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I recently started a new job as a school nurse for five elementary schools located within 10 minutes of my office. The parents of students with severe allergies provide epinephrine autoinjectors and a practitioner's orders to cover treatment in an emergency. The school system also keeps these devices in stock at each school, and teachers and health assistants are taught how to use them according to a written protocol.


My question is this: If a student who's never been diagnosed with an allergy develops signs and symptoms of a severe allergic reaction, are teachers and other unlicensed personnel authorized to administer the medication if I'm not available?-J.J., GA.


In situations where minutes can mean the difference between life and death, unlicensed persons who've been trained to recognize the signs and symptoms of anaphylaxis and how to use an epinephrine autoinjector can be given the authority to act in the school nurse's absence. Some states have laws that protect both the unlicensed individual and the licensed health care professional who use it to treat a student with no history of anaphylaxis. Standing orders and a written protocol on its use from a prescriber provide additional guidance. Your school system's policies and procedures must conform to state and emergency medical services (EMS) regulations. For more information on state regulations about epinephrine autoinjectors, call the American Heart Association at 1-888-277-5463.


Designated individuals should be trained by a qualified, licensed instructor such as you, an RN. Your curriculum should include teaching the basics about anaphylaxis, including signs and symptoms, proper storage, activating EMS (calling 911), reading and following directions on a medication label, proper administration, and steps to follow after administration, including follow-up care and safe equipment disposal. Include return demonstrations in your teaching.

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At all times, at least one person trained in child and adult basic life support should be present in every school building. Policies, protocols, and performance should be reviewed at least annually. Being prepared is the best strategy for any emergency.


Resources: Hazinski MF, et al., Response to cardiac arrest and selected life-threatening medical emergencies: The medical emergency response plan for schools, Circulation, January 20, 2004; National Association of School Nurses,