Establishing an Anaphylaxis Policy in your School

Every Canadian school needs an anaphylaxis management policy! At-risk children (whose numbers are increasing) must be able to learn in a secure and supportive environment. Education of caregivers can make a world of difference, leading to an improved quality of life for allergic students and a reduction in the number of preventable deaths. School personnel can help reduce exposure to allergens, recognize the signs of a reaction and make sure that appropriate treatment is promptly delivered.

The ideal is to have consistent province-wide school policies throughout Canada. Each school should also have measures in place that ensure ongoing accountability and responsibility for the functioning of the various elements of the policy. Whether or not school policies are legally required by the particular province or territory, individual schools can and should take immediate steps to establish a policy if they have not already done so.

School anaphylaxis policies are a delicate balance of rights, risk management measures and responsibilities borne by various stakeholders, including parents, students, administrators, teachers and support staff. Policies need to be sufficiently flexible to deal with a wide variety of allergies and allergic conditions and they need to be broad enough to use in schools of different sizes, physical layouts and grade levels. Everyone who comes in contact with at-risk children has a role to play and they should all be aware of the policy. This includes lunch program monitors, bus drivers and parent volunteers.

At minimum, all anaphylaxis school policies should include the following elements:

• Responsibilities of parents, school administrators, students, teachers
• Procedures for identifying students at risk and ensuring that medical forms are obtained and updated.
• Requirement for annual (and preferably semi-annual) staff training about life-threatening allergies, use of auto-injectors and general emergency procedures.
• A provision allowing school staff, in an emergency, to administer epinephrine to an anaphylactic student without parental consent.
• Emergency protocol

A list of resources is appended; it includes the policies in place in some provinces. In addition, individual schools need to consider:

• How epinephrine auto-injectors will be stored / carried
• Strategies to reduce exposure to allergens in the lunchroom, classroom, common areas (i.e. library, gym, computer room, playgrounds and playground climbing equipment)
• Communication strategies for disseminating information on life-threatening allergies to parents, students and staff
• Procedures for field trips and special events

Getting Started

If your school is in a province or school district that has mandated a policy, you should begin by implementing that policy. There may still be work to be done – once the required policy elements are in place, then the school can proceed to identify gaps, special circumstances, and particular needs of the individual school. Keep in mind the need for ongoing accountability – a policy that fizzles is not much use. If it is to be effective over the long term it needs to become part of the fabric of the school and everyone must be aware of it and committed to it.

If there is no provincial or board format required, then we recommend that you proceed as follows:

• Assign the overall responsibility for the policy to a senior or professional staff member. While many schools in the past have relied on parent volunteers to advocate for allergic children, it is very important that there be a formal written policy and ongoing accountability for that policy. Ideally the responsibility should appear in a job description, so that it will be taken seriously and provide accountability for the future, even if there are personnel changes.
• Try to involve the school nurse, if a nurse is assigned to the school on a full or part time basis. In some provinces or particular districts they also assume some responsibilities for allergies. As a health professional the nurse is well positioned to take responsibility for identifying students at risk, ensuring that medical forms are up to date, training staff and communicating with parents about medical issues. They have professional credibility and they can provide accountability and follow-up.
• Consider establishing an allergy committee that can help formulate specific policies for the particular school, e.g. procedures on where students will eat, how lunch areas will be cleaned, how field trips and special events will be handled and communications with the parent body about any food restrictions. The allergy committee could be composed of both staff members and parent volunteers.
• Emphasize education, awareness and proper food-handling hygiene. Simply banning a particular allergenic food is not sufficient and should never be the only step taken. The goal should be to create an environment that is allergy aware and therefore safer for any student who is at risk of anaphylaxis, which could be triggered by foods or stinging insect or even medication (although less likely in a school setting). The most common food allergens in children are peanut, nuts, egg, milk, wheat, soy, sesame, shellfish or fish – but other less common food allergies can occur. The AAIA has an excellent anaphylaxis training kit for schools that can be used by a school nurse or a layperson to train staff.
• Make sure that all school personnel have an opportunity to practice using an auto-injector at least once and preferably twice a year. Auto-injector training devices are available – see EpiPen^® and Twinject^® websites in the Useful Resources chart.

Mary Allen, August 2008