For Safety's Sake: Planning for Students with Food Allergies
c 1993 v. 07, 2010
ANDREW IS FIVE YEARS OLD.
He is severely allergic to corn, soy, egg, almonds, walnuts, tuna, spinach, berries, and penicillin. Even the penicillin residue in milk products and veal may cause a life-threatening allergic reaction.
Last November his mother and several other parents complained to the school board that their school was not prepared for emergencies. During lunch, only parent volunteers and cafeteria staff supervise students while the principal and office secretary frequently leave the building. The parents want a nurse to be in the school at lunch time and teachers to be trained to prevent and handle emergencies. One school official suggested putting red notebooks with students' names and emergency instructions on the secretary's desk.
Specialists concerned about safety for students with special health care needs advise that more comprehensive planning is called for. "... Emergency plans are usually procedural guidelines indicating who to call and other information to be used when a predictable emergency occurs," writes MaryKay B. Haas, in the new book, The School Nurse's Source Book of Individualized Healthcare Plans, (Sunrise River Press, 1993).
FALSE SECURITY
"...if only an emergency care plan is used, it can give the false impression that a student's needs are being met when in fact there may be steps that can be taken to prevent emergencies if a more complete assessment of the student had taken place and been documented in an IHP."
THE SCHOOL'S RESPONSIBILITIES
Schools protect their liability by carefully documenting a student's needs and developing proper staffing, procedures, guidelines and training to meet those needs. In addition, federal civil rights laws which apply to government services and public accommodations (Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act), require schools to ensure that students with a physical impairment or vulnerability such as severe food allergies can attend school as safely as other students.
IMPROVING ANDREW'S PLAN
Andrew's documentation describes his multiple allergies and his history of asthma and severe allergic reactions. Because he is only five years old, the school's draft plan states that "Andrew needs to be watched closely to see that he does not go in the lunch line or sample food from anyone."
The school plan omits many important elements. It does not identify who will watch Andrew nor what specific action to take. Other important issues the plan should address include: What information should peers have to minimize the chance that a classmate might offer Andrew a prohibited food? How can the school help Andrew cope with his frustration and disappointment that he cannot share food or go through the lunch line and earn stickers like everyone else?
A complete plan for Andrew needs to address the potential risks during snack time, field trips, holiday events, class parties, or on the school bus. How accessible is his medication in each of these situations? Should Andrew sit where the teacher or bus driver can always see him? Should a backup EpiPen be kept in the cafeteria? Who carries the EpiPen on field trips?
WHEN MINUTES COUNT
Parents should know the limits of the local emergency system. Not all towns have a 911 emergency system. Is the local rescue squad a public service of the local fire or police department or run by a private firm? How skilled is the rescue squad? Are they trained emergency medical technicians? Do they carry epinephrine? What is the school's backup plan if the ambulance is delayed or unavailable?
When a student has a potentially life-threatening condition, the planning process needs to involve the local rescue team to determine the best way to handle a child whose condition requires special knowledge or care.
The school needs to provide the designated rescue team with a map of the school showing access routes, doorways, the location of classrooms and other student areas. Parents need to provide the rescue team and emergency facility with a summary of the child's allergy information, the physician's emergency care guidelines, insurance information and up-to-date "permission to treat" authorizations. Parents have the right to designate a hospital different than the one the school would use for other types of emergencies.
EMERGENCY PHONE PROCEDURES. To prevent confusion and mistakes, post an emergency phone procedure.
- Dial the emergency number.
- Say who you are and where you are. "I am (your name), a (nurse, teacher, principal) at (school) at (school address) in (city)."
- State what is wrong with the student.
- Give directions to the exact location of the student.
- Ask the person to repeat your information. Hang up only when all the information is correct.
- Contact the person in charge of the building (the principal or designated backup person) and say "The emergency plan for (student) is in effect. The student is located ____"
(Adapted from Project School Care - Guidelines for Care, Children's Hospital, Boston, MA 02115.)
REHEARSE THE PLAN
A practice drill can reveal significant gaps in the plan. Is the EpiPen immediately accessible? Is there a cell phone or intercom for instant communication between the school office and all school areas? (If not, the school needs to have one.)
Who gets and uses the EpiPen? Who stays with the child? Who is authorized to call the rescue team? Who meets the rescue team and leads them to the child? Who calls the parents? Who accompanies the child in the ambulance? Who documents the incident?
TRAINING/DOCUMENTATION
Training, especially of first responders, prepares staff to act fast. The school administrator should review procedures and responsibilities with all personnel before the student enters school and on a regular basis, i.e., at least every three months, whenever there is a change in staffing, and when an emergency has occurred.
The school nurse needs to provide necessary medical background and explain the student's needs. If the nurse is not current in allergy knowledge and skills, the school needs to contact a board-certified allergist to assist the school nurse and to train school personnel in recognizing and responding to allergic reactions.
The student's parents are also important resources for child-specific information and guidelines. Every staff member needs to practice with an EpiPen "trainer" until he or she is comfortable using it. All training needs to be documented. Who was trained, who did the training, what was taught, and how were trainees evaluated for competency?
CLASSMATES
Just as students are taught how to behave during a fire, earthquake, power failure, or other potential emergency, they need to know what is expected of them if someone has a medical emergency in class or on the playground. Schools need to teach students how to report a problem and what to do while a teacher is occupied with the ill or injured student.
SIBLINGS
Of course, the main focus is on the child at risk, but don't forget the siblings. Tell them how emergencies will be handled. Someone sensitive to their needs can be assigned to let them know what is going on. Can the sibling accompany the child in the ambulance? Where should the sibling(s) go after school if the parent is at the hospital? Some elementary schools require that parents sign a written authorization naming individuals to whom the school can release a child. All authorizations and release forms need to be reviewed and updated at least every six months.
RE-ENTRY
After an incident, both the student and his classmates may have questions and concerns. They need information and reassurance. If the student and parent consent, the student's experience can be an opportunity for the school nurse to discuss allergies and school safety guidelines.
Andrew's Safety Plan is complete only after all the prevention and emergency decisions have been made and safeguards have been implemented.
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