Staff training and school policies

Supporting Pupils requires governing bodies to ensure that staff supporting children with a medical condition have appropriate knowledge, and where necessary, support. Therefore, schools already have a duty of care to provide training to staff in the emergency management of anaphylaxis where they have a pupil who has been diagnosed as being at risk. This includes the use of an adrenaline auto-injector (AAI), although staff are not obligated to use AAI if they do not wish to.

The Department of Health has stated that it is reasonable for ALL staff to:

• be trained to recognise the signs and symptoms of an allergic reaction;
• understand the rapidity with which anaphylaxis can progress to a life-threatening reaction, and that anaphylaxis may occur with or without prior mild (e.g. skin) symptoms;
• appreciate the need to administer adrenaline (using an AAI) without delay as soon as anaphylaxis occurs, before the patient might reach a state of collapse (after which it may be too late for the adrenaline to be effective);
• be aware of the anaphylaxis policy;
• be aware of how to check if a pupil is on the register;
• be aware of how to access the AAI;
• be aware of which staff members have received training to administer AAIs, and how to access their help.

In the following advice, the term ‘designated members of staff’ refers to any member of staff who has responsibility for helping to administer a “spare” AAI, i.e. they

• have volunteered to help a pupil use AAIs in an emergency
• have received training on how to use AAIs, relevant to their level of responsibility.
• are identified in the school’s medical conditions or allergy policy as someone to whom all members of staff may have recourse in an emergency.

Schools must arrange specialist anaphylaxis training for staff where a pupil in the school has been diagnosed as being at risk of anaphylaxis. This should include practical instruction in how to use the different AAI devices available. Online resources and e-learning modules are NOT a substitute for face-to-face training.

Any staff member may volunteer to take on the responsibilities set out in this guidance, but they cannot be required to do so. Staff may already have wider responsibilities for administering medication and/or supporting pupils with medical conditions.

Severe anaphylaxis is a time-critical situation

It is therefore appropriate for as many staff as possible to be trained in how to administer AAIs. Schools will want to ensure there are a reasonable number of designated members of staff to provide sufficient coverage, including when staff are on leave.

Designated members of staff should be trained in:

• recognising the range of signs and symptoms of severe allergic reactions;
• responding appropriately to a request for help from another member of staff;
• recognising when emergency action is necessary;
• administering AAIs according to the manufacturer’s instructions;
• making appropriate records of allergic reactions.

It is recommended that schools should also ensure that:

• a named individual is responsible for overseeing the protocol for use of the “spare” AAI, and monitoring its implementation and for maintaining the allergy register;
• at least two individuals are responsible for the supply, storage care and disposal of the AAI.

As part of the medical conditions policy, the school should have agreed arrangements in place for all members of staff to summon the assistance of a designated member of staff, and for collecting the spare AAI(s) in the emergency kit. These should be proportionate, and flexible – and can include:

• phone calls being made to another member of staff
• responsible secondary school-aged children being asked to request the assistance of another member of staff and/or collect the AAI device(s) (but not checking the register)
• procedures for supporting a designated staff member’s class while they are helping to administer an AAI.

Delays in giving adrenaline have been associated with fatal outcomes

The school should consider where delays could occur (for example, a phone call is made to summon help but there is no answer). The school’s policy should include a procedure for allowing a quick check of the Allergy register as part of initiating the emergency response. This does not need to be undertaken by the designated member of staff, but the register should be easily accessible. Alternatively, allowing pupils to keep their AAI(s) with them allows for confirmation of consent without the need to check the register.

Enabling a school to be “allergy aware”:

The best way to keep school pupils safe from allergic reactions is for a school to be “allergy-aware”. This means:

• those with allergies can participate in daily school life and not feel left out.
• raising awareness of food allergies and anaphylaxis, so it becomes something which everyone knows about
• everyone can play their part in keeping people with food allergies safe.

Many schools have successfully taken this on as a project in social responsibility, involving both students and school staff. Click here for more information.