People often unaware of the expiration datesof their epinephrine

National Association of EMS Physicians, 2011

Students need access to epinephrineStorage concerns

20 – 25% of epinephrine administration inschools involve children and youth whoseallergy was unknown at the time of the episodeNeed to advocate for stock epinephrine and anon patient specific order for epinephrine inour schools

Gregory, 2012

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Each state has unique laws and regulationsVirtually every state has passed legislation toallow students to carry prescribedepinephrine at schoolDepending on the wording of the law, thepermission to carry may also extend toactivities held on school property, and duringtransportation to and from school or schoolrelated eventsReview of laws for our state

It’s time for all school staff toGET TRAINEDto administer an epinephrine auto injectorin an emergency!

Get Trained© Program

Developed by NASN Staff through anunrestricted grant from Mylan SpecialtyWritten by school nurses for school nursesComprehensive program for school nurses totrain school staff on epinephrineadministration using an auto injectorEverything needed is included

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Getting Prepared to Train School Staff:“Get Trained” for the School Nurse TrainerA short online learning experience to preparethe school nurse to present the school stafftraining. The outline includes:Plan!Prepare!Present!

Presentation NotesSchool Nurse Trainer’s NotesTraining Program Checklist

Training Tools:“Get Trained” for School StaffComprehensive 20 minute training for theschool nurse to present to school staff totrain them to administer epinephrinethrough an auto injector.

Script for School Nurse for PresentationHandout: Preventing Allergic ReactionsSample Allergy Action/ Emergency Care PlanEpinephrine Training Sign in Sheet

What is Anaphylaxis?

Signs and Symptoms

Epinephrine Administration

Written in lay language with non nursing staff

in mind

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What is Anaphylaxis?

An example of a few slides from the GetTrained program . . .

LatexAllergies

InsectSting

Allergies

FoodAllergies

Anaphylaxis is a severe allergic reaction thatcan be life threateningIt must be treated immediatelyThe drug of choice is epinephrineThe time to learn how to give life savingmedication is now – it needs to be givenwithout delay

It’s time to GET TRAINED!

Preventing exposures is keyFor students with a diagnosed allergy:Know who can help!

Talk to your school nurse or care coordinator

Know how to react!Know the signs and symptoms of anaphylaxisLearn about the student’s Action / Emergency Care PlanKnow where your student’s medication is and how to helpin an emergency

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Remove student from allergen if possible – orremove allergen from studentAssess student symptoms – be prepared toinitiate an Emergency Care Plan quicklyAdminister an epinephrine auto injectorWITHOUT DELAYEpinephrine may need to be repeated in 5 – 20minutes

Be sure an ambulance is on the wayHave two auto injectors available if possible

Epinephrine is the drug of choice foranaphylaxisShould be administered PROMPTLYSome protocols call for epinephrine to beadministered with or without symptoms

A delay in treatment can have devastatingresults

Epinephrine Auto injectors are easy to useCome with instructionsTrainers available for practice use

Websites have video demonstrations – knowthe auto injector prescribed for your studentand know how to administer it!

Epi Pen video

Auvi Q video

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The need for Emergency Care Plans ishighlighted in the program:Uses the FAAN Emergency Care / AllergyAction Plan as template for ECPStaff is instructed that the ECP, written bythe school nurse, will help them to knowwhat to do in an emergencyEncourage practicing plan – using table topdrill, scenarios

Know what auto injectors your students haveShow videos to staff for specific auto injectorsEncourage use of trainers to practice withstaffLet your staff handle them and practiceIncrease confidence level

And when you’re done, you can tell your staffthe following:

TODAY IS THE DAY THATYOU LEARNED HOW TOSAVE A CHILD’S LIFE!

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A time to work together and then share yourideas with the whole group!

Small Group Scenarios

Look at scenario provided

Ask someone to facilitate the conversation

and another to report back to the group

Take 10 minutes to work

Discuss the assigned topic

Share your thoughts and expertise!

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Get ready to present Get Trained!

Training Tips for the School Nurse

Three easy steps:Plan!

Prepare!

Present!

Talk to your School Administrator to discussimportance of staff epinephrine administrationtrainingChoose a time (or offer several times) for trainingthat is convenient for your faculty and staffArrange for an appropriately sized room forpresentation where everyone can see thePowerPoint presentationBe sure your staff knows when training will beheld – and understands the importance of thetraining

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Be familiar with the issues and concernsrelated to allergies and anaphylaxis. You canfind valuable information on the topic at:NASN Food Allergy and Anaphylaxis online Tool KitNASN Online Continuing Education Program: FoodAllergy in the School Setting: A Best PracticeApproachFood Allergy and Anaphylaxis Network (mergingwith Food Allergy Imitative – watch for new nameand link)Allergy and Asthma Network: Mothers ofAsthmatics

Set up presentation room with handoutsSet up presentation equipment and be readyto go!Have fun

and remember –

You are the expert in the roomwhen itcomes to administering epinephrine!

Get Trained ProgramEverything you need to train your schoolstaff on epinephrine auto injectoradministration

School Nurse Trainer’s NotesTraining Program ChecklistProfessional Development on anaphylaxismanagement

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A new concept to support the school nurse

Epinephrine Resource School Nurses

School nurses supporting school nursesList of ERSNs available for contact withquestions or concernsHave had additional training on epinephrineadministrationChosen following a national call forparticipants

Reach out if you have a need!

It’s time for all school staff toGET TRAINED

to administer an epinephrine auto injectorin an emergency!

Remember The work of School Nurses helpsto save lives.

Are You Ready?

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Food Allergy and Anaphylaxis Network (2012). Retrievedfrom: http://www.foodallergy.org/

Robinson, J. & Ficca, M. (2012). Managing the student withsevere food allergies. Journal of School Nursing, 28(3), 187194. doi: 10.1177/1059840511429686.

Sicherer, S. & Simons, F.E. (2007). Self injectable epinephrinefor first aid management of anaphylaxis. Pediatrics, 119(3),638 646. doi: 10.1542/peds.2006 3689.

Gupta, R. et al. (2011). The prevalence, severity, and distributionof childhood food allergy in the United States. Pediatrics, 128:e9 e17. doi: 10.1542/peds.2011 0204National Association of School Nurses (2011). Online foodallergy tool kit. Retrieved from:http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxisNational School Boards Association. (2010). Food allergy andfood safety 101. Retrieved from: http://www.nsba.org/BoardLeadership/SchoolHealth/101Packets/FAFS 101.pdfNational Association of School Nurses. (2006). Positionstatement: Delegation. Available at:www.nasn.org/Default.aspx?tabid_349.

National Diabetes Education Program. (2010) Helping thestudent with diabetes succeed: A guide for school personnel.Retrieved from:http://www.ndep.nih.gov/media/youth_schoolguide.pdf?redirect=trueLieberman J., Weiss C., Furlong T. J., Sicherer, M., & Sicherer S. H.(2010) Bullying among pediatric patients with food allergy.Journal of Allergy, Asthma and Clinical Immunology. 105 (4) 282– 286.

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For more information – know the brand ofepinephrine auto injector that your studenthas been prescribed:

Epi Pen : www.epipen.com

Auvi Q : https://www.auvi q.com/