Cathy Owens was a nurse at Murrieta Valley High School in 1997 when she encountered a student in the throes of a severe allergic reaction, unable to breathe and fading fast. Owens called for an ambulance, but the teen was deteriorating too quickly. She made a split-second decision to use another student’s prescription epinephrine injector.
Her action was a breach of federal law, but a necessary one under the circumstances, she said. “That’s not a choice anyone should have to make, but I had to make it,” Owens said. “We didn’t want a child to die.”
Now, with the passage of a new law in September, all schools in California will be required to stock at least one injector that is prescribed to the school or district, rather than a specific person, and to train at least one staff member on how to use it.
The new law, which takes effect next year, was the result of more than a decade of legislative battles by allergy activists, who in 2001 backed a bill that allowed, but did not require, the use of injectors not prescribed for a particular student. The push for a requirement intensified last year when 13-year-old Natalie Giorgi of Carmichael died from an allergy attack – medically termed anaphylaxis – after taking one bite of a Rice Krispies treat that her family believes contained a peanut ingredient at Camp Sacramento near Lake Tahoe. Giorgi died despite receiving injections of epinephrine from her father, a doctor.
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Anaphylaxis, a severe and potentially life-threatening allergic reaction, can occur within seconds of encountering an allergic trigger, such as food, medicine, an insect bite, latex or exercise. Symptoms include narrowing of the airways, rashes or hives, nausea or vomiting, a weak pulse and dizziness.
Once an anaphylactic attack begins it’s critical to inject the allergic person with epinephrine, the drug used to combat the attack, as quickly as possible, said Dr. Ruchi Gupta, associate professor of pediatrics at Northwestern University and spokeswoman for EpiPen4Schools, a nationwide program that provides free injectors to about 1,500 schools throughout California and about 70 in the Sacramento area. The injectors are commonly known as pens, and EpiPen is one of the major brands.
The program, started in 2012 by EpiPen manufacturer Mylan Specialty, announced late last month that it would expand its resources to keep up with the national trend toward anaphylaxis preparedness. California is one of eight states now requiring schools to stock up on epinephrine, according to the nonprofit Food Allergy Research & Education.
Injectors are available from several manufacturers, and are typically administered to the outer thigh during emergencies and held there for 10 seconds. Epinephrine, which can be injected through clothing, counters the effects of the allergen by relaxing the muscles around airways and tightening blood vessels to maintain respiratory and cardiovascular function. After epinephrine administration children should seek emergency care, as they may be susceptible to additional attacks.
“This can happen in adults and children very similarly – the big issue in children is they may not be able to communicate what’s happening in their body as well to an adult,” Gupta said. “They may say things like ‘I feel funny,’ or things that are not as descriptive.”
Food allergies among children increased by approximately 18percent between 1997 and 2007, according to the U.S. Centers for Disease Control and Prevention, and now affect an estimated 4percent to 6percent of children in the nation.
Researchers report that about 25percent of anaphylactic attacks occur during school hours to children who had not previously been diagnosed with a food allergy.
That’s because kids are constantly trying new foods and sharing foods at school, said Owens, now the coordinator of student support for Murrieta Unified School District and state public relations chairwoman for the California School Nurses Organization. Owens is leading a committee that is working with the California Department of Education to update the state’s current training standards on auto injector use.
Opponents of the new law were initially concerned about asking nonmedical personnel to administer the drug. But the injector is simply designed and easy to use, said Owens, and would have minimal negative effects on a child if it was used erroneously.
The bill requires that every school have at least one trained volunteer capable of using the injector. That poses a challenge for the many schools that have not had designated school nurses since the budget cuts of the recession, said Scott Nelson, risk manager for the Elk Grove Unified School District. He is working on getting the word out about the law and is soliciting volunteers.
Elk Grove schools previously stocked only prescription injectors provided by parents for specific children with diagnosed food allergies.
“This gives an extra level of protection beyond what diagnosed students might have,” Nelson said. “But a situation where a kid may not know he has an allergy, the key is how quickly someone recognizes (an epinephrine injection) is needed and can get there and get it to them. That’s the biggest challenge the districts will face.”
Districts also have voiced concern about the cost of the injectors, which Daniel Thigpen, a spokesman for Folsom Cordova Unified School District, estimates at about $260 for a pair of pens per site. The injectors need to be replaced after they expire, whether they’ve been used or not.
Thigpen said staff in his district are more than prepared to use the injectors because they are all trained in rescue medicine at the beginning of every school year.
“We’ve been providing these trainings for years on how to not only use the devices but to recognize the signs and when it’s necessary,” he said. “The staff has always been willing to provide that service.”
Schools Insurance Authority, the joint powers authority that coordinates risk management and risk financing for all 13 Sacramento school districts, is in the planning stages for centralized anaphylaxis training for school volunteers. Martin Brady, executive director, said the organization is also looking into ordering the injectors in bulk to minimize costs to schools.
There are many logistical components to this bill, he said, and working together will help districts comply more efficiently.
“There’s a difference between people who theoretically envision a program of this nature, and there’s the practical realities of having it be functional and operational,” he said. “It’s a challenge, but it’s not anything we haven’t dealt with before. We’re excited to get this up and running for our members.”
Natalie Giorgi’s mother, Joanne Giorgi, testified in support of the new law, even though her daughter’s life could not be saved even with an injector on hand. Giorgi, whose three other children also have food allergies, said having the injectors at schools is an important safety measure and she feels better knowing that nurses and teachers will be able to help allergic children.
“For any parent of a child with food allergies, it’s a constant worry, it’s a constant fear,” she said. “It’s a reality that parents like us know all too well. ... Whatever we can do to help with the safety and well being of the kids while we’re they’re at school, it’s there. It’s just a safeguard.”
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