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					                             EMERGENCY EPIPEN-AUTOINJECTION GUIDELINES

The administration of epinephrine (at appropriate dosage for weight) is approved for use in the Rockford
Public Schools. This standing order, signed by the School Health Physician, is kept in the office of the
Health Services Supervisor. The use of EpiPen (or equivalent) may be used when students or staff
exhibit signs or symptoms of any anaphylactic reaction. These guidelines are to be followed:

PURPOSE:
     To ensure proper procedure when administering epinephrine via EpiPen Auto Injector (or
     equivalent) for anaphylaxis or extreme allergic reaction.

DEFINITIONS
     Anaphylaxis – an allergic hypersensitivity reaction of the body to a foreign protein or drug.
     reactions that constitute anaphylactic shock may occur suddenly.
     EpiPen Auto Injector – a disposable drug delivery system with a spring activated, concealed
     needle. It is designed for emergency administration to provide rapid, convenient first aid for
     individuals sensitive to potentially fatal allergic reactions. EpiPen , 0.3mg Epinephrine, and
     EpiPen Jr., 0.15mg. Epinephrine or equivalent may be used in the schools.

PROCEDURE

1) Nurse or trained staff member will identify symptoms that signal onset of an extreme allergic
   reaction. Symptoms include:
                  A. Itching of the skin and raised rash (hives)
                  B. Flushing, swelling of the tissues of the lips, throat, tongue, hands and feet
                  C. Wheezing, shortness of breath, coughing, hoarseness
                  D. Headache
                  E. Nausea, vomiting, abdominal cramps
                  F. Sense of impending doom, loss of consciousness

2) Procedure for administration of administration of epinephrine through the use of EpiPen Auto-
   Injector (or equivalent):
                   A. Pull of safety cap
                   B. Place black tip on outer thigh and hold firmly in place. May be injected through
                       clothes.
                   C. Push EpiPen Auto-Injector against thigh until activates, and hold in place for
                       approximately 10 – 20 seconds
                   D. Place in sharps disposal box for safe disposal
                   E. Keep victim warm and avoid unnecessary exertion

3) CALL 911. Every time epinephrine is administered for an anaphylactic reaction, emergency
   services must be called. You will often see immediate improvement of symptoms (within a few
   seconds), but this situation may reverse in 10-15 minutes.

4) Call parent/guardian of student. Fill out Incident Report Form. One copy of this form is to be given
   to the Emergency Department Personnel, one copy faxed to the Assistant Superintendents office,
   and one copy retained in student records.

5) This event should be documented on an “Accident” report form, and documented on the students
   health card.

                                                                                                          1
Health Services Department
Revised 3/2008
                                    ROCKFORD PUBLIC SCHOOLS #205
                                    HEALTH SERVICES DEPARTMENT

     GUIDELINES FOR TRAINING OF STAFF IN ADMINISTRATION OF EPINEPHRINE


Rockford Public School employees may be trained in the administration of epinephrine via use of EpiPen
(or equivalent) in the event of an anaphylactic or severe allergic reaction. The school nurse under the
guidance of the principal should identify the needs of the building, and determine any appropriate staff
willing to be trained.

PURPOSE

          To ensure that employees other than the nurse are competent in administering emergency
          medication via EpiPen (or equivalent).

GUTDELINES

          Staff employees other than the nurse may be instructed and trained to ensure competence in
          administering epinephrine via EpiPen in the event of an anaphylactic or severe allergic reaction.
          These employees must demonstrate competency.

PROCEDURE

          1)        Staff member, who is willing to be trained to administer epinephrine, must read or be
                    given training o n this subject matter. See accompanying literature.

          2)        The staff member is to be instructed regarding the district's procedure, signs and
                    symptoms of anaphylactic reactions, Incident Report Form, and necessity to
                    call 911 for this emergency.

          3)        The staff member must complete a written test on which they must obtain a score of
                    100%. The employee test may be repeated.

          4)        The staff member must demonstrate proper use of EpiPen Auto-Injector with a training
                    device, to the school nurse.

          5)        The staff member is instructed on Incident Report Form to accompany student with
                    paramedics, and must give a full report to school nurse so she can follow-through with
                    any medical needs.




                                                                                                              2
Health Services Department
Revised 3/2008
                                     ADMINISTRATION OF EPINEPHRINE

                             EMPLOYEE COMPETENCY VERIFICATION OF TRAINING




Name: __________________________________                 Date: ____________________________



Employee has demonstrated understanding and competency in:

1) _____ Knowledge of universal procedures

2) _____ Verbalizes drug action of Epinephrine

                         Upper Respiratory                   Pale Skin
                         Dizziness                           Chest Pain
                         Headache                            Nausea & Vomiting
                         Excitability / Anxiousness

3) _____ Chooses proper injection site – thigh

4) _____ Demonstrates removal of safety cap

5) _____ Demonstrates appropriate dose based on body weight
              0.3 mg = adult > 30kg                0.15mg = child < 30kg

6) _____ Holds injector demonstrator against site for 10-20 seconds

7) _____ Properly discards “Auto-Injector”

8) _____ Calls 911



Employee Signature______________________________________ Date: ____________



School Nurse: _____________________________________________ Date: ____________



I hereby acknowledge that the person listed above has demonstrated EpiPen Competency by successful passing the
Employee Competency Test and through practical demonstration the techniques using an Epi-Pen Auto Injector
demonstrator.



                                                                                                                 3
Health Services Department
Revised 3/2008
                                 ADMINISTRATION OF EPINEPHRINE
                                  EMPLOYEE COMPETENCY TEST

         1) What is the active ingredient in the EpiPen?

         2) Which of the following are symptoms signaling the onset of a severe allergic
         reaction, also called anaphylaxis?
               a. Itching of the skin, hives, headaches, nausea, vomiting, abdominal cramps
               b. Flushing, swelling of tissue of the lips, throat, tongue, hands, feet,
               c. Shortness of breath, wheezing, hoarseness
               d. Sense of impending doom, loss of consciousness
               e. All of the above

         3) The proper site for administration of epinephrine through the use of an Auto-
         Injector is:
              a. Buttocks                   b. Upper arm
               c. Abdomen                      d. Thigh
         4) The medication in EpiPen acts by:
               a. Relaxing smooth muscle in the lungs to improve breathing
               b. Stimulating the heart and constricting blood vessels
               c. Working to reverse hives and swelling around face and lips
               d. All of the above.
         5)    The three steps to the use of EpiPen are:


         6) The EpiPen may be given through clothing. True             False

         7) How long should the EpiPen be held in place after being injected?

         8) The EpiPen should begin to work in             minutes.

         9) How should the EpiPen be disposed of following use?

         10) What measures should be taken following the administration of EpiPen?
             a. Call 911                         b. Notify parent/guardian
             c. Notify the school nurse          d. Fill out Incident Report Form
                             e. All of the above



Employee Signature: ____________________________________                       Date: _____________________


School Nurse Signature: __________________________________ Date: ____________________


                                                                                                         4
Health Services Department
Revised 3/2008
                                             INCIDENT REPORT



STUDENT’S NAME:                              GRADE:              DISCIPLINE CODE:

DATE OF INCIDENT:                    TIME:

ATTENDANCE CENTER:

INCIDENT LOCATION:

ADMINISTRATOR REPORTING INCIDENT:

DESCRIPTION OF INCIDENT:



POLICE CASE:                 YES   NO POLICE CASE NUMBER:

SPECIAL EDUCATION ELIGIBILITY:                 YES    NO

WERE PARENTS CONTACTED?                       YES     NO         HOW?

ACTION TAKEN:

REPORT SUBMITTED BY:




cc: Executive Director, Special Education (Please fax ASAP - 966-3157)
Revised September 2007


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Health Services Department
Revised 3/2008

				
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