Page 36 - Anaphylaxis in Schools & Other Settings, 3rd Edition

Note: Some school boards may choose to allow a parent or guardian to note “on file” if a physician’s signature has already been obtained (e.g. on previous Anaphylaxis Emergency Plan or written instructions about treatment protocol) and there has been no change in the child’s condition or treatment strategy. The document with the physician’s signature should be kept in the pupil’s file for future reference.
Note: The AllerjectTM provides voice prompts which can help people through the steps of the injection. If for any reason the voice prompts do not work or the voice cannot be heard due to noise, the device will still work and deliver the dose of epinephrine in an emergency situation. There are also written instructions printed on the AllerjectTM which can be followed.
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Anaphylaxis in Schools & Other Settings
Copyright © 2005-2015 Canadian Society of Allergy and Clinical Immunology
Appendix D
Anaphylaxis Emergency Plan (individual) Recommendation
ƒ In schools and other child care settings, each child at risk of anaphylaxis should have an Anaphylaxis Emergency Plan. (See following page.)
ƒ The Anaphylaxis Emergency Plan should be signed by the parent or guardian, and if required, by the child’s physician.
ƒ There may be situations where individuals were given recommendations that differ from those outlined in this Anaphylaxis Emergency Plan. In these cases, specific instructions for treatment of symptoms and risk reduction strategies should be provided in writing by the child’s physician. Parents of allergic children should discuss individualized plans with their children’s school staff.
ƒ If an anaphylactic emergency occurs, both the school anaphylaxis plan and the Anaphylaxis Emergency Plan should be reviewed and amended as necessary.
The Anaphylaxis Emergency Plan has two pages:
1. First page – form with the person’s photo and allergy information, signs and symptoms, brief action plan, contact information, and consent to administer medication. See next page (Anaphylaxis Emergency Plan) which can be photocopied.
2. Second page – epinephrine auto-injector instruction sheet for either the EpiPen® or AllerjectTM. Select the instructions which correspond to the device prescribed for the individual. Instruction sheets are available on the pages that follow and can also be downloaded from the following sites:
– www.epipen.ca – www.allerject.ca