437R - Administration of Epinephrine

    1. Overview

      Anaphylaxis is a severe systemic allergic reaction from exposure to allergens that is rapid in onset and can cause death. Common allergens include animal dander, fish, latex, milk, shellfish, tree nuts, eggs, insect venom, medications, peanuts, soy, and wheat. A severe allergic reaction usually occurs quickly; death has been reported to occur within minutes. An anaphylactic reaction can occur up to one to two hours after exposure to the allergen.

      Symptoms of Anaphylaxis may include:

      • Shortness of breath or tightness of chest; difficulty in or absence of breathing

      • Sneezing, wheezing or coughing

      • Difficulty swallowing

      • Swelling of lips, eyes, face, tongue, throat or elsewhere

      • Low blood pressure, dizziness and/or fainting

      • Heart beat complaints: rapid or decreased

      • Blueness around lips, inside lips, eyelids

      • Sweating and anxiety

      • Itching, with or without hives; raised red rash in any area of the body

      • Skin flushing or color becomes pale

      • Hoarseness

      • Sense of impending disaster or approaching death

      • Loss of bowel or bladder control

      • Nausea, abdominal pain, vomiting and diarrhea

      • Burning sensation, especially face or chest

      • Loss of consciousness

      Although anaphylactic reactions typically result in multiple symptoms, reactions may vary. A single symptom may indicate anaphylaxis. Epinephrine should be administered promptly at the first sign of anaphylaxis. It is safer to administer epinephrine than to delay treatment for anaphylaxis.

    2. School Responsibilities

      Frederick County Public Schools shall provide at least two (2) doses of auto-injectable epinephrine (hereinafter called ‘unassigned or stock epinephrine’) in each school. Epinephrine may be administered to any student believed to be having an anaphylactic reaction on school premises during the academic day by a school nurse or employee of the School Board who is authorized and trained in the administration of epinephrine. The Code of Virginia §8.01-225 provides civil protection for employees of a School Board who are appropriately trained to administer epinephrine. This regulation is not intended to replace student specific orders or parent provided individual medications and does not extend to activities off school grounds (including transportation to and from school, field trips, etc.) or outside of the academic day (sporting events, extra-curricular activities, etc.).

    3. Parent/Student Responsibilities

      Parents of students with known life threatening allergies and/or anaphylaxis shall provide the school with written instructions from the students’ health care provider for handling anaphylaxis and all necessary medications for implementing the student specific order on an annual basis.

    4. Training

      Principals shall be responsible for identifying at least two employees, in addition to the school nurse (RN or LPN), to be trained in the administration of epinephrine by auto-injector. Only trained personnel shall administer epinephrine to a student believed to be having an anaphylactic reaction. Training shall be conducted in accordance with the most current edition of the Virginia Department of Education’s Manual for Training Public School Employees in the Administration of Medication. Training shall be conducted annually or more often as needed.

    5. Standing Orders

      Standing orders are written to cover multiple people as opposed to individual-specific orders, which are written for one person. Frederick County Public Schools shall designate an authorized medical provider with prescriptive authority to prescribe non-student specific epinephrine for the school division, to be administered to any student believed to be having an anaphylactic reaction on school premises during the academic day. Standing orders must be renewed annually and with any change in prescriber.

    6. Responding to Anaphylaxis

      If student-specific orders are on file they should be followed for students with known life threatening allergies and/or anaphylaxis. For suspected anaphylaxis without specific orders, the following procedures shall be followed:

      1. Based on symptoms, determine that an anaphylactic reaction is occurring.

      2. Call the school nurse, School Board employee, employee of a local appropriating body or employee of a local health department who is authorized by a prescriber and trained in the administration of epinephrine.

      3. Call the principal/principal’s designee to advise of situation.

      4. The school nurse, School Board employee, employee of a local appropriating body or employee of a local health department who is authorized and trained in the administration of epinephrine shall determine the proper dose and administer epinephrine. Document the time the epinephrine is administered.

      5. Direct someone to call 911 and request medical assistance. Advise the 911 operator that anaphylaxis is suspected and that epinephrine has been given.

      6. Stay with the person until emergency medical services (EMS) arrive.

      7. Stay with the patient and monitor their airway and breathing.

      8. Direct someone to contact the student’s parent/guardian.

      9. If symptoms continue and EMS is not on the scene, administer a second dose of epinephrine 5 to 15 minutes after the initial injection. Document the time the second dose of epinephrine is administered.

      10. Even if symptoms subside, EMS must still respond and the patient must be evaluated by a physician. A delayed or secondary reaction may occur.

      11. Document the incident and complete the appropriate incident report.

      12. Replace epinephrine stock medication as appropriate.

    7. Post Event Actions

      Once epinephrine is administered, local EMS shall be activated and the student transported to the emergency room for follow-up care. In some reactions, the symptoms go away, only to return one to three hours later. Often these second-phase symptoms occur in the respiratory tract and may be more severe than the first-phase symptoms. Therefore, follow-up care with a health care provider is necessary. The student will not be allowed to remain at school or return to school on the day epinephrine is administered.

    8. Epinephrine Storage, Access and Maintenance

      Epinephrine shall be stored in a safe, unlocked and accessible location, in a dark place at room temperature (between 59-86 degrees Fahrenheit). Epinephrine shall not be maintained in a locked cabinet or behind locked doors. Staff shall be made aware of the storage location in each school. The expiration date of epinephrine solutions should be checked monthly and the drug should be replaced if it is approaching the expiration date. In addition, the contents shall be inspected monthly through the clear window of the auto-injector. The solution should be clear; if it is discolored or contains solid particles, the unit shall be replaced.

      Each school shall maintain documentation that stock epinephrine has been checked on a monthly basis to ensure proper storage, expiration date, and medication stability.

      The school division shall maintain a sufficient number of extra doses of epinephrine for replacement of used or expired school stock on the day it is used or discarded. Expired auto-injectors or those with discolored solution or solid particles should not be used. They shall be discarded in a sharps container.


    Legal Reference(s):
    Code of Virginia, as amended, Section(s) 8.01-225, 22.1-78, 22.1-274.2, 54.1-2952.2, 54.1-2957.02, 54.1-3408


    Cross Reference(s):
    Regulation 402R-A, Students- Code of Student Conduct

    Policy 437P, Students- Administration of Medications to Students


    Adopted: August 21, 2012
    Amended: September 4, 2013
    Amended: September 12, 2018