Since 2017, schools have been allowed to purchase spare, back-up AAI’s for use on pupils who have been deemed at risk of anaphylaxis and have medical authorisation and parental consent for use. This acts as a back-up safety measure, ensuring that emergency medication will be available if needed. Although schools are encouraged to take on this initiative, they are not required to store spare, back-up AAI’s.

AAI’s are available in different doses, depending on the manufacturer:  The Resuscitation Council (UK) recommends that healthcare professionals treat anaphylaxis using the age-based criteria as follows:

*Product not available, see BNFc important Safety Information

** If > 60 kg; if small or pre-pubertal offer 0.3 mg

It is a matter for schools to decide the brand and quantity of AAI to order. Some have a longer expiry date and they may wish to take this into consideration. It is recommended that schools purchase the brand of AAI that is most commonly prescribed to its pupils. Schools may need to purchase two 0.15 mg dose AAI and two 0.3mg dose AAI based on the age of registered pupils with allergy. The decision as to how many devices and brands to purchase will depend on local circumstances and is left to the discretion of the school. Some schools may wish to seek appropriate medical advice when deciding which AAI device(s) are most appropriate.

The Scottish guidance can be found  here and the Department of Health guidance  here

The Spare, back-up AAI is to be used when the pupil’s own device is not available e.g. due to being:

     Expired
     Broken
     Misfired or injected incorrectly
     Forgotten

They also act as a back-up in cases where a second dose of adrenaline is required but the pupil has only one AAI available.

Ordering spare AAIs

Spare, back-up AAI’s can be purchased by sending an order form to pharmacies. Currently there are no funding arrangements in place, so schools are required to pay for the spare AAI as a retail item.

Pricing information can be found here.

More information on purchasing devices from pharmacies can be found here.

The form for ordering spare, back-up AAI’s from pharmacies can be downloaded here.

Protocol for the use and storage of spare AAIs

Schools who choose to purchase the spare, back-up AAI should implement a protocol for its storage and use in the school. This protocol should be part of the school’s allergy management policy or part of the wider medical conditions policy, as good practice.

The Department of Health advises the protocol should include:

	Arrangements for the supply storage and care of the AAI, in line with the Scottish Government ‘Supporting children and young people with medical needs’ Guidance.
	A checklist of all the AAI’s stored in the school, identified by batch number and expiry date with monthly checks recorded. Replacement AAIs should be obtained when expiry dates approach (this can be facilitated by signing up to the expire alerts through the relevant AAI manufacturer).
	A written consent from the pupil’s parents/carers for use of the spare, back-up AAI (s) as part of the pupil’s individual healthcare plan.
	Assurance that any spare, back-up AAI is used only in pupils with medical authorization and written medical consent have been provided (See BSACI Allergy Action Plan).
	Appropriate support and training for staff in the use of AAI in line with the school’s wider policy on supporting pupils with medical needs or allergy management policy.
	A process for informing a record of use of any AAI(s), as required by the guidance and informing parents/carers that an AAI has been administered to their child and whether this was the school’s spare, back-up AAI or the pupil’s own device.

 Department for Health states that it may be appropriate in some instances for schools to arrange for the spare AAI to be brought to sporting events or school trips. Such arrangements should be included in the protocol.

It is recommended for schools to store generic Allergy Action Plan with the spare, back-up AAI.

The BSACI Allergy Action plan can be downloaded here. 

Storage and care of spare, back-up AAIs

The Department of Health recommends that the spare, back-up AAI should be stored as part of a school emergency kit, in a central location no more than 5 mins from high risk areas (canteen, classroom, playground). It could also be stored with an emergency asthma inhaler kit. In larger schools, more than one kit may be required.

The school’s emergency kit should be clearly labelled and separate from individual children’s kits to avoid confusion.

The guidance states that the emergency kit should include:

	The spare, back-up AAI(s).
	Instructions for using and storing the device(s).*
	The manufacturer’s information.
	A checklist of all the AAI’s stored in the school, identified by batch number and expiry date with monthly checks recorded.
	A note of the arrangements for replacing the injectors.
	A list or register of pupils to whom the AAI can be administered.
	A record of cases where an AAI was administered in the school.

It is recommended for schools to store a generic Allergy Action Plan with the spare, back-up AAI. *AAI's should be stored in a cool and dark place at room temperature (15 - 25°C).
Storing them at lower temps risks damaging the device.
The BSACI Allergy Action plan can be downloaded here.