PROCEDURE PR.548.SCO
TITLE:
CARE OF STUDENTS WITH SEVERE, LIFE-THREATENING MEDICAL
CONDITIONS
Date issued:
16 September 1998
Last revised:
November 2015
Authorization: Senior Staff: 18 June 1998
1.0
OBJECTIVE
To provide guidelines for addressing the needs of students with severe or life threatening
medical conditions in schools in the Ottawa-Carleton District School Board in compliance with
Sabrina’s Law, Ryan’s Law and all other relevant legislation.
2.0
DEFINITIONS
2.1
Anaphylaxis means a severe, allergic reaction, usually to foods, insect bites,
medications, latex products, and, rarely, vigorous exercise, that, if untreated, can lead to
sudden death.
2.2
Asthma means an inflammatory condition of the bronchial airways which causes the
normal function of the airways to become excessive and over-reactive and lead to
airway obstruction, chest tightness, coughing and wheezing.
2.3
Asthma inhaler (puffer) means a hand-held portable device that delivers medication to
the lungs. Available types include a dry powder tube inhaler, a powder disk inhaler and
a single-dose powder disk inhaler.
2.4
Autoinjector means a medical device designed to deliver a single dose of a particular
(typically life-saving) drug.
2.5
Available staff means staff members who are accessible and able to carry out
necessary procedures.
2.6
Board means the Board of Trustees of the Ottawa-Carleton District School Board.
2.7
Diabetes Mellitus also known as Type 1 or Juvenile Diabetes, means a condition which
results from the inability of the pancreas to produce insulin.
2.8
District means the Ottawa-Carleton District School Board.
2.9
Epilepsy means a chronic neurological disorder which causes sudden bursts of
electrical activity in the brain. This electrical activity produces seizures which vary from
one person to another in frequency and form.
-1PR.548.SCO
3.0
2.10
Heart condition means a condition, or group of conditions, affecting the structure and
functions of the heart.
2.11
Hyperglycemia “high blood glucose” means the condition which occurs when the
amount of blood glucose (sugar) is higher than an individual’s target range. An urgent
response to hyperglycemia may be necessary.
2.12
Hypoglycemia “low blood glucose” (mild or moderate) means an urgent and
potentially emergency situation which occurs when the amount of blood glucose (sugar)
has dropped below an individual’s target range.
2.13
Hypoglycemia (severe) means an urgent and life threatening situation requiring
assistance of another person and an emergency response. Symptoms include fainting,
seizure, and difficulty speaking.
2.14
In loco parentis is a legal term, means in the place of a parent or with a parent’s rights,
duties and responsibilities.
2.15
Pacemaker means a heart device that overrides slow or abnormal heart beats, and
ensures adequate function for activities of daily living. Without treatment, a slow heart
beat can lead to weakness, confusion, dizziness, fainting, shortness of breath and
death.
RESPONSIBILITY
3.1
The school principal is responsible for:
a)
implementing the OCDSB General Guidelines for Creating Safe and Healthy
Schools for Anaphylactic Students, 2009, and OCDSB Guidelines for Creating
Safe and Healthy Schools for Students with Diabetes 2015, in accordance with
Sabrina’s Law, 2005, and the requirements outlined in Ryan’s Law 2015;
b)
ensuring the appropriate documentation is complete for each student identified
as having asthma, anaphylaxis, diabetes or another life-threatening medical
condition;
c)
permitting, with the parent or guardian’s permission, a student under 16 to carry
their asthma medication with them in the school and where appropriate to allow
a student over 16 to carry their asthma medication with them in the school;
d)
ensuring that all staff and others who are in direct contact with pupils on a regular
basis receive the Ministry recommended training or other suitable training on
anaphylaxis and asthma; and
e)
ensuring every student known to have asthma and/or anaphylaxis in the school
has an individual plan and that the individual plan is made known to staff and
others in regular contact with the student.
3.2
School Staff are responsible for:
a)
identifying students with whom they are in regular contact who have asthma
and/or anaphylactic allergies;
b)
ensuring that they understand the training provided and are comfortable with
their responsibilities for students with asthma or anaphylactic allergies; and
c)
posting the information in their classrooms about students with life threatening
medical conditions and making the individual plans available to occasional
-2-
PR.548.SCO
teachers, casual staff and volunteers who are in regular contact the students
concerned.
3.3
4.0
Parents/Guardians/Students over 16 are responsible for:
a)
informing the school of any changes to the student’s medication or treatment
plan so that the student’s file and individual plan may be kept up to date at the
school; and
b)
supplying all relevant information to the school about the student’s condition,
including relevant general information about asthma, asthma and anaphylaxis
triggers, the level of independence of the student and the preventative measures
they regularly take at home.
PROCEDURES
4.1
In implementing the OCDSB General Guidelines for Creating Safe and Healthy Schools
for Anaphylactic Students, 2009, and OCDSB Guidelines for Creating Safe and Healthy
Schools for Students with Diabetes 2015, in accordance with Sabrina’s Law, 2005, and
the requirements outlined in Ryan’s Law 2015 the principal will establish:
a)
a process which will encourage parents/guardians of a student with an identified
life-threatening condition, including but not limited to, anaphylaxis, asthma or
diabetes to identify the student to school staff;
b)
a process to inform all students, staff, and parents/guardians of their
responsibilities in dealing with potentially life-threatening medical conditions in
the school;
c)
strategies that reduce the risk of exposure to asthma triggers, anaphylactic
causative agents, and blood sugar fluctuation risk factors in classrooms and
common school areas; and
d)
plans to address issues potentially affecting life-threatening medical conditions
arising from transportation, field trips, and other school activities.
Documentation
4.2
The principal will develop an Individual Care Plan for each student identified as having
asthma, anaphylaxis, diabetes or another life-threatening medical condition. In
developing this plan, the principal shall take into consideration any recommendations
made by the student’s health care provider.
4.3
The principal will inform all staff, casual staff, office administrators, occasional teachers,
and early childhood educators as well as making sure that classroom teachers inform
parent volunteers, in direct regular contact with a student with a life threatening medical
condition of the contents of the student’s Individual Care Plan.
4.4
The individual care plan will include:
a)
details informing staff and others in direct contact with the student on a regular
basis of the monitoring and avoidance strategies and appropriate treatment for
the condition;
b)
a readily accessible emergency procedure for the student, including emergency
contact information;
c)
details regarding the storage of the pupils medication and, in the case of asthma,
whether or not the student has the parent or guardian’s permission to carry their
asthma medication and/or inhaler with them; and
d)
whether any spare medication is kept in the school and, if so, where it is stored.
-3-
PR.548.SCO
4.5
The principal will ensure that, upon a student’s registration, parents guardians and,
where appropriate, the student, shall be asked to supply relevant information about
anaphylaxis, asthma, diabetes, or any other identified life threatening medical condition.
Information specific to the student shall be disseminated to school staff and of more
general information to the school council, students’ council and other school
organizations as appropriate.
4.6
The school principal will maintain a file of current treatment and other information for
each student with asthma, anaphylaxis, diabetes or other life threatening medical
condition, including a copy of any notes or instructions from the student’s health care
provider and an emergency contact list.
4.7
The principal will ensure there is a signed OCDSB 405: Emergency Use of an AutoInjector Authorization (section 1), and / or an OCDSB 405 (section 2) Emergency Use of
an Auto-Injector Authorization (Non-Prescribed) on file for each student with
anaphylaxis and General Authorization OCDSB 405 (section 3).
4.8
The school, through the principal, will ensure that they have a written emergency
protocol on Form OCDSB 616: Severe and Life Threatening Allergy Protocol, for each
student with anaphylaxis, agreed to by parents/guardians, a physician, and the school
staff.
4.9
The principal will submit three copies of the OSTA Life-Threatening Medical Conditions
Emergency Transportation Form, for those students being transported by the Ottawa
Student Transportation Authority (OSTA), to the General Manager (or designate) of
OSTA within 10 school days from the start of each school year.
4.10
All original copies of all pertinent forms shall be kept in a secure location in the school
office, with copies going to the parent/guardian and the OSR.
Training
4.11 The District, through the school principal, will ensure the training of staff members,
including occasional teachers, in the details of the Emergency Plan for anaphylactic
students as outlined in the OCDSB General Guidelines for Creating Safe and Healthy
Schools for Anaphylactic Student, 2009, for the school based management of students
with diabetes in accordance with the CHEO videos and the OCDSB Guidelines for
Creating Safe and Healthy Schools for Students with Diabetes 2015, and on the
indications and treatment of asthma in accordance with Ministry resources, including on
the Severe and Life-Threatening Allergy Protocol Registration completed for each
student with anaphylaxis.
4.12
the training of volunteers who are involved in high-risk activities as defined in Board
Policy P.067.SCO: Volunteers in the details of the Emergency Plan for anaphylactic
students as outlined in the OCDSB General Guidelines for Creating Safe and Healthy
Schools for Anaphylactic Students, 2009 and specifically on the Severe and LifeThreatening Allergy Protocol Registration completed for each student with anaphylaxis;
4.13
The principal will review the OCDSB General Guidelines for Creating Safe and Healthy
Schools for Anaphylactic Students, 2009, and the indications and treatment of asthma
with staff and the school council on an annual basis.
-4-
PR.548.SCO
4.14
The District will make every attempt to inform all staff, including bus drivers, to refrain
from providing food to anaphylactic students and diabetic students without express
written permission from their parents/guardians.
Administration of Medication
4.15 The principal will provide for each student with the form OCDSB 616: Severe and LifeThreatening Allergy Protocol Registration on file, an accessible, appropriate location or
locations, and informing staff members responsible of the location(s), of two auto
injectors.
5.0
4.16
Students with diabetes shall have appropriate, accessible, safe and private spaces to
test their blood sugar and administer their insulin and staff will be informed of the
location of the student’s diabetic safe kit.
4.17
The principal will ensure that the appropriate consent has been obtained from the
parent/guardian of a student with asthma who is under 16 for them to carry their
inhalers with them in school if that is the wish of the parent/guardian. If the student is 16
years or older they do not require parent/guardian permission to carry their inhaler.
4.18
Staff may be preauthorized through parental consent to administer medication or
supervise a student while they take medication in response to an asthma exacerbation,
or to administer appropriate insulin or sugar to a student with diabetes who is
experiencing hyperglycemia or hypoglycemia. In cases of severe hypoglycemia, fast
acting glucose may be administered.
4.19
If a staff member has reason to believe that a student is experiencing an asthma
exacerbation, an anaphylactic reaction, or a diabetic emergency the staff member may
administer the appropriate medication even without preauthorized consent.
4.20
No action or other proceeding for damages shall be commenced against an employee
for an action in good faith in the execution or intended execution of any duty of care.
APPENDICIES
Appendix A: OSTA Life-Threatening Medical Conditions Emergency Transportation Form
Appendix B: OCDSB 405: Emergency Use of an Auto-Injector Authorization
Appendix C: OCDSB 616: Severe and Life Threatening Allergy Protocol Registration
Appendix D: Individual Care Plan
Appendix E: OCDSB General Guidelines for Creating Safe and Healthy Schools for
Anaphylactic Students, 2009
Appendix F: Inhaler Fact Sheet
6.0
REFERENCE DOCUMENTS
Canadian Charter of Rights and Freedoms
Ontario Human Rights Code
Ministry of Education and Training Memorandum No. 81: Provision of Health Support Services
in School Settings
Ryan’s Law 2015 Government of Ontario
Sabrina’s Law, 2005 Government of Ontario
Ministry training and support documents:
http://www.edu.gov.on.ca/eng/healthyschools/anaphylaxis.html
-5PR.548.SCO
OCDSB Guidelines for Creating Safe and Healthy Schools for Students with Diabetes
Board Policy P.108.SCO: Care of Students with Life-Threatening Medical Conditions
Board Policy P.067.SCO: Volunteers
Board Procedure PR.547.SCO: Administering Medication to Students
-6-
PR.548.SCO
APPENDIX A
PR.548.SCO
LIFE-THREATENING MEDICAL CONDITION
EMERGENCY TRANSPORTATION FORM
Student Name:
STUDENT’S
Student #:
PHOTO
Address:
HERE
Phone #:
School:
Grade:
LIFE-THREATENING MEDICAL CONDITION:
Life-Threatening Allergy/Anaphylaxis:
Auto Injector can be found:
(Please indicate location of Epinephrine Auto Injector on pupil)
Epilepsy
Asthma
Diabetes
Other (specify):
Heart Condition
Pace Maker
Consent for administration of medication form on file at school:
(Principal’s Signature)
YES
NO
(Date)
1.
Use of this form is to be limited ONLY to pupils with life-threatening medical conditions
that may require the emergency administration of an epinephrine auto-injector, or other
emergency medical attention, who ride a school bus or use small vehicle transportation.
2.
This form shall contain a clear and recent photograph of the pupil.
3.
Schools are to forward (3) copies of this form (one original form with original photograph
and Principal signature, and no less than two photocopies of the completed form with
clear photographs) to the Ottawa Student Transportation Authority. Forms are NOT to be
given directly to the driver/transportation provider by parents/guardians or school staff.
TRANSPORTATION INFORMATION:
Pickup Bus:
(ROUTE #)
Drop Off Bus:
(ROUTE #)
DISPATCH PROCEDURES:
1.
2.
3.
4.
5.
Obtain exact location and time of administration.
Call 911.
Call Principal of
School at 613(phone number) or cellular at
Maintain radio contact.
Call OSTA General Manager (or designate) at 613-224-8800 ext. 2580.
Information contained on this form is confidential when complete.
Distribution: 1. OSTA
2. OSTA to provide to operator
Confederation Education Centre
1645 Woodroffe Avenue, Nepean, Ontario K2G 1W2
Tel: 613.224.8800 / Fax: 613.224.8840
Website: www.ottawaschoolbus.ca
Page 1 of 1
OSTA /OCT09
OCDSB 405
APPENDIX B
PR.548.SCO
Emergency Use Of Auto-Injector Authorization
(Epipen® or Allerject™)
(Prescribed – Section 1)
(References: P.108.SCO and PR.547.SCO, PR.548.SCO and PR.632.SCO)
NOTE: Please type and submit the original, signed copy to your child’s school principal in a
timely manner. In the case of ongoing serious medical conditions (such as but not limited to
severe, life-threatening allergies, diabetes, epilepsy, heart condition, asthma), this
authorization will terminate on June 30 of each school year. Please ensure to notify the
principal if the prescription changes or expires. This authorization may be cancelled upon
receipt of written notification to the principal.
School Name:
Date:
Principal’s Name:
Teacher’s Name:
ADVISEMENT OF ADMINISTRATION OF MEDICATION
Student’s Name:
Student No. :
Parent/Guardian (if student is under 18 years of age)
Telephone (Home):
Telephone (Business):
Address:
E-mail Address:
Physician’s Name:
Physician’s Telephone:
PHYSICIAN’S STATEMENT RE: THE USE OF EPIPEN® OR ALLERJECT™AUTO-INJECTOR
In my opinion, it is necessary to use the Auto-Injector during school hours:
1. Name of Medication:
2. Storage Cautions, if any:
3. Dosage of Medication:
4. Time of Administration:
5. Special instructions for Administration:
6. Duration of Medication Regime:
7. Caution of Notable Side Effects:
Physician’s Signature:
Date:
PARENT/GUARDIAN AUTHORIZATION RE: ADMINISTRATION
The responsibility for administration of medication involves certain elements of risk. Unexpected
consequences including, but not limited to, illness, adverse reactions or other complications may
occur as a result of the administration (or non-administration) of any medication. These physical
reactions result from the medication and can occur without fault on either the part of the student or
the Ottawa-Carleton District School Board (OCDSB) or its employees or agents. By requesting and
consenting to the administration of medication by the OCDSB to your child, you are assuming the risk
of an unexpected reaction occurring. It is understood that the chances of such a reaction occurring
may be reduced by carefully following the instructions provided by the physician and / or pharmacy at
all times. If you consent to the administration of medication to your child by the OCDSB, you must
OCDSB 405
APPENDIX B
PR.548.SCO
understand that you and not the OCDSB will bear sole responsibility for any physical reaction that
might occur.
I have read the above and I understand that in requesting and consenting to the administration of
medication by the OCDSB, I am assuming the risks associated with doing so.
Name of Medication:
Prescription No.:
The parent (s)/guardian (s) of:
hereby consent that the above medication, using the procedures as outlined by the physician, be
administrated to the student by the OCDSB, its employees or agents.
It is acknowledged that the employees or agents of the OCDSB are not medically trained to
administer medication.
Parent/Guardian Signature (or student if 18 years or older):
Date:
OCDSB 405
APPENDIX B
PR.548.SCO
EMERGENCY USE OF AUTO-INJECTOR AUTHORIZATION
(Epipen® or Allerject™)
(Non-Prescribed – Section 2)
(References: P.108.SCO and PR.547.SCO, PR.548.SCO and PR.632.SCO)
Note: This page must be completed by the parent / guardian if the principal has determined
that it is necessary to equip the school with one or more non-prescribed Auto-Injectors, and
the parents/guardians are unable to provide the school with two Auto-Injectors.
School Name:
Principal’s Name:
Date:
Teacher’s Name:
ADVISEMENT OF ADMINISTRATION OF MEDICATION
Student’s Name:
Student No. :
Parent/Guardian (if student is under 18 years of age):
Telephone (Home):
Telephone (Business):
Address:
E-mail Address:
Physician’s Name:
Physician’s Telephone:
PARENT/GUARDIAN AUTHORIZATION RE: ADMINISTRATION OF A NON-PRESCRIBED AUTOINJECTOR
I/we,
the parent(s)/guardian(s) of
hereby give my consent to the Ottawa-Carleton District School Board (OCDSB), in the event of an
emergency and in the circumstances that a prescribed Auto-Injector (Epi-Pen® or Alerject™) is not
readily available or not provided to the school, to administer a non-prescribed epinephrine auto
injector on my child, which contains a dose of:
0.15mg of epinephrine
or
0.30mg of epinephrine
The responsibility for administration of medication involves certain elements of risk. Unexpected
consequences including, but not limited to, illness, adverse reactions or other complications may
occur as a result of the administration (or non-administration) of any medication. These physical
reactions result from the medication and can occur without fault on either the part of the student or
the Ottawa-Carleton District School Board (OCDSB) or its employees or agents. By requesting and
consenting to the administration of medication by the OCDSB to your child, you are assuming the risk
of an unexpected reaction occurring. It is understood that the chances of such a reaction occurring
may be reduced by carefully following the instructions provided by the physician and / or pharmacy at
all times. If you consent to the administration of medication to your child by the OCDSB, you must
understand that you and not the OCDSB will bear sole responsibility for any physical reaction that
might occur.
I have read the above and I understand that in requesting and consenting to the administration of
medication by the OCDSB, I am assuming the risks associated with doing so.
OCDSB 405
APPENDIX B
PR.548.SCO
It is acknowledged that the employees or agents of the OCDSB are not medically trained to
administer medication.
Parent/Guardian Signature (or student if 18 years or older):
Date:
OCDSB 405
APPENDIX B
PR.548.SCO
EMERGENCY USE OF AUTO-INJECTOR AUTHORIZATION
(Epipen® or Allerject™)
(General Authorizations- Section 3)
(References: P.108.SCO and PR.547.SCO, PR.548.SCO and PR.632.SCO)
PARENT/GUARDIAN AUTHORIZATION RE: CONSENT TO RELEASE
I/we give consent for school staff to use and share the information provided in this form as required to
attend to the education, health and safety of myself/my child. This may include:
 The pertinent information contained within will be shared with the Ottawa Student
Transportation Authority and applicable contracted bus operators (including your child’s bus
driver where appropriate);
 Posting of the student’s photograph (physical and/or electronic) in the school so that all staff,
volunteers and visitors are aware of the medical condition;
 And any such other circumstances that may be necessary to ensure the health and safety of
your child.
Parent/Guardian Signature (or student if 18 years or older):
Date:
PARENT/GUARDIAN AUTHORIZATION RE: CONSENT TO TRANSFER TO HOSPITAL
I/we give consent for my child to be transported to a hospital if deemed necessary by school staff,
and if necessary, a staff member may also accompany my child during transport. Note: The principal
shall decide if an ambulance is to be called.
Parent/Guardian Signature (or student if 18 years or older):
Date:
The personal information on this form is collected under the authority of the Education Act and will
only be used to record parental authorization for the self-administration by the student of the named
medication. Access to this information will be limited to those who have an administrative need, to the
student to whom the information relates and the parent(s)/guardian (s) of a student who is under 18
years of age. If you wish to review this information or have questions regarding its collection, please
contact your school principal.
The information collected will be protected against theft, loss and unauthorized use or disclosure.
PRINCIPAL’S ACKNOWLEDGEMENT
I have reviewed the information provided in this form, obtained clarification if required, and
acknowledge its receipt.
Principal’s Signature:
Date:
THIS FORM MUST BE COMPLETED IN A TIMELY MANNER, INCLUDE ORIGINAL SIGNATURE(S)
AND SUBMITTED TO THE SCHOOL PRINCIPAL.
OCDSB 616
APPENDIX C
PR.548.SCO
Severe, Life Threatening Allergy Protocol Registration
(References: P.108.SCO and PR.547.SCO, PR.548.SCO and PR.632.SCO)
NOTE: Please type and submit the original, signed copy to your child’s school principal in a
timely manner. In the case of ongoing serious medical conditions (such as but not limited to
severe, life-threatening allergies, diabetes, epilepsy, heart condition, asthma), this
authorization will terminate on June 30 of each school year. Please ensure to notify the
principal if the prescription changes or expires. This authorization may be cancelled upon
receipt of written notification to the principal.
School Name:
Date:
Principal’s Name:
Home Form Teacher’s Name:
Student’s Name:
Student No.:
Year/Grade:
Location of Auto-Injector (EpiPen® or Allerject™) on Student:
Pick-up/Drop-off Bus Route Numbers:
Transportation Address:
STUDENT’S PHOTO: PLEASE ATTACH A RECENT PHOTO OF STUDENT TO FORM
ALLERGIES:
Anaphylactic reaction (life-threatening) to (specify):
SYMPTOMS
An anaphylactic reaction can begin within seconds or exposure or after several hours. Any
combination of the following symptoms may signal the onset of a reaction. Please indicate symptoms
to watch for:
Hives
Stomach cramps
Itching (on any part of the
body)
Change of voice
Dizziness
Swelling (of any body
parts, especially eyes,
lips, face, tongue)
Coughing (could sound
like throat clearing)
Fainting or loss of
consciousness
Wheezing
Change of colour
Red watery eyes
Throat tightness or
closing
Other
Runny nose
Difficulty swallowing
Vomiting
Difficulty breathing
Diarrhea
Sense of doom
WARNING:

Symptoms do not always occur in the same order or intensity, even in the same
individuals.

Time from onset of first symptoms to death can be as little as a few minutes if
the reaction is not treated.

Even when symptoms have subsided after initial treatment, they can return as
much as eight hours after exposure.
GENERAL COURSE OF ACTION
Administer Medication and Call Ambulance Even if Parents/Guardians Cannot be
Reached
If there is ANY suspicion that the student may have been exposed to his/her lifethreatening allergies or is displaying any of the above symptoms:

Use Auto-Injector IMMEDIATELY – Storage Locations:
o (It is highly recommended that each student carry an EpiPen® or
Allerject™ at all times, with back-up kept in the office or accessible
location.)

The student should rest quietly.

Send a runner to immediately notify the principal or designate to call
Emergency 911 and have Auto-Injector (if NOT carried by the student)
delivered to the room immediately by an adult.

Do not send the child to the office. (Time is of the essence and supervision
essential.)

The student must be transported immediately to the hospital with extra AutoInjectors to be administered approximately 10/15 minutes later if needed.

Monitor the student until the ambulance arrives.

Have the student ready to go.

Call parents/guardians:
Parent/Guardian Name:
Parent/Guardian Contact Number(s):
OR
Parent/Guardian Name:
Parent/Guardian Contact Number(s):
OR
Emergency Contact Name:
Emergency Contact Number(s):
SPECIFIC COURSE OF ACTION: (To be completed by Allergist/Physician)
Tastes or ingests allergic substance:
Skin contact with allergen:
Smells an allergen substance:
Other:
Instructions re Ambulance:
Allergist/Physician’s Name:
Telephone:
Allergist/Physician’s Signature:
Date:
PARENT(S) / GUARDIAN(S) RESPONSIBILITY:
It is the responsibility of the parent(s)/guardian(s):

To inform the principal of a pupil’s medical needs if medication will be required
during school hours;

To inform the program supervisors of other OCDSB programs such as
Lighthouse, or OCDSB facilitated programs such as Day Care, of a pupil’s
medical needs if medication will be required during their program hours;

To request assistance of the school and discuss procedures that may be
required;

To ensure that accurate and up-to-date telephone contacts are available to the
school;

To submit all required documentation, such as a completed OCDSB 405:
Emergency Use of an auto-injector and OCDSB 616: Severe, Life-Threatening
Allergy Protocol Registration to the principal of the school.
No medication may be left at school without authorization.
Note:
PARENT/GUARDIAN AUTHORIZATION RE: CONSENT TO RELEASE
I/we give consent for school staff to use and share the information provided in this form
as required to attend to the education, health and safety of myself/my child. This may
include:
 The pertinent information contained within will be shared with the Ottawa Student
Transportation Authority and applicable contracted bus operators (including your
child’s bus driver where appropriate);
 Posting of the student’s photograph (physical and/or electronic) in the school so
that all staff, volunteers and visitors are aware of the medical condition;
 And any such other circumstances that may be necessary to ensure the health
and safety of your child.
Parent/Guardian Signature (or student if 18 years or older):
Date:
24
PARENT/GUARDIAN AUTHORIZATION RE: CONSENT TO TRANSFER TO
HOSPITAL
I/we give consent for my child to be transported to a hospital if deemed necessary by
school staff, and if necessary, a staff member may also accompany my child during
transport. Note: The principal shall decide if an ambulance is to be called.
Parent/Guardian Signature (or student if 18 years or older):
Date:
The personal information on this form is collected under the authority of the Education
Act and will only be used to record parental authorization for the self-administration by
the student of the named medication. Access to this information will be limited to those
who have an administrative need, to the student to whom the information relates and
the parent(s)/guardian (s) of a student who is under 18 years of age. If you wish to
review this information or have questions regarding its collection, please contact your
school principal.
The information collected will be protected against theft, loss and unauthorized use or
disclosure.
THIS FORM MUST BE COMPLETED IN A TIMELY MANNER, INCLUDE ORIGINAL
SIGNATURE(S) AND SUBMITTED TO THE SCHOOL PRINCIPAL.
PRINCIPAL’S ACKNOWLEDGEMENT
I have reviewed the information provided in this form, obtained clarification if required,
and acknowledge its receipt.
Principal’s Signature:
Date:
A copy of this form must be kept with the Auto-Injector and in the student’s classrooms,
the lunchroom, and in other central locations where information regarding anaphylactic
students is available.
Share this completed form with all of the student’s teachers.
Use the review of this form as an opportunity to discuss the implementation of the
guidelines with the parent(s)/guardian(s). Place a copy in the student’s OSR folder.
25
Appendix D: Individual Care Plan
PR.548.SCO
INDIVIDUAL CARE PLAN
Student Name:
Date of Birth:
/
tP
ho
to
Age:
Grade:
Teacher:
St
ud
en
Ontario Education Number:
/
DDMM YYYY
EMERGENCY CONTACTS (LIST IN PRIORITY OF CONTACT)
Name
Relationship
Daytime Phone
Alternate Phone
KNOWN ASTHMA TRIGGERS
ˆˆ Colds/flu/illness
ˆˆ Cigarette smoke
ˆˆ Dust
ˆˆ Physical activity/exercise
ˆˆ Pollen
ˆˆ Cold weather
ˆˆ Pet dander
ˆˆ Mould
ˆˆ Strong smells
ˆˆ Allergies (specify):
ˆˆ Anaphylaxis (specify allergy):
ˆˆ Other (specify):
Asthma trigger avoidance instructions:
RELIEVER INHALER USE AT SCHOOL AND DURING SCHOOLRELATED ACTIVITIES
A reliever inhaler is a fast-acting medication (usually blue in colour) that is used when someone is having
asthma symptoms. The reliever inhaler should be used:
ˆˆ When student is experiencing asthma symptoms (e.g., trouble breathing, coughing, wheezing).
ˆˆ Other (explain):
Use reliever inhaler
(Name of Medication)
in the dose of
(Number of Puffs)
Spacer (valved holding chamber) provided?
ˆˆ Yes
ˆˆ No
Place a check mark beside the type of reliever inhaler that the student uses:
ˆˆ Salbutamol
(e.g. Ventolin)
ˆˆ Airomir
ˆˆ Ventolin
ˆˆ Bricanyl
ˆˆ Other (specify):
ˆˆ Student requires assistance to access reliever inhaler. Inhaler must be readily accessible by
teacher/supervisor.
Reliever inhaler is kept:
ˆˆ With teacher/supervisor (location):
ˆˆ In locker #:
Locker combination:
ˆˆ Other location (specify):
ˆˆ Student will carry his/her reliever inhaler at all times including during recess, gym, outdoor and
off-site activities, and field trips.
Reliever inhaler is kept in the student’s:
ˆˆ Pocket
ˆˆ Backpack/fanny pack Case/pouch
ˆˆ Other (specify):
Does student require assistance to administer reliever inhaler? � Yes
� No
ˆˆ Student’s spare reliever inhaler is kept:
ˆˆ In main office (specify location):
ˆˆ In locker #:
Locker combination:
ˆˆ Other location (specify):
CONTROLLER MEDICATION USE AT SCHOOL AND DURING
SCHOOL-RELATED ACTIVITIES
Controller medications are usually taken regularly every day to control asthma. Usually, they are taken in
the morning and at night, so generally not taken to school (unless the student will be participating in an
overnight activity).
Use/administer
Use/administer
Use/administer
(Name of Medication)
(Name of Medication)
(Name of Medication)
in the dose of
at the following times:
in the dose of
at the following times:
in the dose of
at the following times:
CONSENT FOR STUDENT TO CARRY AND SELF-ADMINISTER
ASTHMA MEDICATION
We agree that
(Student Name)
ˆˆ can carry his/her prescribed medications and delivery devices to manage asthma while at school
and during school-related activities.
ˆˆ can self-administer his/her prescribed medications and delivery devices to manage asthma while at
school and during school-related activities.
ˆˆ requires assistance with administering his/her prescribed medications and delivery devices to
manage asthma while at school and during school-related activities.
We will inform the school of any change in medication or delivery device. The medications cannot be
beyond the expiration date.
Parent/Guardian Name:
Parent/Guardian Phone #:
Daytime:
Evening:
Cell:
Parent/Guardian Signature:
Alternate:
Student Signature:
Date:
OPTIONAL PLAN REVIEW
Optional review by health-care provider (e.g., Pharmacist, Respiratory Therapist, Certified Asthma
Educator, Certified Respiratory Educator, Nurse, Medical Doctor, or other clinician working within their
scope of practice):
ere
ls h
ach
Att
io
ript
sc
pre
be
n la
Health-Care Provider’s Name:
Profession:
Signature:
Date:
/
/
DDMM YYYY
APPENDIX E
PR.548.SCO
OCDSB General Guidelines for
Creating Safe and Healthy Schools
for
Anaphylactic Students
Revised
November 2013
OCDSB General Guidelines for Creating Safe and Healthy Schools for Anaphylactic
Students
Table of Contents
General Guidelines...................................................................................................................................... 2
Guidelines for Intermediate and Secondary Schools .................................................................................. 7
Responsibilities of Parents and Students .................................................................................................. 10
Transportation Guidelines (Appendix 1) .................................................................................................. 12
Emergency Procedure (Appendix 2) ......................................................................................................... 16
How to Use the EpiPen® - Visual Instructions (Appendix 3) .................................................................. 17
How to Use the Allerject™-Visual Instructions (Appendix 4)……………………………………….....19
911 Protocol (Appendix 5)........................................................................................................................ 21
Suggestions for Information Sessions (Appendix 6) ................................................................................ 22
Newsletter Samples (Appendix 7) ............................................................................................................ 23
Lunch Suggestions from Ottawa Public Health (Appendix 8).................................................................. 24
Sample Letters to Parents of Students in Same Class as Anaphylactic Student
(Appendices 9-12) .............................................................................................................................. 27
Sample Letter to Parents of Anaphylactic Student (When Information Has Not Been Provided)
(Appendix 13)..................................................................................................................................... 31
Suggestions for Dealing with Non-Compliance (Appendix 14) ............................................................... 32
Sample Reminder/Thank You Letter (Appendix 15) ................................................................................ 33
Information from Anaphylaxis Support Group (Appendix 16) ................................................................ 34
Acknowledgements
This guideline, which was originally created in February, 1995, had its basis in a check-list
developed by the Middlesex-London Health Unit in collaboration with the London Chapter of the
Allergy/Asthma Information Association. The original check-list was amended by the Carleton Board of
Education (CBE) at that time to reflect CBE policy and procedure and the input of principals (members of
a staff sub-committee), parents, and a taxpayer with a personal interest in the issue.
The guideline was updated in June 1997 to include an appendix which covers transportation
(adapted from a Carleton Roman Catholic School Board document) and extracts from a Canadian School
Boards Association publication, “Anaphylaxis: A Handbook for School Boards”.
Upon the creation of the Ottawa-Carleton District School Board (OCDSB) the guideline was
reviewed and updated by a committee of principals with input from the Ottawa-Carleton Health
Department and The Ottawa-Carleton Assembly of School Councils.
This guideline was updated in October, 2009 following a review and public consultation of
OCDSB policy P.108.SCO and all of the associated procedures.
We wish to thank all concerned for their co-operation.
1
Ottawa-Carleton District School Board
SS-93 : Revised September 2013
School Operations
OCDSB General Guidelines for Creating Safe and
Healthy Schools for Anaphylactic Students
School staff and parents are responsible for creating a safe and healthy environment for students
within the limits created by legislation, school configuration, number of anaphylactic students and
available staff. This is an additional challenge for schools attended by students with anaphylaxis. For
some students, severe allergic reactions can be triggered not only by eating foods, but also by their
touch and smell. This has implications for the whole school, not just individual classrooms.
While it is impossible to create a risk-free environment, school staff and parents can take
important steps to attempt to minimize potentially fatal allergic reactions. Accurate records, written
protocols, staff education, parental support, and classroom and school rules should all be considered.
This requires co-operation; please take realistic and practical actions which will be well supported by
everyone involved. It is unrealistic and provocative to attempt to “ban/eliminate” allergens
(e.g., peanuts, nuts, nut oils, fish, milk, eggs, wheat). The goal is to minimize and control allergens
through education. It is recommended that the word “ban” not be used in any communication.
Anaphylaxis may be induced by medications, insect stings, latex products, exercise or foods; in
schools, however, the greatest danger is from allergenic foods. It is important that schools review the use
of food in school and school-sponsored activities. Principals and School Councils are encouraged to
consider items other than food as the focus of special events. It is recommended that caution be
exercised when food is used in fund-raising events.
It is recognized that these guidelines are subject to change whenever additional information
becomes available concerning this condition.
Although the risk to students cannot be eliminated entirely, when a student has been identified as
having anaphylaxis, schools/principals should:
A.
Create a safer school environment by:
ensuring that instructions from the student’s physician are received and reviewed annually with
the parent of the anaphylactic student so that necessary changes can be made (ensure involvement
of current home room teacher)
working in co-operation with students and parents to ensure that emergency medication, labelled
with the student’s name and expiry date, is kept safe and accessible in locations which are known
to all staff (it is highly recommended that each anaphylactic student carry an auto injector
at all times and that an extra be kept in the office)
a completed OCDSB 405, Emergency Use of Auto-Injector Authorization, and / or an OCDSB
405 (section 2) Emergency Use of a Auto- Injector Authorization (Non-Prescribed) must be
2
obtained for all identified anaphylactic students who may require the possible administration of
an auto injector.
discussing, on a need-to-know basis, the individual needs of the anaphylactic student as outlined
on Form OCDSB 616: Severe and Life-Threatening Allergy Protocol Registration, with parental
co-operation
collecting information, where possible, concerning identified students’ anaphylactic allergies at
time of student registration, and updating this information annually or more frequently if
necessary
generating annually a list of identified students with anaphylactic allergies and reviewing with
school staff, e.g., Staff room, lunch room, classrooms used by the student, etc.
posting, in accordance with FOI Guidelines, completed OCDSB 616: Severe and Life-threatening
Allergy Protocols Registration in locations accessible to staff
forwarding appropriate information pertaining to identified anaphylactic students being
transported to the Ottawa Student Transportation Authority (to be shared with the contracted
transportation service provider);
ensuring, where possible, in consultation with the parents/guardians of the anaphylactic student
and the Public Health Nurse assigned to the school, that all staff (including office and custodial
staff) receive training in the following:
anaphylactic allergies and their potential severity
measures to minimize the presence of allergens in classrooms and school areas
recognition of the symptoms of anaphylaxis
administration of auto injector (and the need for a second injection)
emergency plan, including mock practices
the post-incident review plan
The training sessions will be held annually, and as early in the school year as possible. In
schools where a student has recently been identified as having anaphylaxis, or where
training is being given for the first time, it will be given as soon as practicable.
including pertinent information in the first newsletter
sending, during the first week of class, and at appropriate times thereafter, letters home with the
students in the same classes as the anaphylactic students and/or with all students as necessary
3
the contents of the letter will be discussed with the class
B.
Create safer classrooms where:
the home-room teacher regularly reminds students to help in minimizing risk by not bringing food
allergens to school
the teacher plan-books provide clear information for occasional teachers
anaphylactic students are advised that they must eat only the foods they bring from home
no one (including staff) trades or shares food with the anaphylactic student
students are reminded not to share cups or straws
every effort is made to choose allergen-free crafts or foods for classroom events and activities
hand washing is encouraged before and after eating, or after lunch and recess, and the
anaphylactic student is encouraged to wash before eating
desks or other eating surfaces are kept clean
anaphylactic students are allowed, whenever possible, to keep the same desk and/or locker all
year
attempts are made to minimize and control food allergens in the classroom during snacks, lunches
and special occasions (including recess food)
controls are in place if food allergens are inadvertently brought into the classroom
parents are asked to provide detailed labelling of foods they send into the classrooms for group
consumption
students with an allergy to insect venom are immediately removed from the room if a bee or wasp
enters the room
In case of insect stings, never slap or brush the insect off and never pinch the stinger if the
student is stung. Instead, flick the stinger out with a fingernail or credit card.
there is appropriate information/training for older students/volunteers who may assist in
supervision of classrooms (i.e., they need to know who is anaphylactic and how to get help)
4
C.
Create safer conditions outside the classroom where:
plans are in place to ensure safe field trips or extra-curricular activities, or activities in another
classroom or the school yard
emergency plans are reviewed with teachers/volunteers before a field trip (parents are strongly
urged to accompany the child or to designate a knowledgeable volunteer to assist the child if
needed, particularly on extended field trips)
permission forms for off-site activities include information about food or other allergies
students are encouraged to bring allergen-free foods for lunch and recess snacks as appropriate
students in all classrooms frequented by anaphylactic students are encouraged to wash their hands
with water and soap after eating. Alcohol hand sanitizers do not remove food allergens
the anaphylactic student is provided, whenever possible, with means to wash his or her hands
before eating
a list of ingredients is requested if foods are ordered from commercial sources
food preparation/handling areas are kept clean
foods sold in vending machines will, where possible, be free of common allergens (e.g. peanuts);
it is recommended that signs be posted inside machines to alert any staff who restock foods
food to be used in multi-class events will be as allergen free as possible. It is recommended that
signs be posted on the food to alert the anaphylactic student of possible allergens.
students who are anaphylactic to insect stings are allowed to remain indoors for recess during
bee/wasp season
garbage is properly covered
garbage disposal is handled safely to avoid cross-contamination
additional yard clean-up is conducted to remove candy wrappers following Halloween, Easter,
etc.
anaphylactic students are not allowed to participate in garbage clean-ups
5
arrangements are made for a buddy system in the classroom, playground, on the school bus and
on field trips
D.
General Recommendations:
School staff should be encouraged to listen to the student. Anaphylactic students usually know when a
reaction is taking place. If the student complains of any symptoms which could signal the onset of a
reaction, school staff should not hesitate to implement the emergency response as outlined on completed
form OCDSB 616: Severe and Life-Threatening Allergy Protocol Registration. There is no danger in
reacting too quickly, and grave danger in reacting too slowly.
It should be remembered that each student’s needs will be different. Staff should be sensitive to
the needs of the student, and should have all the information they need about the student’s specific
allergies, as well as the severity of the allergies.
It is recommended that a meeting between parent and teacher occur prior to the first day of
school, and that a request be made to parents/guardians in June so that current medical
information can be obtained for September.
It is strongly recommended that the anaphylactic student (as age appropriate) learn to take
responsibility for his or her own well-being.
It is recommended that parents be made aware of, and are urged to comply with, items listed on
page 9 and 10 (Responsibilities of Parents and Students)
It is recommended that a mid-year review of the information/protocol be conducted, and that
thank you, or reminder, letters be sent out.
It is recommended that a working relationship be created between the parent, principal and
teacher so that concerns can be dealt with as they arise. Any mediation should be the
responsibility of the superintendent of schools.
It is recommended that staff refrain from eating foods containing allergens, but if they do, proper
steps should be taken to neutralize the effect (e.g. hand washing, brushing teeth, using mouth
wash).
It is recommended that a cellular phone accompany supervisors on field trips.
It is recommended that parents of anaphylactic students be notified in advance of class events
where food will be brought in. This will help ensure that anaphylactic students will be included.
6
Guidelines for Intermediate and Secondary Schools
General Recommendations
School staff, parents and students are responsible for creating safe and healthy environments for
students within the limits created by legislation, school configuration, and available staff. This is an
additional challenge for schools attended by students with anaphylaxis. For some students, severe
allergic reactions can be triggered not only by eating foods but also by their touch and smell. This
has implications for the whole school, not just individual classrooms.
While it is impossible to create a risk-free environment, school staff and parents can take
important steps to attempt to minimize potentially fatal allergic reactions. Accurate records, written
protocols, staff education, parental support and school rules should be considered. This requires
co-operation. Students with anaphylaxis in lower school grades are dependent upon parents and teachers
for assistance with everything from label reading to snacks and class parties; however, older students
prefer teachers and school staff to have as little involvement as possible. School staff can communicate
their willingness to help while respecting the student’s privacy. Peer pressure and conformity are key
issues for most students, and “thou shall not be different” is often their motto.
Anaphylaxis may be induced by medications, insect stings, latex products, exercise or foods. The
risk of food-allergic reaction in this group of students is particularly high because food is more accessible
and students have more freedom at lunch time. Going out for lunch is a major social component of the
life of an adolescent; however, eating what everyone else is eating can have serious consequences for a
food-allergic student. Most allergic reactions in this age group occur because the student ate food given
by a friend which was presumed to be “safe”.
The combination of the adolescents’ desire to be like everyone else and their belief that they are
invincible, or, that they can “tough out” an allergic reaction, increases risk. It should be emphasized that
speaking up immediately will enable staff to assist the anaphylactic student in not creating a “scene”.
Staff should recommend that the student select a friend who will be advised if a reaction is occurring and
who can get help if necessary. A student who has been exposed to an allergen should never be left
alone.
Most reactions which result in death in this group of students can be related to the fact that
the student was not carrying an auto injector at the time. Even if the student does carry an auto
injector, the student will be asked to make sure that there is a back-up in the office.
Most anaphylactic students in middle or upper grades have probably had food allergies all their
lives, and although some students may not remember their last reaction, for others the traumatic
experience is still clearly remembered. It is vital that anaphylactic students be made aware of the scope
and severity of their own allergy and that they know what to do in the event of an emergency. Some
symptoms are not clearly visible. The student should be fully aware of the symptoms and understand
what to do in the event of a reaction. The student should understand how to use an auto injector, and
should not be afraid to use it in a supervised environment or to ask an adult to use it.
Anaphylactic students need to know they have the support of school staff if they get into trouble.
All complaints should be taken seriously. Even though some adolescents may try every excuse to get out
of class, it is best to assume that students with documented food allergies will not tell staff of imagined
symptoms. Staff should err on the side of safety. When an anaphylactic student has been identified, it
should be ensured that at least two staff members have detailed knowledge of the student’s medical needs.
7
It is recommended that a mutually acceptable plan be developed to alert the staff member in the
event of an emergency. The parents of the anaphylactic student should be involved if possible so that
insight can be gained about any special concerns.
It is recognized that these guidelines are subject to change whenever additional information
becomes available concerning this condition.
Although the risk to students cannot be eliminated entirely, when a student has been identified as
having anaphylaxis, schools/principals should:
Remind students and parents early in the school year about the need to provide the office with
information about the specific allergy, etc. If parents do not send in necessary information, use
sample letter attached.
Ensure, whenever possible, that instructions from the student’s physician are complete, and
review annually with the student and parent so that necessary changes can be made.
With the co-operation of students and parents, ensure that auto injectors labelled with the
student’s name and expiry date are kept in safe and accessible locations which are known to all
staff. (It is highly recommended that each anaphylactic student carry an auto injector with
them at all times and that an extra be kept in the office.)
A completed OCDSB 405, Emergency Use of Auto-Injector Authorization, and / or an OCDSB
405 (section 2) Emergency Use of an Auto- Injector Authorization (Non-Prescribed), must be
obtained for all identified anaphylactic students who may require the possible administration of
an auto injector.
Generate annually a list of identified students with anaphylactic allergies and review with school
staff and/or parents to ensure the accuracy of all information.
Forwarding appropriate information pertaining to identified anaphylactic students being
transported to the Ottawa Student Transportation Authority (to be shared with the contracted
transportation service provider).
Collect information concerning identified students’ anaphylactic allergies at time of student
registration, and update this information annually or more frequently if necessary.
Check registration forms for medical information.
In consultation with the parents/guardians of the anaphylactic student and the Public Health
Nurse assigned to the school, ensure that all staff (including office and custodial staff) receive
training in the following:
anaphylactic allergies and their potential severity
measures to minimize presence of allergens in the school
8
recognition of the symptoms of anaphylaxis
administration of auto injector (and the need for a second injection)
emergency plan, including mock practices
the post-incident review plan
The training sessions shall be held annually, and as early in the school year as possible. In schools where a
student has recently been identified as having anaphylaxis, or where training is being given for the first time, it
shall be given as soon as practicable.
Recommend that a meeting between parents guardians, student and principal/teacher occur prior
to the first day of school.
Ensure that anaphylactic students are encouraged to adopt a buddy system (for each of the
student’s classes and in-school and off-site activities, etc.).
Include pertinent information in the first newsletter.
Include, if possible, auto injector training in students’ health/first aid curriculum.
Ensure, where possible, that food used in Family Studies classes is as allergen-free as possible.
Allow anaphylactic students to choose, without penalty, not to participate in food preparation or
consumption.
Ensure that ingredient lists will be available in the cafeteria and the elimination of allergens
attempted. A non-peanut table (or tables) will be designated.
Ensure, where possible, that foods sold in school vending machines are free of common allergens
(e.g. peanuts). (It is recommended that signs be posted inside machines to alert any staff who
restock foods.)
Exercise caution with respect to the use of food in fund-raising activities. Ensure where possible
that food used in dances, bake sales, fund-raisers, etc. is allergen free.
Allow a student with an allergy to insect venom to leave the room if a bee or wasp enters the
room.
In case of insect stings, never slap or brush the insect off and never pinch the stinger if the
student is stung. Instead, flick the stinger out with a fingernail or credit card.
Ensure that plans are in place to ensure safe field trips (e.g. permission forms should include
information about allergies, a review of the emergency protocol should be conducted, a buddy
system should be established for the anaphylactic student, a cellular phone should accompany
supervisors, if possible, etc.).
9
Responsibilities of Parents and Students
Responsibilities of the Parents/Guardians of an Anaphylactic Student:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Inform the school of student’s allergies.
Complete each of the following forms: OCDSB 616, 405, and/or 405 (section 2)
Provide a Medic Alert bracelet for the student.
Provide the school with physician’s instructions for administering medication.
Provide the school with two up-to-date auto injectors (i.e.: EpiPens®, Allerjects), and keep them
current.
Provide support to school and teachers as requested (e.g., accompany student on field trips or
designate an informed adult volunteer).
Provide information for staff, if requested.
Participate in parent advisory/support groups.
Assist in school communication plans.
Participate in the review of the General Guidelines for Creating Safe and Healthy Schools by school
personnel.
Supply information for school publications:
• recipes;
• foods to avoid;
• alternate snack suggestions;
• resources.
Provide allergen-free crafts or foods for special occasions.
Teach the student:
• how to administer an auto injector
• to recognize the first symptoms of an anaphylactic reaction;
• to know where medication is kept, and who can get it;
• to communicate clearly when the child feels a reaction starting;
• to carry an auto-injector (in a fanny-pack, for example);
• not to share snacks, lunches or drinks;
• to understand the importance of hand-washing;
• to cope with teasing and being left out;
• to report bullying and threats to an adult in authority;
• to take as much responsibility as possible for his or her own safety.
Welcome other parents’ calls with questions about allergen-free foods.
Responsibilities of Anaphylactic Students:
•
•
•
•
•
•
•
•
•
Take as much responsibility as possible to avoid allergens.
Eat only foods brought from home.
Take responsibility for checking labels and monitoring intake (older students).
Wash hands before and after eating.
Learn to recognize the symptoms of an anaphylactic reaction.
Promptly inform an adult as soon as accidental exposure occurs or symptoms appear.
Keep an auto injector handy at all times.
Know how to use the EpiPen® and Allerject auto-injector.
Wear a Medic Alert bracelet.
10
Responsibilities of All Parents/Guardians:
•
•
•
Respond co-operatively to requests from the school to eliminate allergens from packed lunches and
snacks.
Participate in parent information sessions.
Encourage students to respect the needs of the anaphylactic student and school policies and
procedures.
Responsibilities of All Students:
•
•
•
•
Learn to recognize the symptoms of an anaphylactic reaction.
Avoid sharing food, especially with anaphylactic students.
Follow school guidelines about keeping allergens out of the classroom and washing hands.
Refrain from “bullying” or “testing” a student with a food allergy.
11
Appendix 1 – OCDSB General Guidelines for Anaphylactic Students
Transportation Guidelines
Administration of Single Dose Epinephrine Auto-Injector to
Anaphylactic Students
The Ottawa-Carleton District School Board recognizes the possible need for administration of
single dose epinephrine auto-injectors by school bus drivers to identified anaphylactic students experiencing
allergic reaction during transportation to and from school. Medication will be administered in the form of
single dose auto-injectors under emergency life-threatening conditions in accordance with the procedures
noted below.
In using the single dose auto-injector, the school bus driver is acting in accordance with Board
policy and in accordance with the principle of “in loco parentis” and not as a health professional.
The terms schools bus driver(s), and school bus contractor(s) used throughout this guideline shall
include all school bus drivers and drivers of small vehicles contracted by the Ottawa-Carleton District
School Board.
1.
When a student has been identified as having anaphylaxis, schools/principals should:
(a)
whenever possible, collect information concerning identified students’ anaphylactic
allergies at the time of student registration, and update this information annually or more
frequently if necessary;
(b)
generate annually lists of identified students with anaphylactic allergies and review with
school staff;
(c)
highlight the need for accurate up-to-date information in cases of anaphylactic
allergies/conditions in the first newsletter;
(d)
at the beginning of each school year (and, if necessary, at registration periods during the
school year), provide the General Manager (or designate) of the Ottawa Student
Transportation Authority with documentation (in the form of OSTA Life-Threatening
Medical Condition Emergency Transportation Form) for all students identified as having
anaphylactic allergies. (The OSTA Life-Threatening Medical Condition Emergency
Transportation Form should contain a clear photograph of the student, student name,
grade, school, bus route numbers, medical condition information and location of
epinephrine auto-injector on the student.);
(e)
forward three (3) copies (one original and two photocopies) of the OSTA LifeThreatening Medical Condition Emergency Transportation Form to the General Manager
(or designate) of the Ottawa Student Transportation Authority for distribution to the
school bus carrier (the original for the school bus driver and a copy for the dispatch
office). A copy will be retained on file by the Ottawa Student Transportation Authority.
(f)
provide an updated OSTA Life-Threatening Medical Condition Emergency
Transportation Form to the Ottawa Student Transportation Authority if a change occurs
in the student’s bus route number;
12
(g)
2.
obtain a completed OCDSB 405: Emergency Use of EpiPen® Auto-Injector
Authorization, and/or an OCDSB 405 (section 2) Emergency Use of an Auto- Injector
Authorization (Non-Prescribed), for all students identified as having anaphylactic
allergies who may require the possible administration of an auto-injector.
At the beginning of each school year, training sessions will be organized by the Ottawa Student
Transportation Authority and bus contractors for all drivers assigned to a route carrying students
with identified anaphylactic allergies who may require the possible administration of an
epinephrine auto-injector, when the specific health conditions of such students can be reviewed
and refresher training provided in the use of the single dose auto-injector.
School bus contractors and Ottawa Student Transportation Authority officials shall ensure
dispatchers and replacement drivers attend such training sessions annually.
If practicable, bus drivers may be provided with epinephrine auto-injector administration training
in conjunction with training sessions conducted for school staff.
This training must include instruction in the following:
(a)
(b)
(c)
(d)
3.
4.
recognition of the symptoms of anaphylaxis and the need for the administration of an
epinephrine injection;
the proper method for administration of a single dose epinephrine auto-injection;
determining the need for a second injection.
activation of 911 system.
The General Manager (or designate) of the Ottawa Student Transportation Authority will identify
annually, by bus route number and school, students with anaphylactic allergies requiring the
possible use of a single dose epinephrine auto-injector, and provide all necessary information to
bus contractors/drivers and appropriate Ottawa Student Transportation Authority staff.
Designated drivers and transportation dispatchers will be provided (by the General Manager, or
designate, of the Ottawa Student Transportation Authority) with a copy of form OSTA LifeThreatening Medical Condition Emergency Transportation Form, for all identified students
eligible for school bus transportation. This documentation will be held in a specified, consistent,
and noticeable location in the assigned school vehicle at all times, the inspection of which should
form part of the driver’s normal circle check procedures, and will also be posted in the office of
the transportation dispatcher. All carriers will be provided (by the General Manager, or
designate, of the Ottawa Student Transportation Authority) with a copy of the Transportation
Emergency Dispatch Procedure.
5.
If a replacement driver operates a route carrying an identified student with anaphylactic allergies,
the dispatcher must ensure that the replacement driver has been trained as in 2, above, and is
made aware of the student(s) on the route. Similarly, a replacement dispatcher must be made
aware of these conditions and of the documentation held on the school bus and posted in the
dispatch office.
6.
All identified anaphylactic students shall be assigned priority seating on a daily basis in the first
seat opposite the bus driver. Such seating will be considered mandatory for students up to and
including grade 6. For grades 7 to OAC students, priority seating will simply be recommended.
7.
The school bus driver will not carry nor be responsible for the storage of epinephrine autoinjectors. Schools/ principals should confirm with parents that an epinephrine auto-injector, when
required, is to be carried by the anaphylactic student in an identified location during transport by
school bus.
8.
If an identified anaphylactic student passenger appears to be experiencing difficulty:
13
(a)
The school bus driver should:
(i)
(ii)
(iii)
(v)
(vi)
(vii)
(b)
The dispatcher should:
(i)
(ii)
(iii)
(c)
secure the vehicle;
secure the passengers;
administer the single dose epinephrine auto-injection and advise dispatch office
of incident, location and time, and request that emergency response team be
contacted;
help student to remain calm;
monitor student and await arrival of emergency response team;
complete and submit a report to the General Manager (or designate) of the
Ottawa Student Transportation Authority detailing the particulars of the
emergency.
confirm with the school bus driver the location and time of incident;
advise Emergency 911, the school principal, and the Ottawa Student
Transportation Authority of incident;
remain in constant contact with Emergency 911 officials and the school bus
driver.
The school principal/designate should:
(i)
contact the student’s parent/guardian/emergency contact.
14
Attachm ent 1
to Append ix 1
Transportation Emergency
To be posted in Dispatch Office
Dispatch Office Procedure
Life-Threatening Allergy Protocol
1.
Obtain exact location and time of administration
of epinephrine auto-injector.
2.
Call 9-1-1.
3.
Call Principal of school.
4.
Maintain radio contact with school bus driver.
5.
Call Ottawa Student Transportation Authority at
613.224.8800 extension 2580.
15
Appendix 2 – OCDSB General Guidelines for Anaphylaxis Students
To be Posted with Life-Threatening Allergy Protocol
Emergency Procedure - Epi-Pen®.
In Case of Emergency!
1.
Administer the Epi-Pen®.
Don’t hesitate. It can be life saving.
The student should rest quietly. DO NOT SEND THE CHILD TO THE OFFICE.
To Inject:
• Remove Epi-Pen® from carrier tube.
• Hold firmly down with orange tip pointing downward
• Remove blue safety release.
• Swing and push orange tip firmly into OUTER MID-THIGH of child’s leg (This may be done
through light or a single layer of clothing if necessary (no thicker than jeans). A click will be
heard.
• Wait for fluid to enter body (10 seconds—an accurate way to count: one-one thousand,
two-one thousand, etc.).
• The child should be rushed to the hospital after administration of EpiPen®; any additional EpiPens® should accompany the child in case a second injection is required if symptoms persist
or recur.
• The time of the first injection should be noted so that the second Epi-Pen® can be
administered in 10 to 20 minutes, if symptoms persist or recur. (The provision of an adequate
number of Epi-Pens® is the responsibility of the parent/guardian.)
• When the EpiPen® Auto-injector is removed, the orange needle cover automatically extends
to cover the injection needle.
2.
Have someone call 9-1-1.
Tell them that a student has had an anaphylactic reaction.
Give the name and address of the school (use 911 Protocol).
3.
Help the student to remain calm and to breathe normally. An adult must stay with the student.
4.
Call the parents/guardians/emergency contact.
5.
Observe and monitor the student until the ambulance arrives.
6.
Administer a second Epi-Pen® - if needed.
Administer approximately 10 to 15 minutes after the first.
7.
Send any additional Epi-Pens® with student in the ambulance.
Append ix 3 – OCDSB General Guid elines for Anaphylaxis Stud ents
16
Append ix 3 – OCDSB General Guid elines for Anaphylaxis Stud ents
17
18
Appendix 4
How to use Allerject™
Allerject™ contains an electronic voice instruction system to help guide you through
each step of your injection. If the voice instructions do not work for any reason, use
AllerjectTM as instructed in these Instructions for Use. It will still work during an allergic
reaction emergency.
Pull Allerject™ from the outer case
Do not go to step 2 until you are ready to use Allerject™. If you are not ready to use,
put it back in the outer case.
Pull off RED safety guard
To reduce the chance of an accidental injection, do not touch the black base of the
auto-injector, which is where the needle comes out. If an accidental injection happens,
get medical help immediately.
NOTE: The safety guard is meant to be tight. Pull firmly to remove.
19
Place BLACK end against the middle of the outer thigh (through clothing, if necessary),
then press firmly and hold in place for five seconds.
Only inject into the middle of the outer thigh (upper leg). Do not inject into any other
location.
Note: Allerject™ makes a distinct sound (click and hiss) when you press it against your
leg. This is normal and indicates AllerjectTM is working correctly.
Seek immediate medical or hospital care.
Replace the outer case and take your used Allerject™ with you to your pharmacist or
physician for proper disposal and replacement.
AFTER using Allerject™
With an allergic reaction, you may need to administer an additional dose of epinephrine.
Seek medical attention immediately even if the symptoms seem to have subsided.
Because the effects of epinephrine can wear off and there is a chance of a second
reaction, it is important that you seek medical assistance or go to the emergency
room immediately after using AllerjectTM.
Even if you have sought medical help, you must stay within close proximity to a
hospital or where you can easily call 911 for the next 48 hours.
http://www.allerject.ca/en/epinephrine-autoinjector
20
Append ix 5 – OCDSB General Guid elines for Anaphylaxis Stud ents
To be Posted by Telephone
911 Protocol - Anaphylaxis
1.
Emergency Phone Number
2.
Hello, my name is
3.
We are located at:
Address:
Nearest major intersection:
4.
Tell them:
“We need an am bulance im m ed iately. We have a child going into
anaphylactic shock. An auto-injector is being given now .”
5.
Give the following information about the child:
• level of consciousness
• breathing
• bleed ing
• age
6.
My phone number is
7.
The closest entrance for the ambulance is on:
8.
Do you need any more information?
9.
How long will it take you to get here?
10. Tell them: “A staff m em ber w ill m eet you at the entrance to provid e further
inform ation.”
11. Call the parents/guardians/emergency contact.
21
Appendix 6 - OCDSB General Guid elines for Anaphylaxis Stud ents
Suggestions for Information Sessions
Information sessions should be provided by medical personnel to school staff or to interested
parents in the school. A good opportunity for this kind of discussion is at the Meet the Teacher Night.
Presentations might be videotaped for future use.
Available resources for presentation or information booths on anaphylaxis:
Allergy Asthma Information Association
(AAIA)
AAIA Ontario
P.O. Box 2371
St. Mary’s, Ontario N 4X 1A2
Phone: (519) 284-4222
Toll-free 1-888-250-2298
Fax: (519) 284-0384
E-m ail: [email protected]
Website: w w w .aaia.ca
Prevention First
Website: w w w .ew orkshop.on.ca/ allergies
Ottawa Anaphylaxis Support Group
OASG Mem bership Coord inator
23 Southview Crescent
N epean, ON K2E 5R4
Voice Message Service: (819) 778-2562, ext. 3
Fax Line: (613) 825-6601
E-m ail: info@ottaw aasg.com
Website: w w w .ottaw aasg.com
Anaphylaxis Canada
416 Moore Avenue, Suite 306
Toronto, ON M4G 1C9
Telephone: 416-785-5666
Fax: 416-785-0458
E-m ail: [email protected]
Website: w w w .anaphylaxis.ca
MedicAlert
To enroll by phone or to ord er brochures
Tel: 1-800-668-1507
Website: w w w .m edicalert.ca
Ottawa Public Health
Web site: w w w .ottaw a.ca/ health and
search anaphylaxis
Videos
Available for borrow ing from Ottaw a Public H ealth School H ealth Intake Line (613) 580-6744
ext. 24242
It Only Takes One Bite (1995) Ad ult oriented
Available for borrow ing from the Ottaw a Public Library:
A lexander, The Elephant W ho Couldn’t Eat Peanuts (1996) suitable for grad es 1-6.
Books
N o N uts for M e by Aaron Zevy (1995) available in English and French.
D ocuments:
A naphylaxis: A Handbook for School Boards ($15 or dow nload for free)
The Canad ian School Board Association
130 Slater Street, Suite 350, Ottaw a, Ontario K1P 6E2
Tel: (613) 235-3724
Fax: (613) 238-8434
E-m ail: ad m [email protected]
Website: w w w .cd nsba.org
22
Appendix 7 - OCDSB General Guid elines for Anaphylaxis Stud ents
Newsletter Samples
1.
We feel that all parents would like to be aware that there is a student (or several students) in our
school with a severe life-threatening food allergy to peanuts and nuts (anaphylaxis). This is a
medical condition that causes a severe reaction to specific foods and can result in death within
minutes. Although this may or may not affect your child’s class directly, we want to inform you
so that you may choose to send foods to school that are free from peanuts or nut products. There
will be more information about anaphylaxis at our Meet the Teacher Night. Thank you for your
understanding and co-operation.
2.
We request that parents of anaphylactic students (or the student, if he or she is 18 years of age)
submit accurate, up-to-date information to the school office about the student’s life-threatening
allergy by completing Form OCDSB 616: Severe and Life-Threatening Allergy Protocol and
Form OCDSB 405: Emergency Use of an Auto Injector Authorization which are available at the
school and on the OCDSB website.
23
24
25
26
Appendix 9 - OCDSB General Guid elines for Anaphylaxis Stud ents
Example
Letter to Parents
Dear Parent:
I am writing to you on behalf of one of our students and his parent(s). The student is (age of
student) years old in (name of teacher) grade (level) class. He has a life-threatening allergy to peanuts
and all types of nuts. If peanut butter or even the tiniest amount of peanut or any type of nut enters his
body (through his eyes, nose or mouth), he experiences very strong reactions. His face swells and breaks
out in hives, his throat swells and tightens. Without immediate medical treatment he could die within
minutes.
After discussions with school staff and other knowledgeable parties in the medical community, it
has been suggested that the best way to provide a safe environment for this student would be to enlist the
support of parents to help make his classroom a peanut- and nut-free environment. This means that each
child entering this grade is asked to bring snacks and lunches free of any peanuts or nuts. Though it
sounds simple, it means no peanut butter sandwiches or peanut butter cookies. It means you should read
the labels of other foods like muffins, granola bars and cereals before you put them in your child’s snack.
Our concern is for foods where peanuts or nuts might be a “hidden” ingredient, and where
cross-contamination may occur.
I realize this request poses an inconvenience for you when packing your child's snack and lunch;
however, I wish to express sincere appreciation for your support and understanding of this potentially
life-threatening allergy. In the very near future the school will announce a parent meeting for you to
become acquainted with this situation. Literature will be provided suggesting healthy and nutritional
alternatives to peanuts, nuts and their by-products.
Sincerely,
Principal
This letter may only be sent with the written consent of the parents concerned.
-------------------------------------------------------------------------------------------------------------------------------------Please return this portion to the home room teacher
We, the parents/guardians of:
Name of Student
have received and read the letter regarding the student with the life-threatening allergy.
Signature of Parent/Guardian
Date
27
Appendix 9 - OCDSB General Guid elines for Anaphylaxis Stud ents
Example
Letter to Parents
Dear Parents:
Re: Attached Article
The attached article (see reverse*) helped me to understand the possible serious effects of peanut
and nut products on those who are allergic.
We do not want to alarm you or anyone, but it is our hope that we can keep our lunch rooms free
of peanut products so our allergic students can eat with their friends and peers without the concerns noted
on the attached article.
Your help in this matter would be gratefully accepted.
We realize that for some children at this age peanut butter and peanut butter products are almost
the ‘only’ thing they like. We do not want to complicate your ‘lunch making’ duties. If there are no
alternatives for your child, please let us know so we can make appropriate arrangements.
Your continued support is much appreciated.
Yours sincerely,
Principal
* See Appendix 17 for selection of articles
-------------------------------------------------------------------------------------------------------------------------------------Please return this portion to the home room teacher
We, the parents/guardians of:
Name of Student
have received and read the letter regarding the student with the life-threatening allergy.
Signature of Parent/Guardian
Date
28
Appendix 10 - OCDSB General Guid elines for Anaphylaxis Stud ents
Example
Letter to Parents
Dear Parents:
Earlier this week we had the pleasure of having our school’s Public Health Nurse speak to our
grade (level) students regarding allergies, including one of the most deadly, an allergy to peanuts.
From her presentation we learned that:
•
the deaths that occur are generally caused by cross-contamination, i.e., a trace of peanut
butter that is left on a hand, a knife, a desk or another object - the student who is allergic
could inadvertently touch this trace and a reaction (or even death) could occur;
•
after eating peanut butter at home, students and parents should wash thoroughly with soap
and water before coming to school;
•
we have just a few minutes to administer the auto-injector (an injection used for severe
allergic reactions such as hives, swelling, difficulty breathing, wheezing);
•
children with severe allergies should be able to feel as confident and safe as possible knowing
that all precautions have been taken.
The number of students allergic to peanut butter and nut products in our school is growing, and
this year we have a student in grade (level) at the very highest risk level.
Precautions already being taken are as follows: the desk tops are washed with soap and water at
noon hour, staff is receiving information from the Public Health Nurse, and the parent-teacher group is
planning an allergy information session at their forthcoming meeting.
Since it is our goal to ensure that we have as safe an environment as possible when a child’s life
is at stake, we are asking for your help and understanding in having an area in our school that will be free
from peanut butter. The area is (state area). If it is necessary for your child to have peanut butter in his or
her lunch or snack, we wish to be informed by requesting that you label the particular food so that
appropriate precautions can be taken.
If you wish further information, please come to the meeting or phone the school and copies of
articles will be provided. Please find attached some relevant newspaper articles.*
Yours sincerely,
Principal
* See Appendix 17 for selection of articles.
29
Appendix 11 - OCDSB General Guid elines for Anaphylaxis Stud ents
Example
Letter to Parents
Dear Parents:
Re: Medical Danger
One of our (state grade level) students has a life-threatening allergy to all nuts. The only way to
ensure a safe environment for this child is to try to make our classroom nut-free. To do this we need
everyone’s co-operation.
Please check the ingredients of all foods your children bring to school. Coconut is not a risk for
nut allergies only for students with specific coconut allergies.
In a classroom setting, cross-contamination is the greatest risk from this type of allergy.
Cross-contamination is when a few crumbs from one child’s snack are dropped and then picked up by an
allergic child. Even a small amount can kill.
It is difficult at the best of times to get children to eat healthy snacks; however, I hope you will
appreciate the seriousness of this condition and that you will assist us at the school in our efforts to create
as safe an environment as possible. With your co-operation we can minimize the risk of an allergic
reaction.
Anyone wishing further information about this type of allergy may contact the child’s parents.
There is also an information package available at the school.
Yours sincerely,
Teacher
-------------------------------------------------------------------------------------------------------------------------------------Please return this portion to the home room teacher
We, the parents/guardians of:
Name of Student
have received and read the letter regarding the student with the life-threatening allergy.
Signature of Parent/Guardian
Date
30
Appendix 12 - OCDSB General Guid elines for Anaphylaxis Stud ents
When Health Records Indicate Food Allergies
but Parents Have not Supplied Necessary Information:
Dear (parent/guardian):
The forms you submitted for (student’s name) indicate that he/she has an allergy to
(state allergy).
We would therefore appreciate the following:
1.
A completed Severe and Life-Threatening Allergy Protocol Registration, and an
Emergency Use of Auto-Injector Authorization form (attached).
With your permission, the protocol will be displayed in the office, the staff room, the
home-room.
In addition, and with your permission, if student is transported, information will be
shared with the Ottawa Student Transportation Authority, for communication to school
bus operators and drivers, so that appropriate personnel can learn to recognize the
student.
A photograph of (student’s name) will be attached to the protocol and to the information
provided to the Ottawa Student Transportation Authority; please supply (state number)
small photographs.
With your permission, other parents and concerned individuals will be advised of your
child’s condition.
2.
Two epinephrine kits, if prescribed (EpiPen® or Allerject), or other medication to be
used if an anaphylactic reaction occurs.
Your prompt attention to the above is appreciated. We would welcome an opportunity to meet with you
to discuss your child’s allergy. It would be appreciated if this information could be provided by (date).
Yours sincerely,
Principal
........................................................................................................................................................................
Please return this portion to the home room teacher
We, the parents/guardians of:
Name of Student
give permission for the allergy protocol to be displayed in the school office, staff room, and home-room,
and for the Ottawa Student Transportation Authority, school bus drivers and dispatch personnel, and other
parents and concerned individuals to be advised of our child’s condition.
Signature of Parent/Guardian
Date
31
Appendix 13 OCDSB General Guid elines for Anaphylaxis Stud ents
Suggestions for Dealing with Non-Co-Operation
General Statement
It is our goal to have no allergens in the classrooms used by anaphylactic students. We do
NOT support the concept of segregating either the anaphylactic students or students who bring in
foods which are not allergen-free.
Suggestions
•
Remind students who bring allergens (e.g., peanut butter sandwiches) into the
classroom of the dangers involved for the anaphylactic student.
•
Send a letter home with the student who brings allergens into the classroom (e.g.,
Appendix 9).
•
Ask for consideration from the parent or guardian of the student bringing allergens
(i.e., the home-room teacher telephones the parent/guardian and asks for
consideration).
•
Ask again for consideration from the parent or guardian of the student bringing
allergens (i.e., the principal telephones the parent/guardian and asks for
consideration).
•
A student who has brought allergens into the classroom should eat away from the
anaphylactic student. After eating, the location should be carefully cleaned and the
student should wash his/her hands.
32
Appendix 14 - OCDSB General Guid elines for Anaphylaxis Stud ents
Example
Sample Reminder/Thank You Letter
Dear Parents:
Re: Peanut and Nut Product Allergies
The children in our school with severe peanut and nut product allergies, and their families, would
like to join me in thanking you for your understanding and co-operation as a result of the request to avoid
sending peanut and nut products to school. There has been a reduction in the number of peanut and nut
products brought to school in snacks and lunches, and we would like to thank you for continuing not to
send these products to school with your child.
Since even a minute amount of the allergic substance can cause a life-threatening reaction,
keeping it out of the classroom is our best method of preventing a serious reaction at school.
If your child does bring a food to school containing peanut or nut products, please ask the child to
let the teacher know.
Thank you again for your co-operation in this important issue.
Yours sincerely,
Principal
33
Appendix 15 - OCDSB General Guid elines for Anaphylaxis Stud ents
34