Guidelines for Managing Students With Life Threatening Hypersensitivity: Kelsey Ryan Act
Extreme hypersensitivity to insects, bee stings, and certain foods are potentially life threatening. Severe allergic reaction (anaphylaxis) can be fatal within minutes if not treated quickly and properly. Florida Statute 1002.20, the Kelsey Ryan Act, gives students the right to carry and self-administer epinephrine while in school, attending school functions and on the bus if exposed to their specific life-threatening allergens.
School environments provide numerous opportunities for exposure to allergens. Examples include food, food additives, stinging insects, medications, chemicals, chemical odors (paint, perfume, air deodorizers), animal hair, and latex rubber.
Allergens of concern are prevalent in most schools. Foods of primary concern are peanuts, tree nuts, fish, eggs, milk, wheat, and corn. Insects of concern are honeybees, wasps, yellow jackets and hornets. Wasps and hornets are capable of stinging multiple times. Antibiotics are responsible for the majority of medication allergies. Avoidance of triggers, early recognition of symptoms, and immediate treatment are essential. Intervention with epinephrine is vital to saving lives.
Anaphylaxis is the medical term for the life-threatening allergic reactions that may occur when allergic individuals are exposed to specific allergens. Signs and symptoms of anaphylaxis include one or more of the following:
- Hives, itching (any part of body)
- Vomiting, diarrhea, stomach cramps
- Red, watery eyes, runny nose
- Wheezing, coughing, difficulty breathing, shortness of breath
- Throat tightness or closing, difficulty swallowing, change of voice
- Flushed, pale skin
- Swelling of any body part
- Fainting or loss of consciousness
- Change in mental status
- Itchy scratchy lips, tongue, mouth and/or throat
Many healthcare providers require students to carry an emergency kit containing injectable epinephrine. A student with extreme hypersensitivity to an allergen who carries an epinephrine self-injecting emergency kit must have a completed Medication/Treatment Authorization Form on file indicating that the student has been trained to use the self-injecting emergency kit. The kit should always be in a place immediately accessible by the student and/or responsible adult. The Kelsey Ryan Act states that students may carry their epinephrine with them at all times during school and on the bus.
- Notify the school of the student’s allergies.
- Provide the school with a completed Medication/Treatment Authorization Form.
- Work with the school staff to develop a plan that accommodates the student’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities and on the school bus.
- Provide properly labeled medications and replace medications after use or expiration.
- Educate the child in self-management of his/her allergy.
- Provide school with accurate emergency contact information.
- Encourage open and honest communication with your child about their fears and concerns.
- Notify the school nurse (on site/ on call) to set up a training program for staff who have contact with the student, especially the classroom teacher, physical education teacher, principal designee for administering medications, and other designated staff who work with the student.
- Designate school personnel who are properly trained to recognize symptoms of allergic reactions and to administer medications as ordered. Training should include symptoms of allergic reaction and anaphylaxis, immediate emergency measures, how to administer emergency injection, calling 911 and parent, side effects of epinephrine, and the importance of monitoring the child until help arrives.
- Ensure that the student has a completed Authorization for Medication/Treatment
Form on file indicating if the student has been trained to use the self-injecting emergency kit.
- Emergency kit should always be in a place immediately accessible by the student or responsible adults as well as any other instructions that must be done for the student’s emergency care.
- Assure that staff who interact with student on a regular basis know student’s allergies and can recognize symptoms of an allergic reaction.
- Maintain a list of students with severe allergic reactions. Copies of this list should be given to all staff and the school nurse (on site/on call).
- Emergency 911 posters should be completed with updated names of current staff certified in CPR/AED and First Aid and posted in obvious locations.
- Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply.
- Review the forms submitted by the parent.
- Identify a core team to work with parents and the student to establish an exposure prevention plan.
- Children with severe food allergies should not be given any food unless the staff is certain of all ingredients. This includes food sent to school by parents for classroom parties.
- Work with district transportation to assure that the school bus driver is aware of student’s allergies and knows to contact emergency services (911) should the child have an allergic reaction while on the bus.
- Discuss field trips with the family to decide appropriate strategies for managing the student’s allergies.
- Periodically the principal should have the playground, fields and buildings inspected for beehives, wasps’ nests and red ant colonies. These should be properly treated and removed as soon as possible.
- Implement measure to minimize the possibility of the student being exposed to the known allergen.
- Notify school social worker, counselors/psychologists regarding expressed concerns regarding coping by the student/family.
- Should not trade food with others.
- Should not eat anything with unknown ingredients or known to contain any allergen.
- Should avoid or minimize contact with known allergens.
- Should be proactive in the care and management of his/her allergies based on student’s age and developmental level.
- Should notify an adult immediately if they believe they may be having an allergic reaction.
- Students trained on the use of the epinephrine auto-injector should carry the epinephrine injector on their person at all times and know how to administer it if needed (age dependent).
- Notify the staff to call 911 if he/she has used the auto-injector.
- Follow the school’s policies and safety procedures. Notify school staff if epinephrine auto-injector is missing.
Teachers/coaches, Bus drivers, and Before and After School Program Staff
- Be trained to recognize symptoms of allergic reaction, how to administer epinephrine, and how to activate the emergency response 911 when a student in their class/ bus is exposed to a life – threatening allergen.
- Ensure that substitute teachers/bus drivers know about the student at risk and emergency procedures.
- Promote proper hand washing or use of hand sanitizer.
Food and Nutrition Services
- Provide and maintain an allergen-free table in the lunchroom and have a policy for cleaning tables after each use.
- Develop a plan so that student with food allergies is not served any food containing allergen.
- Participate in allergen-free school environment to reduce/eliminate use of as many allergens as possible.
School Counselors, Social Workers, Psychologists
- Upon notification by school staff, identify and respond to concerns regarding ineffective coping mechanisms demonstrated by the student or the family.
- Assist the family with community resources and available services.
Emergency Care Plan/Crisis Management/Health Concerns
The school nurse (on-site or on-call) will complete an Anaphylaxis Emergency Health Care Plan based on the orders from the student’s healthcare provider and should indicate any emergency care that may be needed by the student. This plan will serve as the student’s Individualized Health Care Plan and will be part of the student’s cumulative health folder. The school nurse (on-site/on-call) must sign the plan and document the names of the staff that were trained to administer the Epi-pen to the student. Parents and the school’s health personnel should communicate significant changes in the student’s needs or health status promptly to school staff.
Staff should be alerted as to what symptoms to look for so that emergency treatment can be provided. Whenever there is an emergency situation, the student should not be left alone with other students, but rather in the company of school personnel.
Authorization should be provided by parents for appropriate exchange of information between the assigned school healthcare personnel, school administrators, school staff, and the student’s physician/health care team. Emergency contact information should be current and accurate.
Students with severe allergies/hypersensitivity wishing to participate on a field trip must have a completed Authorization for Medication/Treatment form and an Anaphylaxis Emergency Health Care Plan in a zip-loc bag with the medication that may be needed during a scheduled field trip. The Anaphylaxis Emergency Health Care Plan should indicate the names of the staff that are trained to administer emergency medication (Epi-Pen auto-injector) to the student. The Authorization for Medication/Treatment form should indicate if the student is trained to self-administer the auto-injector. Trained school personnel will need to administer the auto-injector to the student if the student is unable to do so. School staff accompanying the student on the field trip need to call 911 if the student has a severe allergic reaction. Emergency contact information should be current and accurate.
A plan of action should be discussed regarding education and training on allergies and anaphylaxis for the appropriate school staff and the specific information needed to assist the student. The school needs to request allergy and anaphylaxis education training for school personnel including teachers, paraprofessionals, clerical staff, bus drivers/aids, and food service personnel.
A Health Services Request, along with a copy of the student’s current Authorization for Medication/Treatment form must be faxed to Coordinated Student Health Services at 754-321-2743 to schedule an allergy/anaphylaxis in-service. To obtain a copy of the Health Services Request (HSR) form please go to the Coordinated Student Health Services web site @ www.browardschools.com.