Children in whom the spare AAI can be used

Adrenaline auto-injector devices (AAIs) are used in the emergency management of anaphylaxis, and can buy valuable time while waiting for an ambulance to arrive.

Under existing legislation, teachers and other non-healthcare professionals may administer AAIs, but only to a person prescribed an AAI device, using the device prescribed to them. In other words, they cannot use an AAI belonging to child ‘A’ to treat anaphylaxis occurring in child ‘B’.

The Human Medicines (Amendment) Regulations 2017 (which came into effect from 1 October 2017) now allows schools to obtain (without a prescription) “spare” AAI devices, for use in emergencies. These “spare” AAIs can be used:

• in any pupil known to be at risk of anaphylaxis, but only if medical authorisation and written parental consent have been provided.
• if the pupil’s own prescribed AAI(s) are not immediately available (for example, because they are broken, out-of-date, have misfired or been wrongly administered).

Children with food allergies are not always prescribed AAI, but may still be at risk of anaphylaxis. These children can be given the spare AAI in an emergency, so long as:

• the school has a care plan confirming that the child is at risk of anaphylaxis
• a healthcare professional has authorised use of a spare AAI in an emergency in that child
• the child’s parent/guardian has provided consent for a spare AAI to be administered.

The British Society for Allergy and Clinical Immunology (BSACI) has produced a range of Allergy Plans which can be used for this purpose, and can be downloaded here. All children with a diagnosis of food allergy and at risk of anaphylaxis should have a written Allergy Management Plan. The BSACI plans can be used as the pupil’s individual healthcare plan to meet the school’s duty under Supporting Pupils, where the pupil has no other healthcare needs.

If a school chooses not to use the BSACI plans, there needs to be an alternative which includes information on:

• Known allergens and risk factors for anaphylaxis in the pupil.
• Whether the pupil has been prescribed AAI(s) (and if so what type and dose).
• Where a pupil has been prescribed an AAI: if parental consent has been given for use of the spare AAI.
• A photograph of the pupil to allow a visual check to be made (this will require parental consent).

These details should also be kept in a register in school. In larger schools (and secondary schools, in particular), it may not be feasible for individual staff members to know which pupils have been prescribed AAIs. Schools should therefore ensure that the register is accessible and easy to read. Schools need to ensure they have a proportionate and flexible approach to checking the register. Delays in giving adrenaline have been associated with fatal outcomes. Allowing pupils to keep their AAI(s) with them will reduce delays, and allows for confirmation of consent without the need to check the register.

It is up to individual schools to decide when it is best to obtain parental/gaurdian consent for use of an AAI. The most appropriate time is probably when a pupil’s individual healthcare plan is agreed. Consent should be updated regularly – ideally annually – to take account of any changes.

If a pupil is having anaphylaxis but does not have the required medical authorisation and parent/guardian consent for a “spare” AAI to be used, the school should immediately call 999 and seek advice: If “spare” AAIs are available, mention this to the call handler/emergency medical dispatcher, as they can authorise its use if appropriate.