7 yr old girl died at school in VA on 1/2/12

[rainbow]

Can anyone from VA confirm if schools in that state can keep generic Epipens on hand (not Rx'd to a certain person, but Rx'd to the school nurse)?
One article said a neighboring school *does* have extra, generically prescribed Epipens available -- for use in a 1st time reaction (25% of in-school reactions are first time!), expired Epipen, failed Epipen, or to keep in a strategic location (eg. defib box or in the lunchroom).

This is also part of the federal legislation - for schools to keep extra Epipens available.

[maeve]

Can anyone from VA confirm if schools in that state can keep generic Epipens on hand (not Rx'd to a certain person, but Rx'd to the school nurse)?
One article said a neighboring school *does* have extra, generically prescribed Epipens available -- for use in a 1st time reaction (25% of in-school reactions are first time!), expired Epipen, failed Epipen, or to keep in a strategic location (eg. defib box or in the lunchroom).

This is also part of the federal legislation - for schools to keep extra Epipens available.

VA schools cannot keep on hand an EpiPen that is not prescribed to a specific person.  VA does not have the legislation in place that Illinois just passed.  IIRC, Illinois is really in the vanguard of having auxilliary epinephrine. 

[maeve]

Here's a link to the Virginia Department of Education's guidance on the management of various special needs.

http://www.doe.virginia.gov/support/health_medical/specialized_health_care_procedures/special_care_issues.pdf

[TabiCat]

 OFF TOPIC_-  Rainbow- are you new or returning under a new name. If your new WELCOME:    either way 

[maeve]

More from the VA code:

D. Pursuant to an oral or written order or standing protocol issued by the prescriber within the course of his professional practice, such prescriber may authorize registered nurses and licensed practical nurses to possess (i) epinephrine for administration in treatment of emergency medical conditions and (ii) heparin and sterile normal saline to use for the maintenance of intravenous access lines.
Pursuant to the regulations of the Board of Health, certain emergency medical services technicians may possess and administer epinephrine in emergency cases of anaphylactic shock.

http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+54.1-3408

VA DOE Health Guidelines
Page 259 is the section on epinephrine:
http://townhall.virginia.gov/l/GetFile.cfm?File=E:%5Ctownhall%5Cdocroot%5CGuidanceDocs%5C601%5CGDoc_VDH_1768_v1.pdf

Great VA DOE page with various health links, including one to the manual for training staff in medication administration:
http://www.doe.virginia.gov/support/health_medical/index.shtml

VA law on school nurses, including information on nurse to student ratios
http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+22.1-274

Online orientation for school nurses
http://www.doe.virginia.gov/support/health_medical/nurse_orientation/index.shtml

[lakeswimr]

This is so tragic.  I hope this will result in more schools having stock epis.  Really, all schools should have epis on hand in case a child has anaphylaxis and doesn't have them at school.

I don't know why there wasn't an epi for this child at the school but the parents should have insisted.  The only reason I can think of for a school telling a parent to keep the epi at home is that the parent did not provide the proper paperwork.  My son's school's nurse is all over this and if I don't turn in the right forms on time I would get a call and be told they must have the forms in order to have the epis.

[maeve]

Also, not all ambulances in VA have epinephrine on board.  Advanced life support ambulances will have it on board.  I found this out from a coworker who is an EMT.  I need to double check with him that this hasn't changed.

[CMdeux]

A better series of quotes from Maria Acebal that seems to indicate a likely funky quote in the earlier CNN bit:

I saw another interview with Maria Acebal in which she is also clearly VERY angry at the school's apparent circling of the wagons and bleating about 'protocol' as a means of diverting attention from the very clear fact that this child was in obvious anaphylaxis and no medication of any kind was given to her.

http://abcnews.go.com/Health/AllergiesFood/year-virginia-girl-dies-allergic-reaction-school/story?id=15295949

When it comes to a life-threatening allergic reaction, it's so simple to save that life," said Maria Acebal, chief executive officer of the Fairfax, Va.-based Food Allergy and Anaphylaxis Network, which championed the bill. "I have no doubt that the school where this little girl went had an EpiPen in the office -- it just didn't have Ammaria's name on it."

The bill would include liability protection for school officials who give epinephrine in good faith, Acebal said.

"No one in this country has ever been sued for giving epinephrine, to my knowledge," said Acebal. "All the lawsuits come about because school officials don't give it when it's needed."

In a healthy child, epinephrine can cause a rapid heart rate, nausea and light-headedness -- mild symptoms that wear off in 15 minutes. It would only be dangerous in children born with a congenital heart condition, which school officials would be aware of.

"We need to do a better job of educating the public about the safety of epinephrine," said Atkins. "Because it's an injection, it scares people. And because it's a device, it scares people. But rather than thinking, 'I might kill a kid with this,' they should be thinking, 'I could save a life.'"

Acebal, whose eldest daughter has a food allergy, said her other children learned how to inject epinephrine by age 6.

"If I can teach a 6-year-old to do it, we can teach school staff," she said.

Acebal said having epinephrine on hand in school would give students, staff and parents added peace of mind.

"My heart breaks for Ammaria's family because any parent who has a child with a food allergy knows what it's like to fear that phone call from the school," she said.

[Janelle205]

Though I don't have any school district experience, both of the camps that I worked at long-term (I don't know for the one that I just spent a summer at) we had epi-pens, as well as syringes and vials of epinephrine on hand, prescribed by the doctor that oversees our camp medical orders.  You never know when someone might have a first allergic reaction, especially to stinging insects, and we weren't necessarily close to medical attention.  (Though to give EMS credit, they did make it to camp in 10-15 minutes when we called because of my heart trouble, which is a REALLY quick trip from where they are located.)

[Carefulmom]

For me the dots don`t connect.  I have never heard of a school refusing an epi for a student there.  I have to wonder if they refused it, because there was no form signed by the child`s doctor.  Our school would do the same.  You can only call the parents so many times and ask for the form and then you give up.  I am not so sure that it is the school`s fault.  Our school`s rule is that one child`s epi cannot be used for another child.  I am not sure if that is district rule or specific to our school.

[rainbow]

I agree that scenario is possible Carefulmom.

However, the school is STILL responsible to recognize anaphylaxis in the child -- especially given they knew the child had a peanut allergy.

IF the forms were the issue, they actually could have refused attendance.  Plus, what about low income parents that can't afford the doctor visit to get the forms filled out?

Neighboring school district(s) are resported to have stock generic Epipens available. This school didn't. Nor did they administer another available Epipen.  The nurse's aide should have known what to do in the case of anaphylaxis!  (I also heard the mom was called before 911).

Imo, the school is negligent. The child died at school and the school staff did not follow proper anaphylaxis protocol.  They have nicely written documents, but failed to act to save the child's life.

[Macabre]

I know my Virginia doctor (we're about two hours away from where this happened) charges $10/form.  That's if you just drop forms off in a timely manner.  We have to have two filled out to administer allergy meds:  the emergency action plan, listing the allergy and asthma meds used during a reaction and a med adminisration form that also lists every single med a child might need administered at school. 

I can see how a mom whose child has never had a severe reaction (I don't know about that in this case) might not get this done due to time or money. 

I'm just heartbroken.  This poor family. 

[maeve]

I agree that scenario is possible Carefulmom.

However, the school is STILL responsible to recognize anaphylaxis in the child -- especially given they knew the child had a peanut allergy.

IF the forms were the issue, they actually could have refused attendance.  Plus, what about low income parents that can't afford the doctor visit to get the forms filled out?

Neighboring school district(s) are resported to have stock generic Epipens available. This school didn't. Nor did they administer another available Epipen.  The nurse's aide should have known what to do in the case of anaphylaxis!  (I also heard the mom was called before 911).

Imo, the school is negligent. The child died at school and the school staff did not follow proper anaphylaxis protocol.  They have nicely written documents, but failed to act to save the child's life.

This came to mind for me as well.  In addition, it's quite possible the EpiPen could have been refused because it was expired or due to expire shortly (my SD will not accept an EpiPen that does not have an expiry date past the last day of school).  In addition, my school system requires that the EpiPen be left at school, which means you have to purchase additional EpiPens for home use and day care use.  That's is beyond the means for many people.  (For my DD, I have to supply a twinpack to school, a twinpack to aftercare, DD self-carries another twinpack, and I have a twinpack in my purse.)   It's possible that the family may not have had health insurance and could have had problems purchasing an Epi or additional EpiPens.

've been ruminating over the need for a charity that helps supply EpiPens for those who do not have health insurance or who cannot afford EpiPens.

[maeve]

I know my Virginia doctor (we're about two hours away from where this happened) charges $10/form.  That's if you just drop forms off in a timely manner.  We have to have two filled out to administer allergy meds:  the emergency action plan, listing the allergy and asthma meds used during a reaction and a med adminisration form that also lists every single med a child might need administered at school. 

I can see how a mom whose child has never had a severe reaction (I don't know about that in this case) might not get this done due to time or money. 

I'm just heartbroken.  This poor family. 

We're fortunate that our pediatrician does not charge for medication administration forms nor does Dr. Wood's office.  Our pediatrician does charge $10 for other school/camp forms.  We have to have several sets of those forms completed each year:  school, aftercare, and two camps during the summer.  It could add up if we had to pay for the medication administration forms (we have one form for EpiPens, one for inhalers, and one for Benadryl; that's three forms each for school, aftercare, and camps).

There's still so little known about what happened but clearly there were failures on several levels.  I'm hoping a thorough investigation will shed light on what happened so that some changes can be made to ensure it doesn't happen again.

We've had enough mishaps at our own pretty enlightened school.  I think some school systems become overconfident in their written procedures and past experience and can become complacent about the continuous vigilance that is required when managing LTFAs.

[kouturekat]

This is so tragic.  I hope this will result in more schools having stock epis.  Really, all schools should have epis on hand in case a child has anaphylaxis and doesn't have them at school.

My SIL just wrote on FB that the Florida school where she works sent an email home to parents that the school will not store extra epipens for students.  All students are to bring their own epipens.  It is due to extreme budget cutting. 

My SIL also pointed out that, "...Crazy they probably spend that amount on "lunch workshops" in a weeks time, but no money to save a life if needed."

How much does it cost to save a life?  $80?  Maybe $400 depending on the response time or extra epis being needed in a bad reaction?   Saving $400 is more important than saving a life ?!?!

Ah...the world we live in!  And some of my points were, "...that really is a travesty because not all kids get adequate healthcare, nor does every doc prescribe an epipen. And for the ones that do, *if* the family has a good prescription program with their healthplan, they're the lucky ones. ..."