The ammended Human Medicines Regulations 2017 allows Schools to obtain "spare" adrenaline auto-injector without prescription for use in emergencies *

From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 will allow all schools to buy adrenaline auto-injector (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but their own device is not available or not working (e.g. because it is broken, or out-of-date).

*The school’s spare AAI should only be used on pupils known to be at risk of anaphylaxis, for whom both medical authorisation and written parental consent for use of the spare AAI has been provided.

The school’s spare AAI can be administered to a pupil whose own prescribed AAI cannot be administered correctly without delay.

An anaphylactic reaction always requires an emergency response

Any AAI(s) held by a school should be considered a spare / back-up device and not a replacement for a pupil’s own AAI(s). Current guidance from the Medicines and Healthcare Products Regulatory Agency (MHRA) is that anyone prescribed an AAI should carry two of the devices at all times. This guidance does not supersede this advice from the MHRA,1 and any spare AAI(s) held by a school should be in addition to those already prescribed to a pupil.

This change applies to all primary and secondary schools (including independent schools) in the UK. Schools are not required to hold AAI(s) – this is a discretionary change enabling schools to do this if they wish. Those facilities choosing to hold a spare AAI(s) should establish a policy or protocol for their use in line with "Supporting pupils at school with medical conditions: Statutory guidance for governing bodies of maintained schools and proprietors of academies in England"2 (Supporting Pupils), and with reference to the guidance in this document.

Supporting Pupils expects schools to:

  1. develop policies for supporting pupils with medical conditions and review them regularly.
  2. develop individual healthcare plans for pupils with medical conditions that identify the pupil’s medical condition, triggers, symptoms, medication needs and the level of support needed in an emergency.
  3. have procedures in place on managing medicines on the premises.
  4. ensure staff are appropriately supported and trained.

 

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Schools may administer their “spare” adrenaline auto-injector (AAI), obtained, without prescription, for use in emergencies, if available, but only to a pupil at risk of anaphylaxis, where both medical authorisation and written parental consent for use of the spare AAI has been provided.
The school’s spare AAI can be administered to a pupil whose own prescribed AAI cannot be administered correctly without delay.
AAIs can be used through clothes and should be injected into the upper outer thigh in line with the instructions provided by the manufacturer.
If someone appears to be having a severe allergic reaction (anaphylaxis), you MUST call 999 without delay, even if they have already used their own AAI device, or a spare AAI.
In the event of a possible severe allergic reaction in a pupil who does not meet these criteria, emergency services (999) should be contacted and advice sought from them as to whether administration of the spare emergency AAI is appropriate.
Practical points:
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When dialling 999, give clear and precise directions to the emergency operator, including the postcode of your location.
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If the pupil’s condition deteriorates and a second dose adrenaline is administered after making the initial 999 call, make a second call to the emergency services to confirm that an ambulance has been dispatched.
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Send someone outside to direct the ambulance paramedics when they arrive.
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Tell the paramedics:
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if the child is known to have an allergy;
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what might have caused this reaction e.g. recent food;
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the time the AAI was given.

he spare AAI in the Emergency Kit should only be used in a pupil where both medical authorisation and written parental consent have been provided for the spare AAI to be used on them. This includes children at risk of anaphylaxis who have been provided with a medical plan confirming this, but who have not been prescribed AAI. In such cases, specific consent for use of the spare AAI from both a healthcare professional and parent/guardian must be obtained. Such a plan is available from the British Society for Allergy and Clinical Immunology (BSACI).10

The school’s spare AAI can be used instead of a pupil’s own prescribed AAI(s), if these cannot be administered correctly, without delay

This information should be recorded in a pupil’s individual healthcare plan. Where a pupil has no other healthcare needs other than a risk of anaphylaxis, schools may wish to consider using the BSACI Allergy Action Plan10. All children with a diagnosis of an allergy and at risk of anaphylaxis should have a written Allergy Management Plan.

Procedures should already be in place to ensure that schools are notified of pupils that have additional health needs, and this information will enable them to compile an allergy register. Some schools will already have such a register as part of their medical conditions policy.

The register could include:
  1. Known allergens and risk factors for anaphylaxis.
  2. Whether a pupil has been prescribed AAI(s) (and if so what type and dose).
  3. Where a pupil has been prescribed an AAI whether parental consent has been given for use of the spare AAI which may be different to the personal AAI prescribed for the pupil.
  4. A photograph of each pupil to allow a visual check to be made (this will require parental consent).
The register is crucial as in larger schools (and secondary schools in particular), it may not be feasible for individual members of staff to be aware of which pupils have been prescribed AAIs. Consequently, schools should ensure that the register is easy to access and easy to read. Schools will also need to ensure they have a proportionate and flexible approach to checking the register. DELAYS IN ADMINISTERING ADRENALINE HAVE BEEN ASSOCIATED WITH FATAL OUTCOMES. Allowing pupils to keep their AAIs with them will reduce delays, and allows for confirmation of consent without the need to check the register.

Schools should ensure staff have appropriate training and support, relevant to their level of responsibility. Supporting Pupils requires governing bodies to ensure that staff supporting children with a medical condition should have appropriate knowledge, and where necessary, support.

It would be reasonable for ALL staff to:

  1. be trained to recognise the range of signs and symptoms of an allergic reaction;

  2. understand the rapidity with which anaphylaxis can progress to a life-threatening reaction, and that anaphylaxis may occur with prior mild (e.g. skin) symptoms;

  3. appreciate the need to administer adrenaline without delay as soon as anaphylaxis occurs, before the patient might reach a state of collapse (after which it may be too late for the adrenaline to be effective);

  4. be aware of the anaphylaxis policy;

  5. be aware of how to check if a pupil is on the register;

  6. be aware of how to access the AAI;

  7. be aware of who the designated members of staff are, and the policy on how to access their help.                                                                                                                                                                                                                                                                                                                                   

 

 Schools must arrange specialist anaphylaxis training for staff where a pupil in the school has been diagnosed as being at risk of anaphylaxis. The specialist training should include practical instruction in how to use the different AAI devices available. Online resources and introductory e-learning modules can be found at http://www.sparepensinschools.uk, although this is NOT a substitute for face-to-face training.

Click the link belowto contact us and arrange the required specialist training for your organisation

 

Ambulance Training

Ambulance Training & Community Response Services, Unit 18 Barry Way, Newport, Isle of Wight PO30 5GY