EpiPen on a thigh
EpiPens are designed to be able to administer a dose of epinephrine into a thigh through clothing, if necessary. Image Greg Friese, flickr creative commons.

At their annual conference in Chapel Hill this week, school nurses were buzzing about having the right medications in schools to treat dangerous allergic reactions.

By Rose Hoban

In January 2012, 7-year-old Amarria Johnson died after accidentally eating a peanut at her elementary school in Chesterfield County, Virginia. Less than four months later, Virginia passed a law making it easier for schools to have a life-saving emergency injection of epinephrine on hand.

Epinephrine auto-injector training devices were given to nurses at the School Nurses Association conference. The trainer on the right is a product that uses a voice to talk someone through the self-injection process. The device on the left is a more traditional self-injection device.

Now school nurses in North Carolina are pushing to get a similar bill passed in this state, and one of their goals is to get it passed before a child dies from a sudden allergic reaction. At their 30th-annual state conference in Chapel Hill this week, school nurses put information about responding to severe allergic reactions – known as anaphylaxis – front and center.

“Schools need to be prepared to handle anaphylaxis,” said Casey Spear, a regional school-health nurse consultant from the state Division of Public Health. “School staff need to know how to save a child’s life.”

Anaphylaxis occurs when a person has a severe allergic reaction to something they ate or came into contact with, like a bug bite. The reaction develops quickly, sometimes in just a few minutes, leading to hives, itching, swelling, shortness of breath and, if left untreated, severe low blood pressure, respiratory collapse and death.

“About 8 percent of children have real food allergies,” pediatrician Rita Marie John told the overflow crowd of more than 550 nurses at the Friday Center. “Of that 8 percent, 40 percent have a history of severe reaction that unless treated immediately could lead to death.”

More disturbingly, John told the crowd that many children have their first allergic reaction at school.

What is epinephrine anyway?

Epinephrine, known also as adrenaline, is used to stop a severe allergic reaction in its tracks. People who are at risk for one of these reactions can carry around a spring-loaded penlike syringe to self-administer a dose in case of a sudden reaction.

These epinephrine auto-injectors usually are provided by the families of children who need them, but sometimes children having a reaction need a second dose, or sometimes the device is in a locker or a bookbag while the child is on the playground. According to Spear, it’s important to have extra doses available and standing doctors’ orders that allow nurses to administer the medication when necessary.

EpiPen rep talking to a nurse
Mylan representative Travis Roseboro explains his company’s products to Wilson County school nurse Sharon Evans at the school nurses’ conference. At least three manufacturers of epinephrine auto-injectors were in attendance.

A bill that would have made it possible to have extra EpiPens® in schools passed the state House of Representatives on a unanimous vote in April. Mylan, the company making EpiPens®, has offered states the opportunity to get the devices into every school initially for free; replacements would then require payment. But the bill got stuck in a Senate committee, in part because of concerns about eventual costs.

“I think this will help save lives, instead of the current situation where you have to have a patient-specific prescription epinephrine-injectable device per student,” Rep. Tom Murry (R-Morrisville), one of the bill’s co-sponsors, said at the time.

Because it passed the House before the legislative session’s crossover deadline, the bill stays alive for the short session in 2014, where it would need Senate approval before it could become law.

Everyday need

During afternoon breakout sessions at the conference, two separate workshops were devoted to teaching the nurses about the auto-injectors, how to train other teachers to use them and how to work with the parents of students who have problems. Both sessions were at capacity, with more than 110 nurses in each.

“It’s important to work with parents, before anything happens,” said Cheryl Blake, a school nurse at the Trinity School in Durham. She noted that some parents need more instruction. Sometimes they’ll send expired devices to school with their children or will only send one, while a backup is recommended.

And sometimes parents don’t tell school officials that their child is prone to problems and is carrying medication in his or her backpack.

Hall said she emphasizes these issues to parents during parent-teacher meetings or open houses at the schools; but with two schools, she said, it’s hard for her to follow up with everyone.

“I was surprised, disappointed and worried to find out that the school nurse was only going to be at my daughter’s school two or three days a week,” said Teri Saurer from Mecklenburg County, whose 5-year-old daughter, Hannah, has life-threatening food allergies.

When Hannah started school last year, Saurer advocated the Mecklenburg Board of County Commissioners to get more school nurses in the district.

“I didn’t know if I could send Hannah to a school where the nurse wasn’t there five days a week,” she said.

Well-spent dollars

The bill that will be revisited in the legislative short session also would require school nurses to train other staff members on how to administer epinephrine, but Mecklenburg County nurse Jonise Hall said that already happens.

Hall covers two schools, each with more than 750 students, so she has to train people to cover her for when she’s at another school. The national recommendation for school nurse-to-student ratio is 1 to 750.

EpiPen on a thigh
Epinephrine auto-injector devices are designed to administer a dose of the drug into a thigh through clothing if necessary. Image Greg Friese, flickr creative commons.

“The principal usually designates who will be medication administrators,” Hall said. “They’re usually the first encounters, those who will be available most of the time. And then there’s the first responders; they have to do first-aid training, and we have to teach the skill for the whole school.”

Hall said when she’s at another school, her fill-in is often the school secretary, who may be unavailable due to other obligations when a child needs medication.

“Having the pens, and having school nurses there to administer them, is a safety issue,” Hall said. “I mean, lawmakers want to spend money on fences and cameras, why not school nurses?”

“Not to diminish the horror of Newtown, but the chances of a kid dying from a medical emergency is way higher than the chances of a school shooter,” she said.

This article has been corrected to reflect the fact that EpiPen® Auto-Injector is a registered trademark licensed to Mylan, Inc. In general, the devices as a class are correctly referred to as “epinephrine auto-injector devices.”

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