Emergency response plan – ASCIA Action Plans for Anaphylaxis

ASCIA Action Plans for Anaphylaxis detail the emergency response for anaphylaxis, including instructions for using the adrenaline injector. A copy should always be stored with the adrenaline injector.

The Australasian Society of Clinical Immunology and Allergy (ASCIA) provides Action Plans for Allergy and Anaphylaxis for personal use, and a First Aid Plan for general use:

• ASCIA Action Plan for Anaphylaxis (RED) – for a specific student who has been prescribed an adrenaline injector (different versions of the plan are available for each type of adrenaline injectors),
• ASCIA Action Plan for Allergic Reactions (GREEN) – for a specific student who has mild to moderate allergies, but has not been prescribed an adrenaline injector,
• ASCIA Action Plan for Drug (Medication) Allergy (GREEN) - for a specific student with drug (medication) allergies, who may not have been prescribed an adrenaline injector,
• ASCIA First Aid Plan for Anaphylaxis (ORANGE) – that does not include information about a specific student and can be used as a poster (different versions of the plan are available for EpiPen® and Anapen® adrenaline injector and generic adrenaline injectors).

Students diagnosed at risk of anaphylaxis must have an emergency response plan as a part of their individual health support plan. For anaphylaxis, the emergency response plan is an ASCIA Action Plan for Anaphylaxis (RED) completed and signed by the child's treating medical or nurse practitioner.

It is the role of the parent or carer to provide the school with the ASCIA Action Plan or Anaphylaxis (RED) (EpiPen® or Anapen® as prescribed) completed and signed by their child's treating medical or nurse practitioner. Where the medical practitioner prescribes a new adrenaline injector they will issue an updated ASCIA Action Plan for Anaphylaxis (RED). This is approximately every 12 to 18 months. Parents provide the school with a copy of the most recent action plan, aligned with the adrenaline injector prescribed. It is recommended that plans are provided in colour.

The plan should be posted in suitable locations for easy reference as discussed with the parent and, where appropriate, the student. The original signed document, prepared by the medical practitioner, should be copied and kept on the student's file.

School first aid kits must include a general use EpiPen® adrenaline injector and the ASCIA First Aid Plan for Anaphylaxis (ORANGE) 2021 EpiPen®.

Schools should note that ASCIA review the action plans annually and update them as necessary. The latest versions of the ASCIA Action Plans for Anaphylaxis are available from the Australasian Society of Clinical Immunology and Allergy (ASCIA) website.

Asthma and anaphylaxis

Where a student has a medical diagnosis of asthma and anaphylaxis, the student's individual health support plan should take account of both conditions and outline the steps staff should undertake if they are unsure if a student’s difficulty breathing is due to asthma or anaphylaxis. ASCIA outlines the steps on their website.

Adrenaline (epinephrine) injectors

Adrenaline injectors contain a single dose of adrenaline and are designed as a first aid device for use by people without formal medical or nursing training. The brands of adrenaline injector available in Australia under the Australian Register of Therapeutic Goods (ARTG) are the EpiPen® adrenaline injectors, and the Anapen® adrenaline injectors.

EpiPens® are available in two (2) doses:

• The EpiPen® adrenaline injector is prescribed for children over 20kg and adults, and
• The EpiPen® Jr adrenaline injector contains a lower dose and is prescribed for children 7.5-20kg

Anapens® are available in three (3) doses:

• The Anapen® 500 is prescribed for children over 50kg and adult
• The Anapen® 300 is prescribed for children over 20kg and adult
• The Anapen® Junior 150 is prescribed for children 7.5-20kg.

A student's individual health support plan for anaphylaxis should outline a process for replacing used and expired adrenaline injectors in a timely way.

It is the role of the parent to provide the prescribed adrenaline injector and to replace it when it expires or after it has been used.

Students carrying their own adrenaline injector and asthma reliever puffer

For asthma and anaphylaxis, it is important for students to have immediate access to their medication. High school students should carry their own prescribed adrenaline injector or asthma reliever medication on them while at school if this is age and developmentally appropriate.

It may also be appropriate for students in the upper primary years to carry their own medication to, from, and at school. This can assist students to develop independence in managing their health condition as they transition to high school and as they are often travelling independently to and from school around this time.

It is important that the school knows the students who carry their own medication to, from, and at school. Arrangements will be agreed in writing between the school and the student's parent and be part of the student's planned health support.

Timing of administering adrenaline injectors

If an adrenaline injector is administered, it is important to note the time of administration. If there is no change in the student's condition after 5 minutes (i.e there is no response) a second adrenaline injector if available, should be administered to the student.

Information about the time that the adrenaline injector was administered to a student should be provided to ambulance personnel when they arrive at the school.

If a second adrenaline injector is required, the school's general use adrenaline injector should be used. However, in an emergency it may be necessary to use another student's adrenaline injector.

If another student's adrenaline injector has been administered and there are concerns that the other student may be placed at risk, that student can be transported in an ambulance to hospital.

Note: Either an EpiPen® or an Anapen® can be used to administer a second dose of adrenaline, regardless of the type of adrenaline injector that was used to administer the first dose.

Frequently asked questions about adrenaline injectors can be found on the ASCIA website.

General use adrenaline injectors for school first aid kits

Each school is issued several general use EpiPen® adrenaline injectors. The distribution of general use adrenaline injectors enables schools to comply with the requirement that there is one general use adrenaline injector in each of their first aid kits. Planning and risk management considerations should include whether the school requires additional general use adrenaline injectors.