7134-asthma & allergic reac

FALLS CITY PUBLIC SCHOOLS
BOARD POLICY
CODE: 7134
ASTHMA AND ALLERGIC REACTION PROTOCOL
The district will adopt and implement the Emergency Response to Life-Threatening Asthma or Systemic Allergic Reactions (Anaphylaxis) Protocol as required by the Nebraska Department of Education. The superintendent, or his designee, in conjunction with licensed health personnel, shall establish administrative regulations for the implementation of this policy during regular hours while school classes are in session. The regulations established shall comply with NDE rules regarding the protocol to follow in case of a life-threatening asthma or systemic allergic reaction and use of an EpiPen and Albuterol. Also, these shall ensure that each school building will procure and maintain the equipment and medication necessary under the protocol in the case of any student or school staff emergency. Staff training in using the protocol shall occur periodically. Records of such training and occurrences of administering medication under the protocol shall be maintained. The parent or guardian of a student of minority age may sign a waiver requesting that their student not receive emergency treatment under this protocol. Information about the waiver shall be provided to parents in the student handbook. ASTHMA AND ALLERGIC REACTION PROTOCOL
EMERGENCY RESPONSE TO LIFE-THREATENING ASTHMA OR SYSTEMIC ALLERGIC REACTIONS
(ANAPHYLAXIS)
DEFINITION: Life-threatening asthma consists of an acute episode of worsening airflow obstruction. Immediate action and
monitoring are necessary.
A systemic allergic reaction (anaphylaxis) is a severe response resulting in cardiovascular collapse (shock) after the
injection of an antigen (e.g. bee or other insect sting), ingestion of a food or medication, or exposure to other allergens,
such as animal fur, chemical irritants, pollens or molds, among others. The blood pressure falls, the pulse becomes weak,
AND DEATH CAN OCCUR. Immediate allergic reactions may require emergency treatment and medications.
LIFE-THREATENING ASTHMA SYMPTOMS: Any of these symptoms may occur:
Chest tightness
Wheezing
Severe shortness of breath
Retractions (chest or neck "sucked in")
Cyanosis (lips and nail beds exhibit a grayish or bluish color)
Change in mental status, such as agitation, anxiety, or lethargy
A hunched-over position
Breathlessness causing speech in one-to-two word phrases or complete inability to speak
ANAPHYLACTIC SYMPTOMS OF BODY SYSTEM: Any of the symptoms may occur within seconds. The more
immediate the reactions, the more severe the reaction may become. Any of the symptoms present requires several hours
of monitoring.
Skin: warmth, itching, and/or tingling of underarms/groin, flushing, hives
Abdominal: pain, nausea and vomiting, diarrhea
Oral/Respiratory: sneezing, swelling of face (lips, mouth, tongue, throat), lump or tightness in the throat, hoarseness,
difficulty inhaling, shortness of breath, decrease in peak flow meter reading, wheezing reaction
Cardiovascular: headache, low blood pressure (shock), lightheadedness, fainting, loss of consciousness, rapid heart rate,
ventricular fibrillation (no pulse)
Mental status: apprehension, anxiety, restlessness, irritability
EMERGENCY PROTOCOL:
1. CALL 911
2. Summon school nurse if available. If not, summon designated trained, non-medical staff to implement
emergency protocol
3. Check airway patency, breathing, respiratory rate, and pulse
4. Administer medications (EpiPen and albuterol) per standing order
5. Determine cause as quickly as possible
6. Monitor vital signs (pulse, respiration, etc.)
7. Contact parents immediately and physician as soon as possible
8. Any individual treated for symptoms with epinephrine at school will be transferred to medical facility
STANDING ORDERS FOR RESPONSE TO LIFE-THREATENING ASTHMA OR ANAPHYLAXIS:
Administer an IM EpiPen-Jr. for a child less than 50 pounds or an adult EpiPen for any individual over 50 pounds
Follow with nebulized albuterol (premixed) while awaiting EMS. If not better, may repeat times two, back-to-back
Administer CPR, if indicated.
______________________________________
___________________________________________ WAIVER OF EMERGENCY RESPONSE TO
LIFE THREATENING ASTHMA OR
SYSTEMIC ALLERGIC REACTIONS PROTOCOL

Falls City Public School District

Student Name: ______________________________ Date of Birth: ____________
School: ________________________________________ Grade: ___________
I am aware of the school policy that provides a protocol to follow by school personnel
to administer EpiPen/albuterol to a student when it is determined that the student is
suffering a life-threatening asthma or systemic allergic reaction while school is in
session.
After considering the school policy and the best interests of my child,
________________ ______________ , I do not wish to have him/her given
or administered albuterol or medication from an Epi-Pen by school personnel under
any circumstances for the 20___ - 20___ school year.
__________ Date ______________________________
Do not return this form without a physicianʼs signature supporting your
request to remove your child from the protocol.

Source: http://www.fctigers.org/vimages/shared/vnews/stories/505b463fac8d8/7134-Asthma%20%26%20Allergic%20Reac.pdf