Anaphylaxis in Schools 3rd Edition

Appendix D
Anaphylaxis Emergency Plan (individual)
Recommendation
• In schools and other child care settings, each child at risk of anaphylaxis should have an
Anaphylaxis Emergency Plan. (See following page.)
• The Anaphylaxis Emergency Plan should be signed by the parent or guardian, and if required, by the
child’s physician.
Note: Some school boards may choose to allow a parent or guardian to note “on file” if a physician’s signature
has already been obtained (e.g. on previous Anaphylaxis Emergency Plan or written instructions about
treatment protocol) and there has been no change in the child’s condition or treatment strategy. The document
with the physician’s signature should be kept in the pupil’s file for future reference.
• There may be situations where individuals were given recommendations that differ from those
outlined in this Anaphylaxis Emergency Plan. In these cases, specific instructions for treatment
of symptoms and risk reduction strategies should be provided in writing by the child’s physician.
Parents of allergic children should discuss individualized plans with their children’s school staff.
• If an anaphylactic emergency occurs, both the school anaphylaxis plan and the Anaphylaxis
Emergency Plan should be reviewed and amended as necessary.
The Anaphylaxis Emergency Plan has two pages:
1. First page – form with the person’s photo and allergy information, signs and symptoms, brief action
plan, contact information, and consent to administer medication. See next page (Anaphylaxis
Emergency Plan) which can be photocopied.
2. Second page – epinephrine auto-injector instruction sheet for either the EpiPen ® or Allerject.
Select the instructions which correspond to the device prescribed for the individual. Instruction
sheets are available on the pages that follow and can also be downloaded from the following sites:
––
www.epipen.ca
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www.allerject.ca
Note: The Allerject provides voice prompts which can help people through the steps of the injection. If for
any reason the voice prompts do not work or the voice cannot be heard due to noise, the device will still work
and deliver the dose of epinephrine in an emergency situation. There are also written instructions printed on
the Allerject which can be followed.
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Anaphylaxis in Schools & Other Settings
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