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Swansea Public School Anaphylaxis

Prevention andManagement Plan

207 Windermere Ave., Toronto, Ontario M6S 3J9Tel: 416-393-9080 Fax: 416-393-9076

1.0) INTRODUCTION ......................................................................................................... 2

2.0) PREVENTION .............................................................................................................. 2

2.1 Allergen Awareness, Reduction and AvoidanceAllergen Awareness, Reduction and Avoidance ........................................................ 2 2.1a) On school property ............................................................................................... 2

2.1b) In the classroom ............................................................................................... 3 2.1c) In common areas ............................................................................................... 32.1d) In the lunchroom ............................................................................................... 3

3.0) MANAGEMENT ......................................................................................................... 4

3.1) ResponsibilitiesResponsibilities ......................................................................................................... 43.1a) Principal ......................................................................................................... 43.1b) Teachers ......................................................................................................... 53.1c) Parent(s)/Guardian(s) of an Anaphylactic Child Parent(s)/Guardian(s) of an Anaphylactic Child Parent(s)/Guardian(s) of an Anaphylactic Child .................................................. 53.1d) Anaphylactic Student Anaphylactic Student Anaphylactic Student ............................................................................................ 63.1e) All Parents ......................................................................................................... 63.1f) All Students ......................................................................................................... 6

3.2) Identifi cation of Children at Risk .............................................................................. 63.2a) Medical Alert form .............................................................................................. 63.2b) Red Medical Concern duotang ........................................................................... 63.2c) Key tags .............................................................................................................. 73.2d) Medical Bracelets ............................................................................................... 7

3.3) Availability and Location of EpiPensAvailability and Location of EpiPens® ........................................................................ 7

3.4) Anaphylaxis Resource PersonsAnaphylaxis Resource Persons ................................................................................. 7

3.5) Substitute Teacher Protocol ...................................................................................... 7

3.6) Field Trip ProtocolField Trip Protocol ..................................................................................................... 7

3.7) Training and EducationTraining and Education ............................................................................................. 8

4.0) EMERGENCY RESPONSE .......................................................................................... 9

5.0) APPENDICES Anaphylaxis Signs & SymptomsAnaphylaxis Signs & Symptoms ............................................................................................. 10911 Protocol - Anaphylaxis911 Protocol - Anaphylaxis ...................................................................................................... 11EpiPenEpiPen® - How to use® - How to use® .............................................................................................................. 12Field Trip Organizer’s ChecklistField Trip Organizer’s Checklist ................................................................................................ 13Field Trip Field Trip Cellphone NumbersCellphone Numbers ................................................................................................... 14How To Provide A Peanut/Nut - Free Snack ............................................................................... 15Peanut/Nut - Free Snack Ideas .................................................................................................. 16Substitute Teacher’s Checklist ................................................................................................. 17

SWANSEA PUBLIC SCHOOL ANAPHYLAXIS PREVENTION AND MANAGEMENT PLAN

Referenceshttp://www.anaphylaxis.org/, http://www.safe4kids.ca/index2.asp

http://www.allergysafecommunities.ca/pages/default.asphttp://www.foodallergy.org/, http://www.tdsb.on.ca/pandp/ppdocs/docs/r/PR563.pdf

http://www.allergyfoundation.ca/, http://www.tdsb.on.ca/pandp/ppdocs/docs/r/PR563.pdf

ACKNOWLEDGMENTSThis Anaphylaxis Prevention and Management Plan is a collaborative project by members of the Swansea School Community and the

Anaphylaxis Committee: Faegi Bines, Louise Blokowski, Jennifer David, Michelle Huang, Cindi Morshead, Kathy Richmond and Anita Wong

2008

1.0) INTRODUCTION 2

CONTENTS

1.0) INTRODUCTION

Anaphylaxis is a severe allergic reaction that can be fatal1. It affects about 2 percent of Canadians, possibly more children2, and Swansea Public School’s population refl ects this fi gure. Food most commonly causes anaphylaxis, but insect stings, medicine, latex and exercise can also be triggers. Although it is unusual, without immediate appropriate medical aid, death may result.

The key responsibility in preventing such tragedies lies with anaphylactic individuals and their family. However, because of the very young age of much of Swansea’s population, keeping dangerously allergic students safe requires the co-operation of the entire school community.3

Swansea is a peanut- and tree-nut-safe environment. This Anaphylaxis Prevention and Management Plan, which is consistent with the Toronto District School Board’s Anaphylaxis Operational Procedure PR.563 SCH (Nov. 5, 2005) and the Ontario government’s Sabrina’s Law, outlines the school’s procedures for:

• reducing the risk of an anaphylactic reaction occurring at Swansea; • preparing school employees to respond to a reaction effectively; • educating the entire Swansea community – staff, students and parents – about anaphylaxis and• the emergency response to incidents of possible anaphylactic shock.

2.1) Allergen Awareness, Reduction and Avoidance2.1) Allergen Awareness, Reduction and Avoidance

The Canadian government has identifi ed nine Priority Food Allergens, which cause more than 90 percent of severe adverse reactions related to food allergens. They are:

• peanuts• tree nuts (almonds, Brazil nuts, cashews, hazelnuts or fi lberts), macadamia nuts, pecans, pine nuts,

pistachios, walnuts) • sesame seeds• milk• eggs• fi sh, crustaceans (e.g. crab, crayfi sh, lobster, shrimp) and shellfi sh (e.g. clams, mussels, oysters, scallops)• soy• wheat• sulphites

At Swansea, the most prevalent dangerous allergies are to peanuts and tree nuts. (As of the 2007/08 school year, every student who has been medically diagnosed as potentially anaphylactic is allergic to peanuts and/or tree nuts). There are allergies to other foods and insect stings as well.

Therefore, Swansea takes the following measures to reduce the risk of allergens:

2.1a) On school property• Swansea Public School is a peanut- and tree-nut safe environment. Peanut and tree-nut allergies require

stringent management plans. They are one of the most common food allergies and the leading cause of food-induced anaphylaxis4. Minute amounts of certain foods such as peanut when ingested can be life threatening. In school settings several children have had skin rashes and stomach upsets from simply touching residual peanut butter on tables wiped clean of visible material.5 Parents are asked to ensure that any food brought to school – for lunch, snack, class distribution, crafts, fi eld trips and School Council sponsored events – be peanut/nut safe! No peanuts/nuts, nut products or nut by-products please!6 Please see the appendix for instructions on how to read food labels.

1.0) INTRODUCTION

Anaphylaxis is a severe allergic reaction that can be fatal1. It affects about 2 percent of Canadians, possibly more

1 Toronto District School Board Operational Procedure on Anaphylaxis, PR.563 SCH, Nov. 5, 2005, page 12 Anaphylaxis Canada and Health Canada, http://www.hc-sc.gc.ca/iyh-vsv/med/allerg_e.html3 PR.563 SCH, page 14 “Anaphylaxis in Schools and Other Child Care Settings,” prepared by the Canadian Society of Allergy and Clinical Immunology, Ontario Allergy Society, and Allergy Asthma Information Association. http://www.safe4kids.ca/content/schools/safeschools.pdf.f.f5 ibid6 Swansea School’s peanut/nut-safe logo


1.0) INTRODUCTION

2.0) PREVENTION2.0) PREVENTION

2

• Maintenance staff must cover/remove garbage containers, including Dumpsters, to reduce the risk of insect- induced anaphylaxis.7

• The school’s fi rst-aid supplies are allergen-free, with non-latex gloves and non-latex Band-Aids.8

• In accordance with TDSB policy, Swansea School strongly encourages celebrations, activities and rewards or incentives that do not involve food. For example, birthday loot bags containing things such as pencils, erasers, stickers, sports cards, costume jewellery, note pads and other dollar-store items.9

2.1b) In the classroom• In classrooms of anaphylactic students, special care is taken to avoid allergens. Any specifi c allergens in

addition to peanuts and tree nuts that may trigger anaphylaxis in a particular student must not be brought into that child’s classroom. Parents must consult the teacher before supplying food, toys, balloons, or craft materials to these classrooms.10 Because of cross-contamination risks, this also applies to a class without an anaphylactic child if it shares the classroom with another group that does have an anaphylactic student (e.g. morning and afternoon kindergarten classes that use the same space). • For classes with a daily snack, the tables and chairs should be wiped with a clean cloth and soap and water

(alternatively, personal place mats can be used and wiped clean) and the students should be encouraged to wash their hands with soap and water before and after eating. If a child arrives with a snack that a supervising adult suspects contains an allergen that could trigger anaphylaxis in a classmate, it will be replaced with something from the school snack program. The child’s snack will be returned home and the teacher will remind the parents of the school’s food policy in writing.

2.1c) In common areas

To minimize contamination with allergens, during regular school hours, food is not allowed in common areas including the library, gyms, swimming pool, music room, computer room and hallways except under special circumstances. Some events with food do take place in the common areas outside school hours and in such cases a tablecloth (preferably paper), is strongly encouraged to minimize contamination by allergens.

2.1d) In the lunchroom• Lunchroom supervisors, like all other employees, receive full anaphylaxis and epinephrine training every

September.• Anaphylactic students using the lunchrooms must have an EpiPen® on hand and the lunchroom supervisors ® on hand and the lunchroom supervisors ®

must be informed of its whereabouts.• The school keeps two spare adult EpiPens® in the lunchroom locker, to which lunchroom staff have a key. ® in the lunchroom locker, to which lunchroom staff have a key. ®

Before every lunch period, staff will remove the EpiPens® from the locker and keep one in each lunchroom. ® from the locker and keep one in each lunchroom. ®

Immediately after lunch, the EpiPens® will be secured in the locker again.® will be secured in the locker again.®

• Lunchroom staff keep a Medical Alert (sec. 3.2a) form of every anaphylactic student using the lunchroom with the attendance list and a Medical Concern duo tang (sec. 3.2b) in both lunchrooms. At the parent’s request, the Medical Alert form can also be posted on the wall of the lunchroom.• A poster describing the symptoms of anaphylaxis and how to administer an EpiPen® is on the wall of the ® is on the wall of the ®

lunchroom.• Posters in the lunchrooms remind students to wash their hands with soap and water before and after eating.• If peanut or tree-nut products are brought into the lunchroom, lunchroom staff remove the item for return

home, send a note home to the parents reminding them of the school’s food policy and give the child an alternative from the school’s snack program.• The lunchroom supervisors are equipped with walkie-talkies in the lunchroom and playground so they can

contact the principal (or designate), who will wear the receiver, immediately in an emergency. • After lunch, the lunch bags of anaphylactic students must be kept separate from the other lunch bags. • In a case of anaphylaxis, lunchroom staff will follow the emergency procedures outlined below (sec. 4.0).

One supervisor will stay with and attend to the injured child and the others will oversee the lunchrooms.

7 PR.563 SCH, page 48 ibid9 PR.563 SCH, page 510 PR.563 SCH, page 1


3

3.1) Responsibilities3.1) Responsibilities

Keeping Swansea’s anaphylactic students safe is the responsibility of the anaphylactic students and their parents fi rst. But they need the help of the entire school community. To minimize risk of exposure and to ensure rapid response to an emergency, parents, students and school personnel must all understand and fulfi ll their responsibilities.

3.1a) Principal

The school principal oversees and enforces Swansea’s Anaphylaxis Prevention and Management Plan and ensures that the school is in compliance with TDSB Operational Procedure PR.563 and Sabrina’s Law. As such, the principal:

• Offers parents of each anaphylactic student a meeting each September (or end of August) with the principal and appropriate school staff to gather medical information related to the child’s condition including: causal factors, severity of allergy, past incidents of anaphylactic reactions, and other health considerations.11

• Provides to all interested parents TDSB Operational Procedure PR.563 SCH and Swansea’s Prevention and Management Plan.• Ensures that upon registration, parents, guardians and students are asked to supply information on life-

threatening allergies, and to complete Form 536A, Administration of Prescribed Medication and Form 536B, Management of Emergency Medical Concerns.12

• Maintains a fi le for each anaphylactic student of current treatment and other information, including a copy of any prescriptions and instructions from the student’s physician or nurse and a current emergency contact list.13

• Develops an individual plan for each student who has an anaphylactic allergy. Each individual plan has: details of the type of allergy; monitoring and avoidance strategies and appropriate treatment; a readily accessible emergency procedure including emergency contact information; and the location of the student’s medication.14

• Distributes Form 536B (Management of Emergency Medical Concerns) and the Medical Alert form/TDSB form 536C (Student Medical Alert) to all appropriate school personnel (student’s teacher(s), educational assistant, offi ce staff, bus driver, lunch supervisors, etc.)15.• Appoints at least three Swansea employees to be Anaphylaxis Resource Persons (sec. 3.4).• Ensures all staff – including teachers, educational assistants, lunchroom supervisors, support staff,

custodians, substitute teachers, bus drivers – are trained at the beginning of every school year by Anaphylaxis Canada (or equivalent qualifi ed organization) to recognize the symptoms of anaphylaxis and are trained to use an epinephrine ® The principal arranges for training for all staff (sec. 3.7). He/She will keep a list of who attended the session and, as soon as possible, hold additional workshops by Anaphylaxis Resource Persons to train those who did not attend the fi rst session. • Sends a letter home in September and before holidays/celebrations that traditionally include food, e.g. Halloween, Christmas, Valentine’s Day, Easter, etc., to all parents explaining Swansea’s policies on not

bringing peanuts and tree nuts and their by-products to school and encouraging activities and celebrations that do not include food.17

• Informs teachers at placement meetings who will have an anaphylactic child the following school year so that appropriate plans can be made in advance.• In the event a potentially anaphylactic student experiences an allergic reaction at school (anaphylaxis

or not), the principal or designate will promptly investigate by interviewing all involved – such as the allergic student and parents, adults present during the reaction, and anyone who may have introduced the allergen into the school. The principal will brief all teachers at the next staff meeting on the circumstances

11PR.563 SCH, page 312ibid13ibid14 ibid15PR.563 SCH, page 416PR.563 SCH, pages 4, 917PR.563 SCH, page 4


3.1) Responsibilities

3.0) MANAGEMENT3.0) MANAGEMENT

4

surrounding the incident. If the reaction was due to the introduction of an allergen that the school has already requested not be brought to school, the principal will send a letter home to all parents reminding them of Swansea’s allergy policy and use the reaction as an opportunity to educate the community.• Make available the EpiPen® trainers at all staff meetings so that staff can practice administering ® trainers at all staff meetings so that staff can practice administering ®

epinephrine.

3.1b) Teachers18

The potentially anaphylactic child’s teacher spends the most amount of time with the student at school and is therefore likely to be on the frontline of a reaction. His/her responsibilities are wide-ranging. Because a reaction can occur anywhere in the school, all teachers need to know and follow Swansea’s policies on anaphylaxis and the emergency procedure. All teachers, whether or not they have an anaphylactic student in class:

• Keep in the classroom and review the red Medical Concern duo tang, which holds pictures of all Swansea students with urgent medical issues, including those who may be anaphylactic.• Keep themselves informed of whom in their class is potentially anaphylactic; be available to meet with such

students’ parents before the school year starts, in late August or early September.• If there is an anaphylactic student, the teacher sends a letter to the classmates’ parents at the beginning

of the year explaining there is a dangerously allergic child in the class, the risk of contamination, requesting that children take measures such as washing their faces and brushing their teeth if consuming peanuts/nut products or other allergens before arriving at school, and providing a list of specifi c allergens that must not be brought into the classroom if they extend beyond peanuts and tree nuts. The letter could also include a list of “safe” snacks.• Keep the Medical Alert form/TDSB Form 536C (Student Medical Alert) of any anaphylactic students in the

class in the Day Book and affi xed to the teacher’s desk. At the parent’s request, the form can also be posted on the wall of the classroom.• Discuss anaphylaxis with the class, in age-appropriate terms, at the beginning of the year.• Facilitate communication with other parents.• Enforce school rules about bullying and threats.• Leave information in an organized, prominent and easily accessible format for occasional teachers.• For activities in which the child must remove the EpiPen® from his/her person (e.g. swimming classes), the ® from his/her person (e.g. swimming classes), the ®

teacher establishes a procedure with child and parents on who will keep the medication for the child and ensure it is returned to the child immediately after the activity is over.• If the teacher notices an item with allergens has been brought to class, he/she sends it back along with a

note home. The student can receive an alternative from the school snack program. • Reinforces the school’s policy of encouraging activities, celebrations, teaching units, and rewards and

incentives that do not include food.• Sets an example for students by adhering to Swansea’s peanut/tree-nut safe policy of not bringing or

consuming such products to school.

3.1c) Parent(s)/Guardian(s) of an Anaphylactic Child193.1c) Parent(s)/Guardian(s) of an Anaphylactic Child193.1c) Parent(s)/Guardian(s) of an Anaphylactic Child• Informs the school of their child’s allergies and completes Form 536A, Administration of Prescribed

Medication, and Form 536B, Management of Emergency Medical Concerns.• Ensures that their child’s fi le is kept up-to-date, including the medication the child is taking, any changes to

his/her medical condition and current parent emergency contact information.• Provides a medical bracelet for their child.• Provides the school with two up-to-date auto-injection kits, clearly labeled with child’s name and

prescription details; provides student with a body pouch or fanny pack for carrying at least one auto- injector at all times on their body. (An alternate arrangement may be necessary for very young students or those who have diffi culty in managing responsibility.)• Reviews the school Prevention and Management Plan with school personnel and provides in-service

support and information as requested.• Provides their child with safe foods, including for special occasions.• Teaches their child: about their allergy and to avoid the substances that trigger it; to recognize the fi rst

symptoms of an anaphylactic reaction; to know where medication is kept and who can get it; to

18PR.563 SCH, page 519PR.563 SCH, page 5,6


5

communicate clearly when he or she feels a reaction starting; to carry his/her own auto-injector in a body pouch, backpack or fanny pack; not to share snacks, lunches or drinks; the importance of hand-washing; to cope with teasing and being left out; to report bullying and threats to an adult in authority; and to take as much responsibility as possible for his/her own safety.

3.1d) Anaphylactic Student203.1d) Anaphylactic Student203.1d) Anaphylactic StudentIt is crucial that potentially anaphylactic students take responsibility for their allergy and have an age-appropriate understanding of it. He/She must:

• Learn how to inform others of the allergy and its consequences.• Take as much responsibility as possible for avoiding allergens.• For a food allergy, check labels and monitor food intake (older students).• Learn to recognize symptoms of an anaphylactic reaction.• Promptly inform an adult as soon as accidental exposure occurs or symptoms appear.• Keep an auto-injector on their person at all times and never eat without it.• Know how to use the auto-injector (for older students). (Someone going into anaphylactic shock may be

unable to self-administer.)

Given that anaphylaxis can be triggered by minute amounts of allergen, children with food-related anaphylaxis must be encouraged to follow certain guidelines:

• Before eating, wash hands with soap and water and ensure the lunch space is clean;• Never eat without his/her EpiPen®;• Eat only food from home, unless it is packaged, clearly labeled and approved by parents; • Do not share food, utensils or containers;• Avoid placing food directly on the table; • Take measures to prevent other students from touching his/her food, pack up own food and leave it with the

supervising adult when leaving the eating area, and do not mix lunch bag with others.

3.1e) All Parents21

• Respond co-operatively to requests from school to eliminate allergens from packed lunches and snacks.• Participate in parent information sessions.• Encourage their children to respect anaphylactic students and school prevention plans.

3.1f) All Students22

All students should: • Learn to recognize symptoms of anaphylactic reactions.• Avoid sharing food, especially with anaphylactic students.• Follow school rules about keeping allergens out of the classroom and washing hands.• Refrain from bullying or teasing a student with a food allergy.• Bring only allergy-safe foods/items to school.

3.2) Identifi cation of Children at Risk3.2) Identifi cation of Children at Risk

3.2a) Medical Alert form A photograph and a description of each child’s allergy, their individual treatment plan and location of EpiPens® is ® is ®

summarized in a Medical Alert form. It is equivalent to the TDSB’s Form 563C, Student Medical Alert. It is posted on the wall of the school offi ce and staff room, kept in the Day Book of teachers with anaphylactic students, attached to the teacher’s desk and kept with the lunchroom attendance list. With parental permission, it can also be posted in the child’s classroom and lunchroom.

3.2b) Red Medical Concern duotangThis duo tang contains the Medical Alert forms of all Swansea students with serious medical conditions, including anaphylaxis. It is kept in every classroom, the lunchroom, library, the offi ce and custodians’ offi ce. The duo tang is put together and distributed every September and updated throughout the year as necessary. All staff (teaching and non-teaching) should regularly review this duo tang.


20 PR.563 SCH, pages 6, 721 PR.563 SCH, page 722 PR.563 SCH, page 7 6

3.2c) Key tagsA tag is attached to the key of every classroom that has a potentially anaphylactic student. The tag states that the class includes a child who is “medically fragile” and serves as a reminder to teaching staff (especially substitute teachers) to review the details of the student’s allergy and treatment.

3.2d) Medical BraceletsAnaphylactic children are strongly encouraged to wear a medical bracelet.

3.3) Availability and Location of EpiPens3.3) Availability and Location of EpiPens®

• Each potentially anaphylactic student must have two epinephrine auto-injectors at school. When age- appropriate, the child is strongly encouraged to wear one of the auto-injectors on his/her body at all times. At the parent’s request, the offi ce can keep the other auto-injector. They are stored above the safe behind the offi ce counter; each EpiPen® is kept in a box clearly labeled with the child’s name and a current ® is kept in a box clearly labeled with the child’s name and a current ®

photograph of the child. Each box has a sign-in/-out sheet inside that must be fi lled out indicating who is removing the auto-injector, the reason, the date and time of removal and return.23 When there is no auto-injector inside, the box will be kept open. Aside from an emergency, acceptable reasons for removal include fi eld trips and parents taking them for personal reasons such as vacations. Any auto-injector that is removed must be returned promptly!Any auto-injector that is removed must be returned promptly!• The school has four extra regular adult EpiPens® and two EpiPen Jrs.® and two EpiPen Jrs.® ® The EpiPen Jrs.® The EpiPen Jrs.® ® are kept in the ® are kept in the ®

offi ce; two of the adult EpiPens® is stored in the lunchroom locker, the other two in the offi ce. ® is stored in the lunchroom locker, the other two in the offi ce. ®

• One staff member is in charge of checking all the EpiPens® in the offi ce and lunchroom at the beginning of ® in the offi ce and lunchroom at the beginning of ®

each term (September, January and April) to ensure that they are all present and accounted for and submits a report to the principal or designate. He/She also notifi es the principal when the school’s EpiPens® are going to expire.® are going to expire.®

• If a child must remove his/her EpiPen® for a school activity, such as swimming, the adult supervising the ® for a school activity, such as swimming, the adult supervising the ®

activity should keep the medication with him/her and return it to the student immediately after the activity is over.

3.4) Anaphylaxis Resource Persons3.4) Anaphylaxis Resource Persons

Each year, the principal will designate at least three school employees to take a leaders on the issue of anaphylaxis. They are identifi ed in the red Medical Concern duo tang, next to the phone in each classroom, on the wall in the offi ce where the Medical Alert forms are displayed, and in the staff room. In addition to receiving annual training in anaphylaxis and administering an epinephrine auto-injector (EpiPen®), these individuals will train any substitute teachers and other school employees who require it. They will also be called upon in cases of possible anaphylaxis to provide support and direction. These individuals should be people who are likely to be able to respond to an anaphylactic emergency immediately. It is desirable that they are also trained regularly in CPR and fi rst aid.

3.5) Substitute Teacher Protocol3.5) Substitute Teacher Protocol24

• Substitute teachers must check the tag attached to the classroom key to see whether there is an anaphylactic child in the class. If so, the substitute teacher must consult the Day Book, the surface of the teacher’s desk, or the red Medical Concern duo tang for the Medical Alert form/TDSB Form 536C (Student Medical Alert) to review who in the class may be anaphylactic, the triggers, and treatment.• If there is a potentially anaphylactic student in the class, the occasional teacher must consult with an

Anaphylaxis Resource Person or the principal (or designate) before the school day starts for training on the symptoms of anaphylaxis, the emergency protocol and practice with an EpiPen® trainer.® trainer.®

3.6) Field Trip Protocol3.6) Field Trip Protocol• All fi eld trip information sent home in advance must include a reminder that any snacks or meals for

the students must not contain peanuts or tree nuts. If there will be an anaphylactic student on the trip who is dangerously allergic to other substances, the note must also ask that these allergens not be brought on the trip as well.


23 PR.563 SCH, page 924PR.563 SCH, page 4 7

• The fi eld trip organizer must ascertain the location of the closest hospital to the fi eld trip destination and determine that the destination is easily accessible to ambulances. • At least two epinephrine auto-injectors must be taken on the trip. The number of auto-injectors to be

carried should be determined by the estimated number of minutes transportation to the closest hospital will take. One auto-injector should be on the anaphylactic student’s body or in his/her personal belongings (alternative arrangements may be made according to the child’s maturity); the other(s) to be carried by the adult directly supervising that child25.• Always place the anaphylactic student in the group of his/her teacher if his/her own parent on the trip is not

supervising him/her.• The supervising adult must also carry a cellphone26. One is available from the school.• The fi eld trip organizer must inform staff at the fi eld trip destination in advance that there will be a potentially

anaphylactic student visiting and that activities should be planned with that in mind.• The supervising teachers must carry a list of emergency phone numbers for all students on the fi eld trip.• The fi eld trip organizer must identify anaphylactic students on the fi eld trip to all volunteers and staff before

departure and the teacher must briefl y train all volunteers using an EpiPen® trainer on how to use an ® trainer on how to use an ®

EpiPen® and the symptoms of anaphylaxis.® and the symptoms of anaphylaxis.®

• All fi eld trip volunteers and staff must exchange cellphone numbers with one another so that they can stay in contact with each other.

3.7) Training and Education3.7) Training and Education• The school has a yearly budget for anaphylaxis training, which covers training of staff, educating students

and the cost of paying staff to attend training sessions held outside of school hours or PA Days.• All school personnel (including occasional teachers, secretaries, educational assistants, aquatic staff,

caretakers, food services staff, bus drivers, and volunteers) must attend an anaphylaxis and epinephrine auto-injector (EpiPen®) training session by Anaphylaxis Canada or other qualifi ed organization for all employees by the end of every September (usually the fi rst staff meeting on the second day of school), as arranged by the principal. The Anaphylaxis Prevention and Management Plan will be reviewed and distributed to everyone at this meeting. The principal will keep a list of who attended the session and arrange for the Anaphylaxis Resource Persons to train those who did not attend as soon as possible.27

• In particular, the teachers and educational assistants who have potentially anaphylactic children in their classes must attend the fi rst available training session of the school year. • As a quick refresher on a periodic basis, teachers could practice use of the epinephrine auto-injector during

scheduled staff meetings.• All requests home for food to be brought to school must include standard wording of Swansea’s peanut- and

tree-nut-free policy. • Posters explaining the symptoms of anaphylaxis and the administration of the auto-injectors EpiPen® should ® should ®

be posted in the offi ce, staff room, lunchrooms, classrooms (especially if used by an anaphylactic student). • In September, each class will spend at least one teaching period on anaphylaxis education led by

an Anaphylaxis Resource Person, the parent of an anaphylactic child at Swansea, or a representative of Anaphylaxis Canada. This could include showing the students an age-appropriate video about anaphylaxis.28

• Each September, the principal sends home a letter explaining the school’s peanut- and tree-nut-free policy and the dangers of anaphylaxis and contamination. • Written reminders should be repeated throughout the year, especially around celebratory dates such as

Halloween, Christmas, Valentine’s Day, Easter and the end of the school year.29

• Teachers of anaphylactic students must send a letter home to their students’ parents outlining which allergens must not be brought into their particular classroom.


25 PR.563 SCH, page 526 ibid27 PR.563 SCH, page 928 ibid29 ibid 8

4.0) EMERGENCY RESPONSE

1) The epinephrine auto-injector ( EPIPEN®) MUST BE ADMINISTERED AS SOON AS ANAPHYLAXIS IS SUSPECTED, by the fi rst trained individual on the scene. Note the time of administration. It will not harm the child, so if in doubt, administer! Note that over-the-counter allergy medications (such as Benedryl) WILL NOT treat a system shutdown (anaphylaxis) and that epinephrine needs to be adminepinephrine needs to be administered IMMEDIATELY. It can be life saving. DO NOT SEND THE CHILD TO THE OFFICE.

2) A trained individual (or if there is not one, an adult) must stay with the injured student at all times until the ambulance arrives. The adult should reassure the student and help them to remain calm and to breathe normally.

3) The student’s second auto-injector (EPIPEN®) should be ready for administration 10 to 15 minutes after the initial injection, if the symptoms persist or recur. If the second EpiPen® is kept in the offi ce, send either another available adult or two students to the offi ce to retrieve it.

4) Call the offi ce for assistance. If there is no immediate response, send another available adult or two students to the offi ce. The individual(s) must be able to relay the nature of the emergency and that the principal or designate must attend the scene immediately.

5) CALL 911 or have the principal or offi ce staff call immediately after using the auto-injector. • Tell them that a student has had an anaphylactic reaction. • Give the name of school, Swansea Public School, and address, Swansea Public School, and address, Swansea Public School 207 Windermere Avenue (nearest 207 Windermere Avenue (nearest 207 Windermere Avenue ( major intersection: Windermere Ave., and Bloor Street West. (Use “911 Protocol” information sheet) Regardless of the degree of reaction or response to epinephrine, transfer the child to a hospital emergency room. Symptoms may recur up to eight hours after exposure to allergen.

6) The principal or designate will ensure a staff member is in constant communication with emergency personnel until the ambulance arrives; notify parent(s)/guardian(s)/emergency contact; designate a staff member to accompany the child to hospital. A custodian with a key to the gate by the south teacher’s parking lot will open it and stand by to fl ag down the ambulance.

7) Summon a designated Anaphylaxis Resource Person to assist.


4.0) EMERGENCY RESPONSE4.0) EMERGENCY RESPONSE

4.0) EMERGENCY RESPONSE

EpiPen® can be administered in 2 simple steps:

1) Remove the yellow or green cap from the storage tube. • Grasp the Auto-injector with the black tip pointing -injector with the black tip pointing down • Pull off grey safety cap

2) Place black tip against mid-outer thigh and press fi rmly fi rmly until the Auto-injector activates. Hold while counting for Hold while counting for several seconds (a slow count to ten), then remove. • Massage the injected area for 10 seconds

Seek medical attention immediately.CALL 911.

How to use an EpiPen®

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5.0) APPENDICES

After eating, being stung by a bee, ingesting medicine such as antibiotics or being exposed to latex (in BandAids, gloves), a person who is known to have a potentially life-threatening

allergy (anaphylaxis) might have any of these signs and/or symptoms:

Face: Itchy eyes, itchy nose, fl ushed face, swollen lips, swollen tongue

Airway: Trouble breathing or swallowing, hoarseness, choking, coughing, wheezing

Stomach: Pain, vomiting, diarrhea

Skin: Rash, itchiness, swelling, hives - anywhere on the body

General: Weakness, sense of doom, loss of consciousness

Anaphylaxis can lead rapidly to unconsciousness and death.

Give: The epinephrine (adrenaline) injection (EpiPen®) at the fi rst sign of a reaction. It is dangerous to wait. Give a second dose in 10-15 minutes it the reaction continues or worsens.

Call 911: Tell them someone is having a life-threatening allergic reaction. Ask them to send an ambulance immediately.

Go: To the nearest hospital, even if symptoms are mild or have stopped. Stay in the hospital setting for 4-6 hours. The reaction could come back.

KNOW WHAT TO DO....the fi rst signs of a reaction can be mild, but symptoms can get worse very quickly.

ANAPHYLAXIS SIGNS & SYMPTOMS

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911 Protocol - Anaphylaxis

911 Protocol – Anaphylaxis

1. Emergency Phone Number

2. Hello, My name is ______________________2. Hello, My name is ______________________,,___of Swansea Public School.of Swansea Public School.of Swansea Public School

3. We are located at:

Address: 207 Windermere AvenueNearest major intersection: Windermere Ave., and Bloor St. W.

4. Tell them:

“ We need an ambulance immediately. We have a child going into anaphylactic shock. An EpiPen® is being given now.” And give them the ® is being given now.” And give them the ®

time EpiPen® was administered.”® was administered.”®

5. Give the following information about the child:

• Level of consciousness

• Breathing

• Bleeding

• Age

6. My phone number is 416-393-90807. The closest entrance for the ambulance is: the south teacherʻs parking lot off St.

Olaves Road., Tell them “A staff member with a key will open the gate and stand by to fl ag down the ambulance and to provide further information.”

7. Do you need any more information?

8. How long will it take to get here?

9. CALL the parents/guardians/emergency contact.

TO BE POSTED BY TELEPHONE

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EpiPen® - How to use

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Field Trip Organizer’s Checklist

Please consult this checklist to help you organize a safe fi eld trip for any anaphylactic students participating.

BEFORE THE FIELD TRIP

• Inform staff at the fi eld trip destination that there will be a potentially anaphylactic student visiting and that activities must be planned with that in mind.

• Include a reminder in fi eld trip information to parents/guardians that any snacks or meals packed for the trip must not contain peanuts or tree nuts. If the anaphylactic student(s) on the trip is/are dangerously allergic to other substances, the note must also ask that these allergens not be brought on the trip as well.

• Calculate the number of EpiPens® that must be taken on the trip by: ascertaining approximately how many ® that must be taken on the trip by: ascertaining approximately how many ®

minutes it takes to reach the hospital closest to the fi eld trip destination; divide the number of minutes by 15 to determine how many EpiPens® to take. For example, if it takes 45 minutes to reach the nearest hospital, at least ® to take. For example, if it takes 45 minutes to reach the nearest hospital, at least ®

three EpiPens® must be taken on the trip. Inform the student’s parents they must provide the appropriate number ® must be taken on the trip. Inform the student’s parents they must provide the appropriate number ®

of EpiPens®.

• Place the anaphylactic student(s) in your group or the group of the child’s parent.

• Review symptoms of anaphylaxis, practice administering an EpiPenReview symptoms of anaphylaxis, practice administering an EpiPenReview symptoms of anaphylaxis, practice administering ® with an EpiPen® with an EpiPen® ® trainer, and be ® trainer, and be ®

prepared to briefl y train all fi eld trip volunteers the morning of departure.

• Make a list of emergency contact telephone numbers for all students on the trip.

MORNING OF THE FIELD TRIP

• Ensure the student has the appropriate number of EpiPens® (at least two)® (at least two)® and know where each is to be stored during the fi eld trip. When age appropriate, one should be directly on the student’s body at all times.

• If the child also has ASTHMA, ensure that asthma medication is also carried.

• Ensure the anaphylactic student(s) is in your group or their parent’s group.

• Identify the anaphylactic student(s) on the trip to all fi eld trip volunteers. Review the symptoms of anaphylaxis with them and have each practice administering an EpiPen® with an EpiPen® with an EpiPen® ® trainer (available from ® trainer (available from ®

the offi ce).

• Ensure you have a fully charged cellphone.

• Distribute a copy of the Field Trip Cellphone Numbers form to each fi eld trip volunteer.

• Ensure you have emergency numbers for all students on the trip.

• Distribute to each volunteer laminated cards on the symptoms of anaphylaxis and how to administer an EpiPen® -- they are available from the school offi ce.

DURING LUNCH AND SNACK

• Check that food is being eaten in an allergen-free area.

• Encourage students to wash hands with soap and water before and after eating.

END OF TRIP

• Return extra EpiPens®.

• Collect from each volunteer laminated anaphylaxis cards and return them to the offi ce.

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Field Trip Cellphone Numbers

Field Trip Destination:Date:

Volunteer's name:

Children's names: Notes/Concerns: Volunteer Cellphone Number:Name: Cellphone #::

Field Trip Cellphone Numbers

Field Trip Destination:Date:

Volunteer's name:

Children's names: Notes/Concerns: Volunteer Cellphone Number:Name: Cellphone #::

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How to Provide A Peanut/Nut - Free Snack

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By understanding a few principles, providing peanut- and tree-nut-free snacks and meals is straightforward. First, people allergic to peanuts or tree nuts must strictly avoid these because even a minute amount of allergen can trigger a reaction. Second, peanuts or tree nuts are among the allergens that can often cause anaphylaxis, a life-threatening reaction in which the body’s systems shut down. These guidelines can also be used to avoid other foods that can trigger allergies, such as milk, egg, wheat, soy, shellfi sh and sesame.

1) Only use packaged foodspackaged foods from major North American manufacturersmajor North American manufacturers that have a full ingredient listfull ingredient list.These companies tend to be the most reliable in supplying allergy information.

2) Check the ingredient list for peanuts/nuts every timeevery time; manufacturers, ingredients and processing plants have been known to change without warning. Also avoid foods that “may contain traces of nutsmay contain traces of nuts” or that are manufactured in a facility that also processes nut productsmanufactured in a facility that also processes nut products. This information can be found anywhere on the package but is often immediately after the ingredient list, sometimes in bold lettering. It is surprising the products that can contain nuts or traces of nuts surprising the products that can contain nuts or traces of nuts – e.g. chili, Popsicles. e.g. chili, Popsicles.

3) The following types of food should be avoided: products from independent bakeries including bread, bagels, cakes, cookies and pies; items imported from outside Canada or the U.S. (e.g., European chocolates) and ethnic foods – e.g., Chinese, Vietnamese, Thai; bulk food.

4) Always use clean utensils when preparing food for an anaphylactic individual. For example, a knife that was used to cut a peanut butter sandwich cannot be used to prepare a cheese sandwich for someone allergic to peanuts.

5) Be aware of cross-contamination. If, for instance, you sometimes use the same knife to remove both peanut butter and margarine from their containers, a person allergic to peanuts cannot eat the margarine.

6) According to the Canadian Food Inspection Agency, peanuts and peanut products are sometimes also listed as: arachide, arachis oil, cacahouète / cacahouette / cacahuète, goober peas, kernels, mandelonas and valencias. Various tree nuts can also be called: marzipan, anacardium nuts, calisson and pinon.

7) Items that are peanut- and tree-nut-safe are: fresh fruits and vegetables cut with a clean knife; foods that carry a prominent “no peanuts” or “no nuts” logo; cakes from the French Oven, which distributes its products through grocery stores such as Price Chopper (http://www.thefrenchoven.on.ca/index.html).

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Substitute Teacher’s Checklist For Anaphylaxis

Substitute teachers should consult this checklist before starting the school day.

• When you receive the key to the classroom, look for a tag on the key chain that alerts teachers that there is a child in the class with a serious medical concern, including anaphylaxis.

• If there is such a key tag, have the principal or designate, or the offi ce administrator (Mary White) identify who in your class who is anaphylactic.

• Familiarize yourself with anaphylactic student(s) in your class by reviewing the pupil’s Medical Alert form, which details his/her allergies, symptoms, treatment, where his/her EpiPens® are kept and ® are kept and ®

emergency contacts. These are posted on the wall of the offi ce, staff room and lunchrooms, and are also in the teacher’s Day Book, on the surface of the teacher’s desk and in the red Medical Concern duotang that is in every classroom and in the offi ce.

• If there is a potentially anaphylactic student in the class, you must consult with the principal (or designate), the offi ce administrator (Mary White) or an Anaphylaxis Resource Person (listed near the Medical Alert forms on the offi ce wall) before the school day starts for training on the symptoms of anaphylaxis, the emergency protocol and practice with an EpiPen® trainer. ® trainer. ®

• Make sure you know where the student’s EpiPens® are. Some wear an EpiPen® are. Some wear an EpiPen® ® on his/her body, many have ® on his/her body, many have ®

a second EpiPen® in the offi ce, sometimes the second EpiPen® in the offi ce, sometimes the second EpiPen® ® is kept by the teacher or in the classroom. ® is kept by the teacher or in the classroom. ®

This information is on the Medical Alert form.

• Familiarize yourself with Swansea’s Anaphylaxis Prevention and Management Plan, especially the Emergency Response (page 9) and 911 Protocol (page 11). The plan is in the red Medical Concern duotang that is in every classroom and in the offi ce.

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