The Emergency Response to Anaphylaxis

Allergy awareness and preventative measures that followed by all school staff and pupils are the cornerstone for the management of the allergic child. Emergencies are unpredictable, so it is essential that everyone in the school knows their role in the event of anaphylaxis, much like being prepared for a fire.

Emergency Response Protocol

During anaphylaxis, it is critical that adrenaline is delivered to the patient immediately. The appropriate emergency response requires staff to know how to administer adrenaline via an AAI, but also where the medication is kept, how to position the child and call for help.

It is important for schools to have an emergency response protocol. This is a set of instructions that all staff are aware of and follow in emergencies.

Adrenaline is a powerful drug that is very effective and fast acting. However, it is important to remember that symptoms of anaphylaxis might return even after the administration of adrenaline.

Therefore, anyone who has been treated with adrenaline must be taken to hospital for further treatment, if required, and a period of observation.

An ambulance must always be called following the administration of adrenaline.

The Emergency Response at a Glance



Assess symptoms & stay calm.	Patient Positioning.	Call for help –retrieve emergency kit.	Using allergy action plan – Assess the reaction.


Administer the AAI, then call 999.	Make a note of the time.	Monitor closely until ambulance arrives.	Administer the 2nd AAI if no improvement after 5 mins & make 2nd 999 call.

The emergency response protocol for anaphylaxis should include:

Step 1	Assess for signs & symptoms of anaphylaxis; signs of airway obstruction, increased work of breathing and reduced consciousness level. If any one (or more) of these signs above are present follow the Emergency Response to Anaphylaxis.
Step 2	Stay Calm and Call for Help. Remove allergen if possible (e.g. excess of food, venom sting).
Step 3	Positioning a child presenting with anaphylaxis symptoms; Lying down with legs elevated where possible. If patient is struggling to breathe, sit up, but this should be for as short a time as possible
Step 4	Identify the emergency kit and refer to the Personalised Allergy Action Plan – always bring the kit to the child.
Step 5	Administer adrenaline, note the time given.
Step 6	Call 999 – Stating anaphylaxis (ANA - FIL - AX - IS), that adrenaline has been administered and give clear, precise directions to the operator including the postcode of your location. Ensure a staff member is outside to direct the paramedics to the site.
Step 7	Stay with child until ambulance arrives. Avoid any sudden change in posture; the patient must not be allowed to stand up, or sit in a chair, even if they are feeling better (due to the risk of cardiac arrest). Phone parent/emergency contact. Antihistamines can now be given. If wheezy, give salbutamol inhaler (blue asthma inhaler). If no signs of life, commence cardiopulmonary resuscitation (CPR).
Step 8	If no improvement after 5 minutes, give a further adrenaline dose using a second AAI device, if available. In this instance, make a second 999 call to ensure an ambulance is on its way.

Storing emergency medication in school

The MHRA guideline states that patients should have access to two AAI’s at all times, as a further dose might be required, or in case the AAI device is used wrongly or misfires. The Department of Health states that schools may wish to store pupil’s AAI’s in the school, to avoid the risk of the child/parent forgetting to bring the medication each day. However, such pupils will require access to the AAI when travelling to and from school. For this reason, school aged patients are usually issued with four AAI’s initially (2 sets): 1 set to be stored in the school and 1 set to be kept with the child at all times.

The first kit should be stored as part of an emergency kit in the school which should include:

The Personalised Allergy Action Plan
Antihistamines for mild to moderate reactions
Two adrenaline auto injectors for anaphylaxis
Salbutamol inhaler (blue inhaler: asthma reliever) if the pupil has been prescribed with this along with a spacer

An additional kit should be carried by older kids at all times. For young children, this could be kept in the classroom during school hours which is then passed over to the parents/carers on journeys to and from school.

Schools may wish to ask parents/carers to take their child’s prescribed AAI home before school holidays (including half term breaks) to ensure that their own AAIs remain in date. See Primary Schools for more information.

It is recommended for the child’s name and picture to be displayed on the outside of the kit where possible, for quick identification in emergencies. The Department for Education Data Protection Toolkit for Schools states that this does not breach data protection (GDPR) as it is deemed essential for keeping such children safe. Schools should try to ensure that only the relevant medical information is displayed, the number of people who can see the information is kept to a minimum and parents/carers are informed of the information displayed.

Example:

Medpac Bag

The emergency kits should be stored in a central point in the school, such as the school office, no more than 5 minutes from where they may be needed. It is important that the kits are not locked away as they should be easily accessible for staff in emergencies. They should, however, be safely stored away from pupils.

Parents/Carers Responsibility:
Parents are responsible for ensuring medication at school is correct and in date. The emergency kit should be given to the school at the start of each term. Parents should also inform staff of any changes to the allergy management plan following clinic appointments.
Schools Responsibility:
The school should conduct regular audits of the kit to ensure the medication is correct and in date.
The school may find it helpful to receive email alerts from the AAI manufacturer:
EpiPen
Jext
Emerade