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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/