Why do we need Stock Epi in CA Schools?

Six Students Standing Outside School Together Smiling
What is Epinephrine?

Epinephrine (known as EPI is a natural hormone the body creates.  Many people know it by the name adrenaline.  A shot of EPI gives a body a small jolt of adrenaline.  During a severe allergic reaction, known as anaphylaxis, adrenaline opens up airways allowing a person to breathe.  It also improves blood supply for a person suffering from shock (a severe drop in blood pressure), by constricting blood vessels and increasing heart-rate.  EPI works within minutes, and is short-acting because it only remains in the body for 5-15 minutes (NIAID,  6.3.1.1).

Safety of EPI

Epinephrine is considered a very safe medication, especially in pediatric use.  In fact, when a person is experiencing anaphylaxis, there are few if any reasons not to give EPI (NIAID, 6.3.3)

EPI can have mild side-effects, including anxiety, fear, restlessness, headache, dizziness, palpitations, pallor, and tremor.  The side effects do not last long because the medication is rapidly metabolized (NIAID, 6.3.1.1).

Rarely, EPI may lead to more serious side-effects, but these severe adverse effects are more likely to occur when epinephrine is given in overdose (NIAID, 6.3.1.1)  Overdosing EPI is very unlikely, because Epi auto-injectors used by parents, schools, etc are pre-measured doses.

Stock EPI as First Aid

Stock EPI is Epinephrine that is prescribed to a school, not to an individual person.  A school keeps it on-hand in case any student or adult experiences life-threatening anaphylaxis.  EPI is used to provide first aid while Emergency Services are called to transport the person to the ER for further treatment and observation.

Why does a school need to stock epinephrine?

A large number of students are affected by food allergies – it is 1 in 13 children in the United states (FARE).  Unfortunately, anaphylaxis can cause severe injury or death in as little as 5-10 minutes (WAO) – this window is often not enough time for emergency services to arrive and give this medication.  Also, not all emergency services vehicles in California carry epinephrine – this varies by county – so even if EMS were able to arrive within a few minutes, they may not have the medication.  It’s better to be prepared than to lose a child’s life unnecessarily.

The California Emergency Medical Services Authority (EMSA) Emergency First Aid Guidelines for California Schools includes EPI administration in the list of actions to take for an allergic reaction (page 17).  This booklet is “meant to provide recommended procedures for school staff in responding to medical emergencies when the school nurse is not available and until emergency medical services responders arrive on scene.”

California’s current Stock EPI law

In 2001, California passed a permissive stock epinephrine law (California Ed Code 49414), which allows schools to decide whether or not to stock this medication.  This law also permits school personnel to volunteer to learn to recognize anaphylaxis and to give EPI in an anaphylactic emergency if a school nurse or doctor is not quickly available.  The law includes specific training standards.

Why do we need to change the law to make it mandatory?

Many local education authorities, school districts and schools are unaware of the law,  so there are very few schools in California that stock epinephrine.

A 2011 study showed only 13% of schools in California stocked epinephrine (JSH).  With the food allergy epidemic in our community, schools are learning of the benefits of stocking epinephrine, and are beginning to investigate how to get this life-saving medication on campus.  While awareness is growing, we do not want to lose the life of a child to anaphylaxis in a Californian school.  This would be not only be disastrous for the individual and their family, but will have a long-lasting traumatic effect on the entire school community.

Break the law or watch a child perish? Give School Nurses and Personnel what they need to keep kids safe

If a child experiences anaphylaxis and the school does not stock EPI, the school is forced to decide whether to break the law and use another child’s medication to save this life, or to wait and hope that EMS will arrive in time and with the medication needed to save the child.  In Virginia, Amarria Johnson lost her life while at school, because her school nurse did not break the law; since then Virginia passed a law that requires schools to stock epinephrine.

Californian school nurses have broken the law to keep a student alive, while waiting for EMS.  School nurse Cathy Owens saved Cory Lohman’s life in 1997 (Cathy’s actions saving the child was one of the reasons why the 2001 law was passed.)  We do not want California school nurses nor other school staff to be put in the position of having to choose between breaking the law to save a child’s life, and watching the child perish.

Despite the permissive law introduced over ten years earlier, a 2011 survey showed that 30% of school nurses in California have had to break the law to treat a student in distress (JSH).  We cannot and should not have to rely on Nurses to break the law.

Schools without nurses have also had to break the law to prevent losing a student to anaphylaxis while at school.  Read about Dee, a first grader in a Bay Area school whose life was saved in November 2013, after a school principal used another child’s epinephrine injector.

Who would benefit from this law?

It is likely all teachers and children in California with anaphylaxis will benefit, either directly or indirectly.   Public schools will be required to stock epinephrine.

  • Any child who has undiagnosed allergies will have access to this life-saving first-aid medicine.  Research has shown that a large number – around 25% – of first-time reactions at school that need epinephrine are for students without any known allergies (FARE).
  • Many families with food allergies are not aware that food allergy reactions are entirely unpredictable, and believe their child has “mild” allergies, despite being prescribed an epinephrine injector; so they do not bring the injector to school.
  • Some doctors do not prescribe auto-injectors, even though not using EPI is the main reason people lose their life due to anaphylaxis (NIAID, 6.3.1.1.)
  • Students that need more doses than they have on site, or when an injector malfunctions.
  • Teachers who develop anaphylaxis (stock epinephrine has already saved the lives of teachers in other states!)
Who else will benefit?

Schools’ awareness and understanding of food allergies as a severe, unpredictable condition will grow considerably, benefiting all children with severe allergies to foods, insect stings and medications.  Public school knowledge of anaphylaxis will grow.  Schools will be required to train a staff member to recognize and treat anaphylaxis, and the school will be required to have procedures for anaphylactic emergencies, including calling emergency services.

Community-wide

It is expected that a mandatory law will have ripple-effects in the community.  Private schools, daycare, summer camps etc will all consider whether they also want to provide a safer environment for the children in their care.

(NIAID) NIAID Guidelines for the Diagnosis and Management of Food Allergies in the United States.

(WAO) World Allergy Organization, Anaphylaxis Synopsis.

(JSH) Preparedness for students and School staff with anaphylaxis. J Sch Health. 2011 Aug;81(8):471-6

(FARE) Statistics