Considerations:
- Given that when a student is having a severe allergic reaction, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s severe allergic reaction emergency action plan beforehand.
- As this is an emergency situation, it is important to act quickly while ensuring everyone’s safety.
- Identify symptoms of a severe allergic reaction as indicated on Emergency Action Plan, if possible. These may include:
- obstructive swelling of the lips,
- tongue, and/or throat;
- trouble swallowing;
- shortness of breath or wheezing;
- turning blue; drop in blood pressure,
- feeling faint, confused, weak,
- passing out; loss of consciousness;
- chest pain;
- a weak pulse; and/or
- a sense of “impending doom”.
- Younger children may describe an allergic reaction with words such as:
- “There is something stuck in my throat”
- “My tongue is too big”
- “My mouth itches”
- If your school participates in a stock epinephrine program, be sure to:
- Know your school’s policy, plan and protocol regarding stock epinephrine administration
- Know the storage locations of the stock epinephrine, and
- Have proper training to administer the stock epinephrine
- Your school nurse or other licensed health care professional must review the epinephrine administration procedure with you to ensure that you have the skills to perform this emergency medication administration
- Store the severe allergic reaction emergency plan and epinephrine auto-injector in a location that is easily accessible during a severe allergic reaction
- The school nurse should develop a plan to systematically check the expiration date on the medication to ensure the medication has not expired
- Ensure that the medication is clear and replace the medication if it is discolored and replace the medication if it is discolored
Supplies:
- EpiPen®
- Gloves
- Approved Sharps Container
- Alcohol Pad (if possible)
- Band-Aid (if possible)
- Emergency Action Plan/Healthcare provider’s order
- Student Individualized Healthcare Plan (IHP)
- Parent/guardian authorization form
Procedure:
- Identify that symptoms of a severe allergic reaction are present and that based on the child’s severe allergic reaction emergency plan, medication needs to be given.
- Call for assistance.
- Ask that another school staff personnel call 911 or emergency medical services and notify parent.
- Remove other students from the area, as necessary.
- Ensure proper documentation of parent/guardian authorization to administer the medication.
- Gather needed supplies and place on a clean surface near the student.
- Quickly talk to the student and evaluate the situation. Prepare the student.
- Position student, providing as much privacy as possible.
- The injector can be given through clothing in most circumstances.
- Review the medication administration form, the medical provider, emergency action plan, or district protocol/plan form, and the parent/guardian consent form, if available
- Review the six rights of medication administration to be sure it is:
- For the right student
- The right medication
- The right dose, an approximation of the child’s weight may be needed, if using a stock epinephrine auto-injector
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Be sure to check the medication to ensure that it is not expired
- Review student’s allergy status
- Wash your hands, if possible
- In a true emergency situation, there may not be time to do this step.
- Put on gloves.
- Review the Six Rights again to be sure that it is:
- For the right student
- The right medication
- The right dose (an approximation of the child’s weight may be needed)
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Remove the EpiPen® auto-injector from the container.
- Inspect the medication to ensure that the solution is clear
- Hold the auto-injector in your fists with the orange tip pointing downward
- “Blue to the sky, orange to the thigh”
- Remove the blue safety guard from the pen by pulling straight up
- Firmly press the orange tip against the student’s mid-outer thigh (upper leg) at a right angle (perpendicular to the thight)
- Press against the thigh until click is felt, and then hold for 3 (three) seconds.
- The pen can be given through clothing in most circumstances.
- Remove the auto-injector from the student’s thigh
- The orange tip will extend to cover the needle. If the needle is still visible, do not attempt to reuse it, get a new EpiPen and repeat the above steps
- Massage the area for 10 seconds.
- Replace the pen back into its container and place it into an appropriate sharps container or hand to emergency medical responders.
- If alone with the student and you have not already called 911 or emergency medical services and notified parents, do so now.
- Monitor student’s pulse and respirations.
- Once the emergency medical responders arrive, inform them of the medication administered, including the type of medication, dose, and the time given.
- If not done already, dispose of the injector in an approved sharps disposal container or give to the emergency medical responders.
- Remove gloves and wash hands.
- Document medication administration in student’s medication administration log.
- Follow up with the parent or guardian and healthcare provider, as needed.
References:
Bingemann, T.A., Nanda, A., and Russell, A.F. (2021). Pharmacology update: School nurse role and emergency medications for treatment of anaphylaxis. NASN school nurse (Print), 36(5), 264–270. https://doi.org/10.1177/1942602X211021902
Butler, S.M., Boucher, E.A., Tobison, J., & Phan, H. (2020). Medication use in schools: Current trends, challenges, and best practices. J Pediatr Pharmacol Ther., 25(1): 7–24. doi: 10.5863/1551-6776-25.1.7
Campbell, R.L., & Kelso, J.M. (2020). Anaphylaxis: Emergency treatment in a R.M. Walls and A.G. Randolph (Eds.), UpToDate. Retrieved May 26, 2023, from https://www.uptodate.com/contents/anaphylaxis-emergency-treatment
Children’s Hospital St. Louis. (2017, June). Emergency preparedness/response. Food allergy management and education. Retrieved June 21, 2023, from https://www.stlouischildrens.org/sites/legacy/files/pdfs/FAMEToolkit2017-section1-emergency.pdf
Food Allergy Research & Education. (2020, May). Food allergy & anaphylaxis emergency care plan. Retrieved May 26, 2023, from https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/food-allergy-anaphylaxis-emergency-care-plan
Food Allergy Research & Education. (n.d.). Symptoms. Retrieved May 26, 2023, fromhttp://www.foodallergy.org/symptoms
Viatris. (2022). How to use your EpiPen® (epinephrine injection, USP) auto‑injector. Retrieved May 31, 2023, from https://www.epipen.com/-/media/epipencom/assets/pdf/epi-2020-0273_v4_how_to_use_pdf.pdf?la=en
Page last reviewed on February 28, 2025
Page last updated on: February 28, 2025
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.