SYMJEPI Administration



  • 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”.
  • Given that when a child 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 plan beforehand.
  • If your school participates in a stock epinephrine program, be sure to:
    • Know your school’s 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.
  • Be sure to check the expiration date on the medication package to ensure that the medication is not expired.
  • Also, make sure that the medication is clear and replace the medication if it is discolored.
  • As this is an emergency situation, it is important to act quickly while ensuring everyone’s safety.


  • Gloves
  • Approved Sharps Container
  • Alcohol Pad (if possible)
  • Band-Aid (if possible)

This video was developed in partnership with the Wisconsin Department of Public Instruction


  1. 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.
  2. 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.
  3. Gather needed supplies and place on a clean surface near the student.
  4. Quickly talk to the student and evaluate the situation. Prepare the student.
  5. Position student, providing as much privacy as possible. The injector can be given through clothing in most circumstances.
  6. Quickly review the medication administration form, the medical provider or district protocol/plan form, and the parent/guardian consent form, if available, as you review the “5 Rights” of medication administration.   
  7. Check the epinephrine autoinjector and order to be sure it is:
    1. For the right child
    2. The right medication
    3. The right dose, an approximation of the child’s weight may be needed, if using a stock epinephrine auto-injector
    4. Being given at the right time and
    5. Being given by the right route.
  8. Be sure to check the medication to ensure that it is not expired
  9. Wash your hands, if possible. In a true emergency situation, there may not be time to do this step.
  10. Put on gloves.
  11. Quickly review the Five Rights once again while checking the epinephrine auto-injector to be sure that it is:
    1. For the right child
    2. The right medication
    3. The right dose (an approximation of the child’s weight may be needed)
    4. Being given at the right time and
    5. Being given by the right route.
  12. Pull cap off to expose needle.
    • Handle the device carefully to avoid an accidental needle stick.
  13. Holding by the finger grips, slowly insert the needle into the thigh.
    • The injection can be given through clothing.
  14. After needle is in the thigh, push the plunger all the way down until it clicks.
  15. Hold in place for 2 seconds.
  16. Remove needle and massage the area for 10 seconds.
    • Note: The correct dose has been injected if the plunger has been pushed all the way down and the solution window is at least partially blocked.
  17. Upon removing the needle be cautious of exposed needle and take care to avoid an accidental needle stick.
  18. While holding the plunger end of the syringe with one hand, use your other hand to slide the safety guard up until it clicks to cover the needle.
  19. Place SYMJEPI® auto-injector into an appropriate sharps container or hand to emergency medical responders.
  20. If alone with the student and you have not already called 911 or emergency medical services and notified parents, do so now.
  21. Monitor student’s pulse and respirations.
  22. Once the emergency medical responders arrive, inform them of the medication administered, including the type of medication, dose, and the time given.
  23. If not done already, dispose of the injector in an approved sharps disposal container or give to the emergency medical responders.
  24. Remove gloves and wash hands.
  25. Document medication administration in student’s medication administration log.
  26. Follow up with the parent or guardian and healthcare provider, as needed.


Adamis Pharmaceuticals Corporation. (2021). Giving SYMJEPI (epinephrine) injection. Retrieved March 15, 2021 from

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: April 22, 2020.

Campbell, R.L., & Kelso, J.M. (2020). Prescribing epinephrine for anaphylaxis self-treatment In a A.M. Feldweg (Ed.) UpToDate. Retrieved: April 22, 2020.

Food Allergy Research & Education (2015). Food allergy & anaphylaxis emergency care plan. Retrieved May 1, 2020, from

Food Allergy Research & Education (2015). Symptoms. Retrieved May 1, 2020, from

National Association of School Nurses (2015). Get trained: Training tools. Retrieved on May 1, 2020, from

Page last updated on: March 15, 2021

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.