Anaphylaxis

10. Adrenaline autoinjectors for general use

Clause 10 of Ministerial Order 706 (PDF) provides that a school’s anaphylaxis management policy must prescribe the purchase of adrenaline autoinjectors for general use.

Purchasing adrenaline autoinjectors

The principal or their allocated staff member of the school is responsible for arranging the purchase of additional adrenaline autoinjector(s) for general use, as a backup to adrenaline devices supplied by parents/carers of students who have been diagnosed as being at risk of anaphylaxis. The additional adrenaline autoinjector(s) for general use can also be used on other students previously undiagnosed for anaphylaxis, where they have a first-time reaction.

Adrenaline autoinjectors for general use are available for purchase at any chemist. No prescription is necessary. These devices are to be purchased by a school at its own expense, in the same way that supplies for school first aid kits are purchased.

The principal or their allocated staff member will need to determine the type of adrenaline autoinjector to purchase for general use. In doing so, it is important to note the following:

• there are currently 3 adrenaline autoinjector devices available in Australia, these are the EpiPen, Anapen and Jext
• the different doses of each device include:
  • EpiPen (300 microgram) is prescribed for adults and children over 20 kg (aged around 5 years or over)
  • EpiPen Jr (150 microgram) is prescribed for children 7.5 to 20 kg (aged around 1 to 5 years)
  • Anapen 500 (500 microgram) is prescribed for adults and children over 50 kg (aged around 12 or over)
  • Jext Jr (150 microgram) is prescribed for children weighing between 15 to 30 kg
  • Jext (300 microgram) is prescribed for adults and children over 30 kg
• Schools cannot purchase the Neffy adrenaline device as a general use adrenaline device. However, Neffy can be used for students where their families have provided the device to the school with an ASCIA Action Plan (RED).

Number of back up adrenaline autoinjectors to purchase

The principal or their allocated staff member will also need to determine the number and type of additional adrenaline autoinjector(s) required to be purchased by the school. In doing so, the principal or their allocated staff member should take into account the following relevant considerations:

• the number of students enrolled at the school who have been diagnosed as being at risk of anaphylaxis
• the weight of the students at risk of anaphylaxis to determine the correct dosage of adrenaline autoinjector/s to purchase
• the accessibility of adrenaline devices that have been provided by parents/carers of students who have been diagnosed as being at risk of anaphylaxis
• the availability and sufficient supply of adrenaline autoinjectors for general use in specified locations at the school including in the school yard, and at excursions, camps and special events conducted, organised or attended by the school
• the adrenaline autoinjectors for general use have a limited life, and will usually expire within 12 to 18 months, and will need to be replaced at the school’s expense either at the time of use or expiry, whichever is first
• the expiry date of adrenaline autoinjectors should be checked regularly to ensure they are ready for use.

Even when a school has no students enrolled with a diagnosed risk of anaphylaxis, the principal or their allocated staff member must purchase at least 2 adrenaline autoinjector/s for general use as some students may experience their first anaphylactic reaction while at school or on a school camp or excursion.

When to use adrenaline autoinjectors for general use

It is recommended that adrenaline autoinjectors for general use be used when:

• a student's prescribed adrenaline device does not work, is misplaced, out of date or has already been used
• a student is having a suspected first-time anaphylactic reaction and does not have a medical diagnosis for anaphylaxis
• when instructed by a medical officer after calling 000.

Schools can use either EpiPen, Anapen or Jext on any student suspected to be experiencing an anaphylactic reaction, regardless of the device prescribed in their ASCIA Anaphylaxis Action Plan (RED).

For first time anaphylactic reactions, the school’s general use adrenaline autoinjector device must be used. If the general use device is not immediately available in an anaphylaxis emergency, staff may use another student's adrenaline device, including the Epipen, Anapen, Jext or Neffy device. This may save a life. If another student's adrenaline device is used in an anaphylaxis emergency, the school must notify the parents of the student whose device was used and immediately replace the device.

Where possible, schools should use the correct dose of adrenaline autoinjector depending on the weight of the student. However, in an emergency if there is no other option available, any device should be administered to the student.

ASCIA advises that no serious harm is likely to occur from mistakenly administering adrenaline to an individual who is not experiencing anaphylaxis.

Refer to ASCIA adrenaline (epinephrine) autoinjectors for general use and frequently asked questions for more information.

Storage of adrenaline autoinjectors

The ASCIA recommends adrenaline autoinjector devices be stored in a cool dark place at room temperature, which they define as 15 and 25 degrees Celsius. If these temperatures cannot be maintained, ASCIA recommends storing the device in an insulated wallet. Refer to the ASCIA website for further information.

The school principal or their allocated staff member is responsible for determining the storage location of all student-owned adrenaline devices and the school adrenaline autoinjectors for general use at school after undertaking a risk assessment. School anaphylaxis supervisors are responsible for informing school staff of the location for use in an emergency.

It is recommended that:

• adrenaline devices be stored close to students at risk of anaphylaxis. This may include the classroom, first aid room, administration office, yard duty bags, and first aid kits
• adrenaline devices be stored in an unlocked, easily accessible place away from direct light and heat, but not in a refrigerator or freezer
• each adrenaline device be clearly labelled with the student's name and be stored with a copy of the student's ASCIA Action Plan for Anaphylaxis (RED)
• adrenaline autoinjectors for general use be clearly labelled and distinguishable from those for students at risk of anaphylaxis and stored with an ASCIA First Aid Plan for Anaphylaxis (Orange)
• adrenaline trainer devices (which do not contain adrenaline or a needle) are not stored in the same location as real adrenaline devices due to the risk of confusion.

Depending on the speed or severity of previous anaphylactic reactions, it may be appropriate to have a student’s adrenaline device in class or transferred to the yard-duty bag at recess and lunch break times.