LESSON 6 – MANAGING ANAPHYLAXIS IN SCHOOLS AND CHILD CARE SERVICES

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  • Where schools and child care services have a student diagnosed at risk of anaphylaxis, staff should receive training in recognition and emergency treatment of anaphylaxis as well as risk minimisation strategies for prevention of exposure to known allergens.
  • It is important to note that anaphylaxis can occur in children not previously identified as being at risk of anaphylaxis. Therefore, all staff should know how to recognise and respond to an allergic reaction, even if they do not currently have children enrolled who have been prescribed an adrenaline autoinjector.

ANAPHYLAXIS IN SCHOOLS

Where schools have a student enrolled with an ASCIA Action Plan for Anaphylaxis, they should:

  • Be familiar with the anaphylaxis guidelines and legislative requirements for Victorian schools and ensure that staff have undertaken anaphylaxis training which meets Ministerial Order 706: www.education.vic.gov.au/school/principals/health/Pages/anaphylaxisschools.aspx
  • Be familiar with the student’s ASCIA Action Plan for Anaphylaxis.
  • Understand the roles and responsibilities of parents/guardians, the school, school staff and students.
  • Develop an Individual Anaphylaxis Management Plan for the student(s) at risk of anaphylaxis, in consultation with the student’s parents/guardians and the student where appropriate (e.g. high school) and implement or review risk minimisation strategies as part of the development of this plan.

Anaphylaxis guidelines and legal requirements

  • Schools have a duty of care to keep students safe at school. This includes minimising the risk of personal injury to students, seeking medical assistance and administration of emergency medication, such as adrenaline autoinjectors when a student has signs of anaphylaxis.
  • It is important that you are familiar with the Children’s Services and Education Legislation Amendment (Anaphylaxis Management) Act 2008. This requires that all licensed children’s services and schools in Victoria have an anaphylaxis management policy in place, when a child is enrolled at risk of anaphylaxis.
  • It is important that you are familiar with Ministerial Order 706 – Anaphylaxis Management in Victorian Schools which outlines the requirements of a school anaphylaxis management policy.
  • Schools should use the Anaphylaxis Guidelines: a resource for managing severe allergies in Victorian schools as a resource to assess and review their current management practices, and to develop a school anaphylaxis management policy that complies with Ministerial Order 706.

 

Anpahylaxis in the pre-school sector

Anaphylaxis – important issues for childcare services

Childcare services with a child diagnosed at risk of anaphylaxis should:

  • Be familiar with both national (ACECQA) and your region’s anaphylaxis guidelines and legislative requirements for childcare services.
  • Ensure staff have undertaken anaphylaxis training.  In Australia, the training should be approved by the Australian Children’s Education & Care Quality Authority (ACECQA).
  • Be familiar with the child’s ASCIA Action Plan for Anaphylaxis.
  • Understand the roles and responsibilities of parents/guardians, the childcare service and staff.
  • Develop an anaphylaxis management/health care plan in consultation with the parents of the child at risk of anaphylaxis.
  • Implement and review risk minimisation strategies as part of the development of an anaphylaxis management/health care plan.

Anaphylaxis guidelines and legislative requirements for childcare services

 

Roles and responsibilities of parents/guardians

  • Notify school of their child’s allergies and provide appropriate medical information.
  • Assist the school in the development of an Individual Anaphylaxis Management Plan for their child and participate in reviews of this Plan.
  • Ensure that the school is notified of changes to the child’s medical condition or emergency contact details.
  • Provide an ASCIA Action Plan for Anaphylaxis completed by the child’s doctor.
  • Provide an adrenaline autoinjector clearly labelled with child’s name to the school. Some upper primary and high school students choose to carry their adrenaline autoinjector on their person, and this is documented in their Individual Anaphylaxis Management Plan. These students must also have an additional adrenaline autoinjector kept in an agreed location (e.g. the first aid room).
  • Provide any other medication indicated on the child’s ASCIA Action Plan for Anaphylaxis and ensure that it is in date.
  • Promptly replace the child’s adrenaline autoinjector if it is used or out-of-date.
  • Provide an updated ASCIA Action Plan for Anaphylaxis after a change in the health condition of the child, through annual (or as required) reviews by a medical practitioner or after an allergic reaction.
  • Assist school staff in planning and preparation for the student prior to school camps, field trips, excursions or special events (e.g. class parties, cultural days, fetes or sport days). Supply alternative food options for the student when needed.
  • Educate the child about their allergies and how to minimise the risk of exposure (such as not sharing food if allergic to food, or taking precautions when outdoors if allergic to insects).

 

Roles and responsibilities of school principals

  • Implement a School Anaphylaxis Management Policy when a student is enrolled at risk of anaphylaxis.
  • The School’s Anaphylaxis Management Policy must include Emergency Response Procedures relating to anaphylactic reactions.
  • Actively seek information from the parent/guardian about allergies that affect their child as part of health information collected at enrolment and as part of regular health updates.
  • Request that the parent/guardian supplies the school with an ASCIA Action Plan for Anaphylaxis, completed by the student’s doctor and an adrenaline autoinjector for the student to be kept at school (if prescribed).
  • Meet with parents/guardians to develop an Individual Anaphylaxis Management Plan for the student. This includes documenting practical strategies for in-school and out-of-school settings to minimise the risk of exposure to known allergens, and nominating staff who are responsible for their implementation. The risk management plan should be customised to the particular student, based on the potential for exposure to known allergens and the age of the child.
  • All canteen providers, including external providers, schools must ensure that the provider can demonstrate satisfactory training in the area of anaphylaxis and its implications for food-handling practices.
  • Ensure that parents/guardians provide the student’s adrenaline autoinjector and that it is not out-of-date.
  • Arrange to purchase and maintain appropriate numbers of adrenaline autoinjectors for general use to be part of the school’s first aid kit.
  • Develop a communication plan to provide information to all staff, students and parents/guardians about anaphylaxis and the school’s anaphylaxis management policy.
  • Ensure that there are procedures in place for informing casual relief teachers of the identities of students at risk of anaphylaxis and the steps required for prevention and emergency response.
  • Ensure the Risk Management Checklist for anaphylaxis is completed annually.Ensure all school staff are briefed at least twice yearly by a staff member who has up-to-date anaphylaxis management training on:
    • The school’s anaphylaxis management policy
    • The causes, symptoms and treatment of anaphylaxis
    • The identities of students diagnosed at risk and the location of their medication
    • How to use an adrenaline autoinjector, including hands-on practice with adrenaline autoinjector trainer devices
    • The school’s first aid and emergency procedures
  • Ensure all school staff have successfully completed an approved anaphylaxis management training course.
  • Ensure two school staff are appointed and trained to perform the role of School Anaphylaxis Supervisor.
  • Allocate time, such as during staff meetings, to discuss, practise and review the school’s management strategies for students at risk of anaphylaxis and practise with adrenaline autoinjector trainer devices.
  • Encourage ongoing communication between parents/guardians and staff about the current status of the student’s allergies, the school’s policies and implementation.
  • Ensure that the student’s Individual Anaphylaxis Management Plan is reviewed annually; or if the student’s medical condition changes; or immediately after a student has an anaphylactic reaction at school, in consultation with parents/guardians.
  • Ensure the school’s anti-bullying policy is inclusive of students with allergies.
  • Ensure all school staff are briefed at least twice yearly by a staff member who has up-to-date anaphylaxis management training on:
    • The school’s anaphylaxis management policy
    • The causes, symptoms and treatment of anaphylaxis
    • The identities of students diagnosed at risk and the location of their medication
    • How to use an adrenaline autoinjector, including hands-on practice with adrenaline autoinjector trainer devices
    • The school’s first aid and emergency procedures
  • Ensure all school staff have successfully completed an approved anaphylaxis management training course.
  • Ensure two school staff are appointed and trained to perform the role of School Anaphylaxis Supervisor.
  • Allocate time, such as during staff meetings, to discuss, practise and review the school’s management strategies for students at risk of anaphylaxis and practise with adrenaline autoinjector trainer devices.
  • Encourage ongoing communication between parents/guardians and staff about the current status of the student’s allergies, the school’s policies and implementation.
  • Ensure that the student’s Individual Anaphylaxis Management Plan is reviewed annually; or if the student’s medical condition changes; or immediately after a student has an anaphylactic reaction at school, in consultation with parents/guardians.
  • Ensure the school’s anti-bullying policy is inclusive of students with allergies.

 

Roles of the School Anaphylaxis Supervisor

  • Work with principals to develop, implement and review the school’s Anaphylaxis Management Policy and each student’s Individual Anaphylaxis Management Plan.
  • Obtain current training in how to recognise and respond to anaphylaxis, including administering an adrenaline autoinjector.
  • Verify the correct use of adrenaline autoinjector (trainer) devices by other school staff undertaking the ASCIA Anaphylaxis e-training for Victorian Schools.
  • Provide access to the adrenaline autoinjector (trainer) device for practice use by school staff.
  • Lead the twice-yearly Anaphylaxis School Briefing.
  • Provide or arrange current training to other staff members to recognise and respond to anaphylaxis.
  • Keep an up-to-date register of students at risk of anaphylaxis and of the training undertaken by school staff.
  • Regularly review the Individual Anaphylaxis Management Plans to:
    • Ensure that the students’ emergency contact details are up-to-date
    • Ensure that the ASCIA Action Plan for Anaphylaxis matches the supplied adrenaline autoinjector
    • Check that the adrenaline autoinjector is not out-of-date or discoloured
    • Inform parents/guardians in writing a month prior to the expiry date if the adrenaline autoinjector needs replacing
    • Ensure that adrenaline autoinjectors are stored correctly in an unlocked, easily accessible place and that this storage area is appropriately labelled.
  • Work with staff to conduct regular risk prevention, assessment, minimisation and management strategies.
  • Work with staff to develop strategies to raise school staff, student and community awareness about severe allergies.
  • Provide or arrange post-incident support (e.g. counselling) to students and staff as required.

 

Role of the student

  • Age-appropriate knowledge of how to avoid their known allergens.
  • An in-date adrenaline autoinjector provided by the parents/guardians to the school and readily available for use in an emergency.
  • An ASCIA Action Plan for Anaphylaxis, stored with their adrenaline autoinjector.
  • An Individual Anaphylaxis Management Plan.

Role of Older, more independent students

  • Communicate about their allergies and emergency treatment to peers and teachers.
  • Check food labels.
  • Know the signs and symptoms of an allergic reaction and that they need to get help if they experience an allergic reaction.
  • Be familiar with the use of their adrenaline autoinjector. Practise using their prescribed device using an adrenaline autoinjector trainer device without medication and needle.
  • If it is agreed in their Individual Anaphylaxis Management Plan that the student will carry a personal adrenaline autoinjector and ASCIA Action Plan for Anaphylaxis on them, ensure that there is ready access to their device such as a carry bag.
  • Ensure their adrenaline autoinjector is within its expiry date.

Even if students carry their own adrenaline autoinjector, they may be too unwell to self-administer. It is the responsibility of staff to either administer the adrenaline autoinjector or supervise or assist an older student self-administering an adrenaline autoinjector. Peer education is particularly important in this age group.

It is important for students to know that if they feel sick, they should lay down and immediately call out to someone nearby, such as a teacher, other adult or a student to get help.

 

Roles and responsibilities of childcare services

  • Seek information from the parent/guardian about allergies that affect their child as part of health information collected at enrolment and as part of regular health updates.
  • Ensure that the parent/guardian supplies the childcare service with an adrenaline autoinjector for the child to be kept at the childcare service and an ASCIA Action Plan for Anaphylaxis, completed by the child’s doctor.
  • Ensure an individual anaphylaxis management/health care plan for the child has been developed in consultation with the child’s doctor, relevant staff and the parent/guardian. This plan is to  be reviewed and updated at least yearly as risk minimisation strategies may change.
  • Promote good communication between all relevant stakeholders concerning the childcare service’s anaphylaxis policy and procedures.
  • Store the child’s ASCIA Action Plan for Anaphylaxis in the same location as their personal adrenaline autoinjector (stored unlocked and easily accessible) and display in appropriate areas within the childcare service.
  • Ensure staff have undertaken anaphylaxis training and maintain a register of staff who have completed training.
  • Store EpiPen trainers in a different location to the actual adrenaline containing devices.
  • Promote safety in activities, by minimising exposure to known allergens.
  • Undertake a risk assessment and implement appropriate risk management strategies, including off site activities and review as part of the individual anaphylaxis management/health care plan at least annually.
  • Have a planned emergency response. Yearly practice drills should be considered.
  • Ensure the anti-bullying policy is inclusive of children with allergies.
  • Review and assess anaphylaxis management strategies at least yearly.
  • Establish a process for checking the adrenaline autoinjector expiry dates of adrenaline autoinjectors.
  • Where legislation does not require it, consider the inclusion of adrenaline autoinjectors for general use in first aid kits.

Roles and responsibilities of childcare services staff

  • Know what anaphylaxis and allergies are (refer to Module 1).
  • Know which children are at risk of anaphylaxis.
  • Know how to minimise exposure to known allergens.
  • Know how to recognise an allergic reaction including anaphylaxis and follow the ASCIA Action Plan in an anaphylaxis emergency (refer to Module 2).
  • Know where the child’s adrenaline autoinjector and ASCIA Action Plan for Anaphylaxis are located.
  • Know when and how to give the adrenaline autoinjector (refer to Modules 2 and 3).
  • Know the service’s emergency response procedure.
  • Plan ahead for special activities (such as art, cooking, special occasions, incursions and off-site activities) and liaise with parents/guardians in advance.

 

Risk minimisation strategies

  • Allergic reactions to foods and insects are two of the most common causes of anaphylaxis (refer to Module 1) seen in schools.
  • As it is possible to be allergic to any food, it is not possible, nor practical, to remove all possible food allergens from schools.
  • It is also not possible to remove all insects or ticks that students are allergic to.
  • Minimising exposure to known allergens is therefore a more appropriate way to reduce the risk of anaphylaxis in schools.
  • Age appropriate and practical risk minimisation strategies should be implemented by schools with students who have an ASCIA Action Plan for Anaphylaxis.
  • Students with allergies and their peers should be educated about allergies and anaphylaxis. Curriculum resources for K-12 are available from the Allergy & Anaphylaxis Australia website (www.allergyfacts.org.au/how-to-manage/school-resources). Resources may also be available in the Victorian schools curriculum website: http://victoriancurriculum.vcaa.vic.edu.au/
  • Risk minimisation strategies should be reviewed by schools in consultation with parents/guardians, including when health information is collected at enrolment or updated throughout the year.

 

 Risk minimisation & food bans

Blanket food bans are NOT recommended.

Banning specific foods from an environment will not eliminate the risk of accidental exposure.

Food bans:

  • are not proven to help reduce risk,
  • are difficult to enforce,
  • may result in a false sense of security,
  • may trigger resentment and lack of cooperation with more important measures, and
  • may at times, result in bullying of the individual with food allergy or their parent.

It is unreasonable to expect that a school or preschool will be totally ‘nut free’ and such claims should not be made.

Risk minimisation and food restrictions

  • Unlike food bans, food restrictions may have a role to play in young children who might share common pencils, books or toys where cross contamination with food may result in allergic reactions from oral exposure or greater person-to-person contact in young children. An example of a food restriction may be asking parents of early primary children not to include products containing nuts in their child’s lunch box.
  • Food restrictions become less important for older students who are better able to self-manage their allergies.

 

Risk minimisation – food allergens

Schools & Pre-schools should:

  • Ensure anyone in the school who prepares food is trained in food selection, handling and storage of foods with food allergy in mind.
  • Keep surfaces clean and prevent cross-contamination during handling, preparation, storage and serving of food.
  • Implement age appropriate avoidance strategies for routine and non-routine activities such as meal times, cooking, art, sport days, special occasions (e.g. birthdays), incursions and excursions.
  • Identify foods used in activities that contain known allergens and replace with other suitable foods where possible.
  • To minimise the risk of a first time reaction to peanuts and nuts, schools should not use peanuts or other nuts in curricular or extracurricular activities.
  • Identify foods used in activities that contain known allergens and replace with other suitable foods where possible. For example, a science experiment that uses milk could have soy milk substituted if there was a dairy allergic child in the class.
  • Avoid sharing food, eating utensils or wind musical instruments (close supervision may be required at meal times for younger students).
  • Promote good communication between parent/guardian, staff, volunteers and the student.

Further information on minimising exposure to high risk foods can be found at:
http://www.allergy.org.au/schools-childcare
https://www.allergyfacts.org.au/how-to-manage/schooling-childcare
ASCIA dietary avoidance information sheets may also be useful:
www.allergy.org.au/patients/food-allergy/ascia-dietary-avoidance-for-food-allergy

 

Risk mimimisation – insects

  • Have bee and wasp nests removed by a professional.
  • Consider poisoning Jack Jumper ant nests if there are children with Jack Jumper ant allergy.
  • Cover garbage receptacles that may attract stinging insects.
  • When purchasing plants for an existing or new garden, consider those less likely to attract bees and wasps.
  • Specify play areas that are lower risk and encourage the student and their peers to play in these areas (e.g. away from garden beds or garbage storage areas).
  • Ensure students wear appropriate clothing and covered shoes when outdoors.
  • Be aware of bees in pools, around water and in grassed or garden areas.
  • Educate children to avoid drinking from open drink containers, particularly those containing sweet drinks that may attract stinging insects.
  • Children with food and insect allergy should not be asked to pick up food litter as it may contain an allergen.
  • To reduce the risk of tick bites, wear a hat and cover skin when outdoors. Remove hat and brush clothing before going indoors.
  • The same issues regarding insect bites and stings need to be considered when school camps are held in rural or remote areas or in the bush where exposure to ticks or Jack Jumper ant stings may occur.

Further information on insect and tick allergy is available here:
www.allergy.org.au/patients/insect-allergy-bites-and-stings

 

Risk minimisation – less common allergens

Latex rubber allergy
Latex rubber allergy is relatively rare in children. If a school has a student enrolled with latex allergy, non-latex gloves should be made available in sick bay, first aid kits, canteens and kitchens.

Consideration should also be given to the following:

  • Non-latex swimming caps if a school specific swimming cap must be worn (e.g. interschool sports carnivals) for students with latex allergy.
  • Non-latex balloons.

Medication allergy

  • Severe allergic reactions to medications are relatively rare in young children outside of the hospital setting.
  • Documentation regarding known or suspected medication allergy should be recorded by the school on enrolment.

 

Risk minimisation – excursions

Supervising staff on school excursions need to:

  • Know which students are at risk of anaphylaxis and their known allergens.
  • Know what risk minimisation strategies are in place for students at risk of anaphylaxis in the school setting and how these will need to be adapted when planning an excursion.
  • Have completed training on anaphylaxis management, including the administration of prescribed adrenaline autoinjectors
  • Have the ASCIA Action Plan for Anaphylaxis and adrenaline autoinjector readily available.
  • Know when and how to give the adrenaline autoinjector.
  • Have an excursion specific planned emergency response procedure in place.

If the school has an adrenaline autoinjector for general use, a risk assessment should be undertaken to determine whether it should be taken on the excursion. Refer to the Department’s Guidelines for Managing Anaphylaxis in all Victorian Schools for further advice at: www.education.vic.gov.au/school/principals/health/Pages/anaphylaxisschools.aspx

 

Risk minimisation – camps

School staff should liaise with school staff/camp coordinator(s) prior to the camp to discuss:

  • Emergency response procedures that clearly outline roles and responsibilities of the teachers in policing prevention strategies and their roles and responsibilities in the event of an anaphylactic reaction.
  • All teachers attending the camp should carry laminated emergency cards, detailing the location of the camp and correct procedure for calling ambulance, advising the call centre that a life threatening allergic reaction has occurred and adrenaline is required.
  • Staff attending camp should demonstrate correct administration of adrenaline autoinjectors using training devices prior to camp.
  • Staff should be familiar with all students attending camp who are at risk of anaphylaxis and their allergens.
  • Consider contacting local emergency services and hospital/s prior to camp and advise the number of students in attendance at a specified location, including students at risk of anaphylaxis and the date of the camp. Ascertain location of closest hospital and the ability of the ambulance to get to the camp site area (e.g. consider locked gates in remote areas).
  • Confirm mobile phone network coverage for standard mobile phones prior to camp. If no access to mobile phone network, an alternative needs to be discussed and arranged.

School staff should liaise with parents/guardians prior to the camp to discuss:

  • Encourage parents/guardians to provide two adrenaline autoinjectors along with the ASCIA Action Plan for Anaphylaxis and any other required medications whilst their child is on the camp. The second adrenaline autoinjector should be returned to the parents/guardians on returning from camp.
  • Clear advice between parents/guardians, teachers, camp operators and all students should be communicated prior to camp regarding what foods are not allowed.
  • Food plans for the duration of the camp. Parents/guardians may prefer to provide all of their child’s food for the duration of the camp. This is the safest option. If this is the case, storage and heating of food needs to be organised.
  • Communications with camp catering staff to discuss food options, menu, food brands, cross contamination risks to determine the safest food choices for their child.

Discussions by school staff and parents or guardians with the operators of the camp facility should be undertaken well in advance of camp. Example of topics that need to be discussed would be:

  • Removal of nuts from menu for the duration of the camp (if nut allergic child is attending camp).
  • Creation of strategies to help reduce the risk of an allergic reaction where the food allergen (e.g. egg, milk, wheat) cannot be removed (e.g. a decision may be made to remove pavlova as an option for dessert if an egg allergic child is attending).
  • Awareness of cross contamination of allergens in general (e.g. during storage, preparation and serving of food).
  • Discussion of the menu for the duration of the camp including morning and afternoon teas and suppers.
  • Games and activities should not involve the use of peanut or tree nut products or any other known allergens.

Camp organisers need to consider domestic activities that they assign to children on camp. It is safer to have the child with food allergy set tables, for example, rather than clear plates and clean up.

 

Risk minimisation – overseas travel

Discussions by school staff and parents or guardians with overseas organisations should be undertaken well in advance of any overseas travel. Example of topics that need to be discussed would be:

  • Investigate the potential risks of during the overseas travel (e.g. foreign languages, interpreting food labels, accommodation venues, sourcing safe foods with different cuisines, air and boat travel).
  • Assess and minimise these risks through an updated Individual Anaphylaxis Management Plan.
  • Record details of travel insurance and determine costs/access to associated medication, treatment and medical care.
  • Plan for appropriate supervision of students at risk of anaphylaxis at all times.
  • Review the emergency response procedures in place during overseas travel.

 

Further information

Department of Education and Training – Anaphylaxis Management in Schools
Access to Ministerial Order 706 and the associated guidelines and resources.
www.education.vic.gov.au/school/principals/health/Pages/anaphylaxisschools.aspx

Australasian Society of Clinical Immunology and Allergy (ASCIA)
ASCIA Guidelines for prevention of anaphylaxis in schools, pre-schools and childcare.
www.allergy.org.au/health-professionals/papers/prevent-anaphylaxis-in-schools-childcare

ASCIA Action Plans for Anaphylaxis and other anaphylaxis resources:
www.allergy.org.au/health-professionals/anaphylaxis-resources

Information for schools and childcare
www.allergy.org.au/schools-childcare

Allergy & Anaphylaxis Australia (Patient support organisation)
www.allergyfacts.org.au

National Asthma Council (NAC) website for Asthma Action Plans:
www.nationalasthma.org.au/living-with-asthma/asthma-tools/written-asthma-action-plans

Information for schools and childcare:

http://www.allergy.org.au/schools-childcare

Anaphylaxis Training, Guidelines, Procedures for Schools and Children’s Services:

www.allergy.org.au/health-professionals/anaphylaxis-resources/anaphylaxis-guidelines-for-schools-and-childrens-services

Allergy & Anaphylaxis Australia (Patient support organisation)

www.allergyfacts.org.au

National Asthma Council (NAC) website for Asthma Action Plans

www.nationalasthma.org.au/asthma-tools/asthma-action-plans/asthma-action-plan-library

Region specific guidelines

www.allergy.org.au/health-professionals/anaphylaxis-resources/anaphylaxis-guidelines-for-schools-and-childrens-services

Lesson tags: Anaphylaxis, CHILD CARE SERVICES, LESSON 6, MANAGING ANAPHYLAXIS
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