Allergies and Understanding Anaphylaxis

What are Allergies?

An allergy is when a person’s immune system reacts to triggers (allergens) that the person is hypersensitive to and is usually harmless to most other people. Symptoms of an allergy can range from mild to potentially life-threatening (severe). It occurs when the body mistakes something as harmful and creates a defence system (antibodies) to fight it.

The ways allergens can enter the body:

• Ingested (most common, in the mouth)
• Inhaled (breathed in)
• Injected (bees, wasps, ants, or medication)
• Absorbed (through touching the skin)
• Allergy symptoms develop when the antibodies are battling the “invading” allergen

The most common causes of allergic reactions in Australia are:

• Dust mites
• Pollen
• Foods such as peanuts, tree nuts, cow’s milk, soy, eggs, wheat, fish, seafood, sesame
• Cats and other furry or hairy animals such as dogs, horses, rabbits, and guinea pigs
• Venom from insect stings (bees, wasps, or ants) or bites (ticks)
• Moulds
• Drugs/medications such as penicillin, aspirin, herbal medicines
• Exercise, latex, cold
  

Symptoms

• Initial signs (these can be used as warning signs to get help)
• May begin with itchy hands, mouth, or feet
• Eyes may become red, watery, and puffy,
• Tingly around the mouth
• Swollen lips and face
• Rash or hives can develop, especially on the chest, armpits, and groin (hives are white itchy bumps that look and feel like insect bites)
• Stomach pain, vomiting, diarrhoea

How the body responds (to allergy):

The first time you eat, breathe in, touch or be injected with the allergen, your immune system responds by making disease-fighting antibodies (called immunoglobulin E or IgE). When you do this a second time, it triggers the release of IgE antibodies and other chemicals, including histamine. Your body is fighting the allergen and trying to get rid of it. All the signs and symptoms happen the second time you are exposed and the signs and symptoms are a sign that the body thinks it is bad.

Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system. If it is released in the ears, nose, and throat, you may have an itchy nose and mouth, or trouble breathing or swallowing. If histamine is released into the skin, you may develop hives or a rash. If histamine is released in the gastrointestinal tract, you likely will develop stomach pains, cramps, or diarrhoea. Many people experience a combination of symptoms but not always all of them.

 

What is a Food Intolerance?

The difference between food intolerance and an allergy

Food intolerance is a digestive system (tummy) response rather than an immune system response (fighting germs). Intolerance occurs when something in a food upsets a person’s digestive system or when a person’s stomach is unable to properly digest or break down the food. Intolerance to lactose, which is found in milk and other dairy products, is the most common food intolerance.

Symptoms of food intolerance include:

• Nausea
• Stomach pain
• Gas, cramps, or bloating
• Vomiting
• Heartburn
• Diarrhoea
• Headaches
• Irritability or nervousness

What is Anaphylaxis?

Anaphylaxis is the most severe form of allergic reaction and can cause death. It must be treated as a medical emergency, requiring immediate treatment and urgent medical attention.

Anaphylaxis often involves more than one body system, e.g. skin (rash), respiratory (breathing), gastrointestinal (stomach), and cardiovascular (heart and blood pressure).

The most dangerous allergic reactions affect breathing and/or the heart and blood pressure. The signs and symptoms of anaphylaxis could happen straight away or can take up to the first 20 minutes after exposure.

Note: Mild/moderate signs and symptoms of an allergic reaction do not always precede anaphylaxis

Symptoms: Severe allergic reaction – ANAPHYLAXIS

• Shock
• Altered mental status
• Difficulty breathing, or shortness of breath and gasping
• Casualty may become very anxious and have a great sense of fear
• Respiratory or cardiac arrest and unconsciousness
• Difficulty and/or noisy breathing
• Swelling of the tongue
• Swelling or tightness in the throat
• Difficulty talking or hoarse voice
• Wheeze or persistent cough
• Loss of consciousness and/or collapse
• Pale and floppy (young children)
• Abdominal pain or vomiting if insect allergy

Common Allergens (triggers) of Anaphylaxis Food

There are nine (9) food groups that account for approximately 90% of allergic reactions. Milk, eggs, peanuts, tree nuts, sesame, fish, crustaceans, wheat, and soy are the most common food triggers.

However, any food can trigger anaphylaxis. It is important to understand that even a trace (small amount) of food can cause a life-threatening reaction. Some extremely sensitive individuals can react to even the smell of food (e.g. fish, peanut butter).

Foods are the most common trigger in children and young adults while medications and insect bites and stings are more common in older adults

Insect Venom

Bee, wasp and jumper ant stings are the most common causes of anaphylaxis to insect stings.

Bites from ticks and fire ants also cause anaphylaxis in some individuals. Stomach pain and nausea with this allergen are a severe reactions.

Medication

Medications, both over the counter and prescribed, can cause life threatening allergic reactions, e.g. aspirin, antibiotics such as penicillin.

Individuals can also have anaphylactic reactions to herbal or ‘alternative’ medicines.

Other

Other triggers such as cold, latex (gloves and balloons) or exercise (with or without food) induced anaphylaxis are less common.

Occasionally the trigger cannot be identified despite extensive investigation.

 

Allergy Diagnosis

Allergies often run in families, suggesting that the condition can be inherited. 15,000 Australian children are newly diagnosed with severe allergies each year, and an estimated 4.1 million (19.6% of the population) Australians live with at least one allergy.

It is estimated that by 2050 this will increase to 7.7 million (26.1% of the population). Milder forms of allergic reaction commonly experienced by Australians are hay fever and eczema which, in some cases, can lead to Asthma and Anaphylaxis.

Allergic people who have a history of eczema and/or asthma are at higher risk of anaphylaxis.

Some reliable sources of information and guidelines on severe allergic reactions are:

• Allergy & Anaphylaxis Australia
• Australasian Society of Clinical Immunology and Allergy (ASCIA)
• National Allergy Strategy
• Ministerial Order 706 – Anaphylaxis Management in Victorian Schools

A person who is suspected of having an allergy should obtain a referral to see an allergy specialist for correct diagnosis, advice on how to prevent it from happening, and emergency treatment.

Those diagnosed with a severe allergy must carry emergency medication as prescribed, as well as an ASCIA Action Plan for Anaphylaxis that must be written and signed by their doctor.

When an adrenaline autoinjector has been used or has expired, the individual’s personal ASCIA Action Plan for Anaphylaxis needs to be reviewed by their doctor. If the individual is a child, the photo should be updated each time, so they can be easily identified.

It is recommended that an individual’s personal ASCIA Action Plan for Anaphylaxis be provided upon initial enrolment or during the staff induction process when commencing a new job.

 

Action Plans

Sufferers of severe allergies should always have a personal ASCIA Action Plan for Anaphylaxis in case of an emergency. The sufferer’s general practitioner (GP) should annually complete or review the sufferer’s Action Plan. The Plan should contain:

• The prescribed medication was taken and when it is to be administered
  o Most plans will include the administering of an autoinjector that has adrenaline in it.
• Emergency contact details
• Contact details of the sufferer’s medical or health practitioner
• Details about deteriorating conditions including signs to recognise triggers and/or worsening symptoms, what to do during an attack or medication to be used
• Sufferer’s details, including a photo

These Action Plans are called REACTIVE, which means they are followed after something has happened.

Always follow a casualty’s ASCIA Action Plan for Anaphylaxis, the casualty’s ASCIA Action Plan for Allergic Reactions or the generic ASCIA First Aid Plan for Anaphylaxis (if a personalised one is not available) to provide first aid responses to allergic reactions, including anaphylaxis.

Please read through these so that you are familiar with their layout when you come to your course. You may also have similar documents at your workplace for children in your care, or perhaps for work colleagues.

It is crucial that if you have anyone who suffers from anaphylaxis in your workplace, that a personalised Action Plan has been received and incorporated into the individual’s Anaphylaxis Management Plan which should be reviewed and updated at the beginning of each year or as per organisational procedures or when the sufferer sees a doctor to arrange for a replacement adrenaline autoinjector.

LINK to personal Action Plan PDF Image: ASCIA Action Plan for Anaphylaxis (RED) 2021 EpiPen®

 

 

General: EpiPen – LINK ASCIA First Aid Plan for Anaphylaxis

Personal – LINK  ASCIA Action Plan for Allergic Reactions

Personal: Anapen – LINK  ASCIA Action Plan for Anaphylaxis

  General: Anapen – LINK  ASCIA First Aid Plan for Anaphylaxis

Adrenaline (Epinephrine)

Adrenaline (epinephrine) is the only medication proven to reverse the symptoms of anaphylaxis. Adrenaline acts as a natural “antidote” to some of the chemicals released during severe allergic reactions and works rapidly to reduce throat swelling, open the airways and maintain blood pressure. Adrenaline must be injected and cannot be taken by mouth.

When someone goes into anaphylactic shock, the sufferer needs a dose of adrenaline. Adrenaline is not harmful and in most cases, will stop the signs and symptoms for a short time. This medication is available via an autoinjector such as an EpiPen®

Please note: If there is no Personal ASCIA Action Plan for Anaphylaxis, follow the guidelines from the General ASCIA First Aid Plan for Anaphylaxis

Please note: An individual with a Personal ASCIA Action Plan for Anaphylaxis will have an EpiPen which is a prescribed medication. Due to the legalities involved in using someone else’s prescribed medication, it is strongly advised that your workplace, school, or child care centre own a number of spare autoinjectors to be used in an emergency.

Adrenaline autoinjectors are available from pharmacies without a prescription at full price.

An adrenaline autoinjector (EpiPen/Anapen) for general use may be required when:

• A child’s medication is unavailable or is out-of-date
• A second dose is required before the arrival of an ambulance
• The device has misfired or been incorrectly discharged
• A previously undiagnosed individual has an anaphylactic episode for the first time

Note: If in an emergency situation another person’s adrenaline autoinjector was used, immediately send someone to replace it

Changes to labels for Adrenaline Autoinjectors

In Australia from April 2016, adrenaline autoinjector labels for EpiPens will start to show ‘adrenaline (epinephrine)’ as the ingredient name. Including both names on Australian medicines should reduce confusion and clarify that these are the same ingredient especially for Australians traveling overseas, visitors to Australia, and health professionals trained internationally.

For a mild or moderate allergic reaction, the autoinjector may not be required. As you may have noticed on the Action Plans only medication (tablets or liquid) may need to be given when the signs and symptoms are not severe.

Always remember that if ever in doubt, just administer the autoinjector. Adrenaline is not harmful and can only be a benefit to a casualty!

Whatever treatment you are giving, do not move the casualty. Bring the medication to them. Only move them if there is danger or risk of further injury to the casualty, including more of the allergen that has caused the problem (e.g. a bee hive)).

Autoinjectors are single-use only. Once it is used it won’t work again.

Once the adrenaline begins to work, the casualty should sweat profusely and have an increase in their pulse and breathing rates. These signs are good!

If the sufferer’s signs and symptoms do not get better after 5 minutes apply their second autoinjector or use the backup autoinjector intended for general use

An adrenaline autoinjector for general use can be used on a casualty displaying signs and symptoms of anaphylaxis regardless of whether they have been diagnosed as being at risk of anaphylaxis

When a person over 20kg is experiencing an anaphylactic reaction and no adult autoinjectors are available, administer either two doses of the EpiPen Jnr (150 mcg) or Anapen® 150

Risk and Side effects of Adrenaline

Palpitations (fast strong heartbeat), tremors, general pallor, or blanching at the site of injection are the main side effects experienced after adrenaline is injected. Other common side effects may include, sweating, nausea and vomiting, difficulty breathing, dizziness, weakness, headache, apprehension, nervousness, or anxiety. If the casualty is resting, the side effects usually quickly disappear.

Adrenaline is well tolerated in children and when given as specified on an action plan, the benefits would always outweigh the possible side effects.

There are no published reports of death or serious injury resulting from the use of adrenaline autoinjectors. No serious or permanent harm is likely to occur from mistakenly administering adrenaline using an adrenaline autoinjector, to an individual who is not experiencing anaphylaxis

 

The EpiPen® Autoinjector

The EpiPen® autoinjector contains one dose of adrenaline which should reverse the effects of anaphylaxis.

There are two strengths:

• Adults and children and over 20kg (yellow)
• Children 10kg to 20kg (green)

The doctor will prescribe the correct one and write it on the Action Plan.

Upon use, an adrenaline autoinjector (EpiPen) should be immediately replaced.

How to Use an Epi-Pen®

1) Remove the autoinjector from its container

2) Check that it is actually an adrenaline autoinjector

3) Ensure the expiry date is still valid and that the solution does not look contaminated by viewing the window on the device

4) You will receive guidance on how to do this by your practical trainer at your class

5) EpiPen® should never be stored in a locked up, inaccessible area

6) Remove the blue cap on top

7) Find the meaty part of the outer thigh; do not simply jab this in any old place, it should be injected into the muscle. It should work through jeans and lighter materials but try

8) It should be flush with the skin. Once there, press the plunger in until it clicks, and then HOLD IT IN PLACE FOR A FULL COUNT OF 3.

9) Remove when finished 

10) Always call an ambulance as the casualty will need extra medical treatment and observation by a doctor

11) The single dose of adrenaline may only buy up to 20 minutes, and then the airway may swell once again. The ambulance will have adrenaline on board to get them to the hospital and they will be treated and observed there

12) In a timely manner, accurately convey first aid management steps undertaken to relieve emergency services

13) Give the EpiPen® to the Ambulance officers and a copy of the Action Plan if available

See a video on how to use an EpiPen: LINK or scan the QR code to access and play the video.

When administering an EpiPen® it is important that:

• You hold the orange end to the thigh, not the end with the blue safety cap. Previously, confused first aiders would inject their own thumb rather than the sufferer. Remember: The orange end is the needle end!
• After removing the safety cap, ensure you push the pen in hard enough until a click is heard for the spring to activate the needle injection
• The needle stays in the sufferer’s thigh for 3 seconds. Do not remove it too early as the adrenaline may still be releasing
• Call 000 for an ambulance
• Contact parent/guardian or another emergency contact

If you are anaphylactic and own an EpiPen®, you should always ensure:

• The autoinjector never exceeds its expiry date (12 – 18 months)
• The autoinjector’s window does not display a cloudy or brown colour
• The autoinjector is always stored below 25 degrees (away from direct sunlight) but not in the fridge
• The autoinjector is with you at all times and is accessible to people who are responsible enough to help you administer it
• The autoinjector remains in its sharps storage container

Anapen® is a pre-filled syringe of adrenaline (epinephrine) contained in an auto-injection device for the immediate emergency treatment of severe allergic reaction (e.g.: anaphylactic shock), distributed by Allergy Concepts in Australia.

To manage the symptoms of allergies & anaphylaxis and open the airways, it is imperative to treat the reaction immediately with an emergency injection of adrenaline (epinephrine), followed by close medical supervision at a hospital. This medicine is for emergency use only and patients or carers should call emergency assistance on 000 after the Anapen® injection, even if symptoms appear to be improving.

You should always carry two Anapen® devices to ensure the recommended dose can be given. In the event one adrenaline dose is not enough to effectively treat the reaction, or the device doesn’t function as intended, be prepared to administer a second dose.

Information as per: https://www.anapen.com.au/anapen

Anapen® Sizes

Anapen® Jr (150 microgram) is prescribed for children 7.5-20kg (aged around one to five years).

Anapen® 300 (300 microgram) is prescribed for adults and children over 20kg (aged around five years or over).

Anapen® 500 (500 microgram) is prescribed for adults and children over 50kg (aged around twelve years or over)

How to use the Anapen® Autoinjector

1. Remove the black needle shield by pulling hard in the direction of the arrow. This also removes the rigid protective needle shield
2. Remove the grey safety cap from the red firing button by pulling as indicated by the arrow
3. Hold the open end (needle end) of the Anapen® against the outer part of the thigh. If necessary, Anapen® can be used through light clothing, such as denim, cotton, or polyester. NB: Anapen® auto-injector is intended only for intramuscular use. Only administer into the outside of the thigh muscle, nowhere else.
4. Press the red firing button so that it clicks. Keep holding the Anapen® auto-injector against the outer thigh for 10 seconds, then slowly remove it from the thigh and note the time adrenaline was administered
5. The injection indicator will have turned red. This shows that the injection is complete. If the injection indicator is not red, the injection must be repeated with a new Anapen®.
6. After the injection, the needle sticks out. To cover it, click the wide end of the black needle shield back on the open end (needle end) as indicated by the arrow.
7. Immediately after use, call 000 and ask for an ambulance and say “anaphylaxis”.
8. Advise the paramedic that an Anapen® has been administered into the thigh muscle and show them the product box for more information.

Note: Do not touch the exposed needle

Information as per: https://www.anapen.com.au/anapen-instructions

Images as per: https://www.allergy.org.au/hp/anaphylaxis/adrenaline-injectors-faqs

See a video on how to use an Anapen: LINK or scan the QR code to access and play the video.

First Aid for Anaphylaxis

DRS ABCD – Basic Life Support flow chart

The Australian Resuscitation Council (ARC) recommends using the following 7 step acronym when caring for a casualty – D R S A B C D

1. DANGERS Check for danger (hazards/risks/safety)
2. RESPONSIVENESS Check for response (if unresponsive)
3. SEND Send for help (Call 000)
4. AIRWAY Open the airway
5. BREATHING Check breathing (if not breathing / abnormal breathing)
6. CPR Start CPR (give 30 chest compressions followed by two breaths)
7. DEFIBRILLATION Attach an Automated External Defibrillator (AED) as soon as available and follow the prompts

How to position a person having anaphylaxis

The ASCIA Action Plans for Anaphylaxis include the following infographics that show the correct and incorrect positioning of a person having a severe allergic reaction (anaphylaxis).

Note: Lay person flat – do NOT allow them to stand or walk

• If unconscious or pregnant, place in the recovery position – on the left side if pregnant, as shown below
• If breathing is difficult allow them to sit with legs outstretched
• Hold young children flat, not upright If unconscious, place them in the recovery position
• The person should NOT stand, walk, or be held upright, even if they appear to have

When a person has anaphylaxis their blood pressure can drop rapidly, which reduces blood flow to the heart. Laying the person flat will help blood flow to the heart which improves blood pressure, whilst standing can make anaphylaxis worse by causing blood pressure to drop.

Note: If the casualty walks, stands, or sits up suddenly, they can die within minutes.

The person having anaphylaxis should not be allowed to stand, sit up suddenly or walk, even if they look like they have recovered. They should be carried on a stretcher or trolley bed to the ambulance

Source information and video on correct positioning: https://www.allergy.org.au/hp/anaphylaxis/positioning

See a video on how to position a person having anaphylaxis, scan the QR code to access and play the video.

First Aid Management of Anaphylaxis:

• Follow DRS ABCD – Check for danger
• Appropriately position the person having anaphylaxis
• If known and possible, remove the source of the allergy
•           Use the autoinjector (EpiPen/Anapen) to inject adrenaline. (Note that the devices have been designed for use by anyone in an emergency as instructions are shown on the label)
• Call 000 / 112 for an ambulance
•           Stay calm and continually monitor the casualty’s airways, breathing, and respiration, as a sudden change may occur which may need CPR at any time. Ensure that the EpiPen/Anapen has been administered before commencing CPR.
• Contact parent/guardian or other emergency contacts
• If available, further adrenaline doses may be given if there is no response after 5 minutes
• If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector FIRST, then asthma reliever

Note: If adrenaline is accidentally injected (e.g., into a thumb) phone your local poisons information centre. Continue to follow the plan for the person with the allergic reaction

Allergic Reactions – Insect Treatment

• In the case of a bee sting, remove the sting. Try to scrape it sideways away from the entry point.
• Apply a cold compress to the affected area to help reduce swelling and pain for periods of 20 minutes (do not apply ice to the eye area).
• Monitor for signs or symptoms of anaphylaxis
• If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline

Allergic Reactions – Tick Treatment

• In the case of a tick bite, if there is no history of tick allergy, immediately remove the tick
• If the casualty has a history of tick allergy, the tick must be killed where it is, rather than removed.
• Monitor for signs or symptoms of anaphylaxis
• If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline

To kill the tick where it is:

• For small ticks (larvae & nymphs), use permethrin cream (available at pharmacies)
• For adult ticks, freeze them with an ether-containing spray (available at pharmacies).
• Wait for the tick to drop off or remove it taking the utmost care to not compress the tick (as this will squirt allergen, toxin and possibly infection into you)
• Note: Do not use tweezers

Calling Triple Zero (000)

Immediately after using an autoinjector (EpiPen/Anapen), call 000 and ask for an ambulance and say “anaphylaxis”. Besides the address details, also convey:

• The time that the anaphylactic reaction started
• The time you administered the adrenaline and second adrenaline if required after 5 minutes
• Everything the casualty was saying to you about their condition
• The signs they are displaying

The casualty should always be monitored for at least four hours following anaphylaxis

Supporting a Casualty

The first aider at all times should display a respectful attitude towards the casualty (whether they a conscious or not) by maintaining respect for privacy, cultural beliefs, religious belief, ethnicity, languages, genders, disabilities, and age when communicating and interacting with the casualty. While giving aid to a casualty be mindful of the following:

• Help comfort the casualty to feel safe, secure, and supported
• Be gentle and help maintain their dignity
• Avoid any unnecessary personal contact with the casualty
• Use appropriate and respectful communication. Speak in a clear, calm, and slow manner
• Help the casualty to remain calm and reassure them that help is on the way
• Stay with the casualty until help arrives
• If available, seek support from others nearby to provide assistance
• A first aider should not go beyond their level of training to help save a casualty

Being Prepared for Individuals with Anaphylaxis

Parents or those who care for individuals with anaphylaxis should be prepared by:

• Knowing their allergic trigger/s
• Knowing how to avoid the trigger/s (if possible)
• Being able to recognise the early symptoms of an allergic reaction and anaphylaxis
• Having a first aid anaphylaxis plan. This would include having an autoinjector device (EpiPen®/Anapen) available

Critical aspects in caring for a child or young adult with anaphylaxis are identifying risks and hazards and removing or minimising them so that adrenaline can be quickly administered. For example, a child has been stung by a bee; this may mean moving the child from the area to a safe location away from the bees.

Anaphylaxis Video:

 

Anaphylaxis in Victorian Schools

Whilst the following is applicable to Victorian schools it is a very good model to follow in all schools, childcare settings, and workplaces in general.

“Ministerial Order 706”

All Victorian schools must review and update their existing policy and practices in managing students at risk of anaphylaxis to ensure they meet the legislative and policy requirements as per the following:

Any school that has enrolled a student or students at risk of anaphylaxis must by law have a School Anaphylaxis Management Policy in place that includes the following:

• A statement that the school will comply with Ministerial Order 706 and associated guidelines
• An Individual Anaphylaxis Management Plan on an annual basis (that includes an individual ASCIA Action Plan for Anaphylaxis) for each affected student, developed in consultation with the student’s parents/carers and medical practitioner

An Individual Anaphylaxis Management Plan must be distributed to all staff responsible per individual at risk and contain the following information:

• Individual personal details
• Parent/carer details (depending on the age of the individual)
• Emergency Contact
• Medical information such as ASCIA Action Plan for Anaphylaxis
  o Photo identification
  o Allergic triggers/allergens
  o First aid response, including prescribed medication
  o Other medical conditions
• Activities that could involve risk
• Preventative strategies to avoid triggers and minimise risks
• Location of the adrenaline autoinjectorInformation and guidance in relation to the school’s management of anaphylaxis, including:
  o Prevention strategies to be used by the school to minimise the risk of an anaphylactic reaction for in-school and out-of-school settings
  o School management and emergency response procedures that can be followed when responding to an anaphylactic reaction
  o The purchase of spare or ‘backup’ adrenaline autoinjector devices(s) as part of the school first aid kit(s), for general use
  o Development of a Communication Plan to raise staff, student, and school community awareness about severe allergies and the School’s Anaphylaxis Management Policy
  o  Regular training and updates for school staff in recognising and responding appropriately to an anaphylactic reaction, including competently administering an EpiPen and completing of an Annual Anaphylaxis Risk Management Checklist
  o (DEECD website, Anaphylaxis guidelines for Victorian Schools, Ministerial Order 706”, 17/05/16, Internet)

Staff that is caring for and/or educating a child or young adult with anaphylaxis must complete anaphylaxis training covering:

• Schools Anaphylaxis Management Policy
• Causes, symptoms, and treatment of Anaphylaxis
• Identities of students diagnosed at risk of Anaphylaxis
• Where medication is located
• How to use an adrenaline autoinjector
• The school’s first aid emergency response plan
• Caring and/or educating a child means: In the classroom, on yard duty, on excursions, camps, and special events
• Out of Hours School Care – Qualified staff (with Anaphylaxis training) must be on the premises at all times if the child that has been diagnosed with Anaphylaxis is in their care

The principal of a school/director of a centre is responsible for ensuring that a Communication Plan is developed in consultation with all relevant stakeholders and it must include strategies on how to respond to an anaphylactic reaction by a student in various environments including:

• During normal school activities including in the classroom, in the schoolyard, in all school buildings and sites including gymnasiums and halls
• During off-site or out-of-school activities, including excursions, school camps, and special events conducted or organised by the school
• Students with a medical condition that relates to allergy and the potential for anaphylactic reaction and their role in responding to an anaphylactic reaction by a student in their care

Stakeholders may include: Carers/parents, Workplace first aiders, Management, Students, Teachers, Nurses, Casual staff, Specialist staff, Early childhood staff, Food industry staff such as carers, canteen staff, School camp providers, Volunteers, etc.

The communication plan should be annually reviewed to maintain its effectiveness.

Anaphylaxis in Australian Childcare Services

Strategies to reduce the risk of an individual’s exposure to known triggers/allergens should be implemented. This should include organisational policies, staff training, emergency response procedures, and all potential risks, for example:

• Food-related risks
  o Avoid using food in activities or as a reward
  o Should selected food items be banned from the premises?
  o Sharing of food
• Outdoor activities (Insect stings)
  o Stay away from flowering plants
  o Children to wear closed shoes, light or dark colours instead of bright
  o Clover to be sprayed (outside of school hours)

The effectiveness of risk minimisation strategies should be reviewed annually, or after an incident.

• If a child has a first time Anaphylactic Shock, qualified (Anaphylaxis) staff can give the autoinjector without ringing “000” for authorisation
• However, “000” is always called after an autoinjector is given for continuing treatment, or during the process if a phone is nearby
• All staff must know the Management policy at all times
• All staff must have been trained every 2 years in the Anaphylaxis course. Also:
  o Skills/knowledge relating to using adrenaline injectors be refreshed annually
  o When a new device enters the market
• This also refers to Long Day Care, Family Day Care, OSHC and Pre-schools
• All staff must also practice with autoinjectors every 12 months
• The Centre must have an Action Plan, for each child with an autoinjector, from the parents, which has been completed by a General Practitioner (Doctor) or specialist
• The Centre must show the policy and provide a copy to parents. This includes a Risk Minimisation, Communication Plan and Emergency Management Plan
  o A risk assessment is undertaken for proposed activities in different environments, e.g. excursions, art, craft, cooking, science, parties, etc.
  o Identification of potential sources of allergens
  o Consider the effect of environments on level of risk, e.g. remote camp location exponentially increases risk
  o Rating of risks
  o The required staff skills in the risk management of anaphylaxis are kept current
• Staff can give medication for Asthma and Anaphylaxis but must call “000” and a parent/guardian
• An appropriate amount of First Aid kits must be fully stocked and available where the child is being educated

Regulation 162 says that there must be health information on the enrolment record for each child with:

• Healthcare needs and any medical conditions
• Allergies and if diagnosed as a risk of Anaphylaxis
• Any documents to be followed (e.g. Action Plans)
• Details of dietary restrictions

Regulation 173 (if applicable) says a notice stating that a child who has been diagnosed as at risk of anaphylaxis is enrolled at the education and care service. This must be displayed for all staff.

To maintain confidentiality & privacy, the personalized charts should not be displayed publicly as parents, tradesmen and visitors may have access to the information. A system needs to be developed per centre where approved staff have daily and quick access to the charts while keeping the files away from public eyes.

• The General ASCIA Action Plan for Anaphylaxis should be publicly displayed
• If the child is taken on an excursion their medication and Action Plan must be taken.
• Medication must be recognizable and readily accessible to staff but not to children and stored away from heat. (Education and Care Services, National Regulations 2011)

10-point allergy action plan for starting school

1. Notify the school about your child’s allergy as early as possible. Be clear about which foods or other allergens may trigger an anaphylactic reaction.
2. Provide the school with a written diagnosis and a personalised ASCIA Action Plan for Anaphylaxis from your treating doctor. This should include details of prescribed medications such as adrenaline or antihistamines.
3. Supply necessary medication and ensure it is clearly labeled, stored correctly, and kept up to date. Anaphylaxis Australia recommends an EpiPen/Anapen travels with the child at all times between home and the classroom, while a second backup unit is stored permanently in the school office.
4. Visit the school and enquire about any other potential risks. E.g. Are children exposed to food allergens during cooking and craft lessons? What can the school do to reduce the risk of insect stings?
5. Ensure teachers and other staff are aware of prevention strategies and ensure they are implemented. Especially plan ahead for special events such as excursions, sports days, and parties.
6. Work with the school to develop an emergency action plan. Ensure appropriate staff members are trained and confident to administer medications.
7. Teach your child from a young age not to accept food from others. Provide a lunchbox that is clearly labelled and remind them not to trade food with friends.
8. Be creative in providing safe food treats for your child. Ask the school to store some of your cupcakes in the canteen freezer so your child can join in with birthday celebrations.
9. Encourage your child to become independent. Remind them to always take their medication to school. It can be kept in an insulated lunch bag, together with a copy of the emergency action plan.
10. Record and check expiry dates of EpiPens® used at school and at home and ensure each unit is replaced prior to expiry

Record Keeping and Reporting

Incident, injury, trauma and illness policies & procedures and reporting Law Section 174, Regulations 12, 85-87, 168, 177-178, 183

• Centres must have incident, injury, trauma and illness policies and procedures in the event that a child:
  (a) is injured; or (b) becomes ill; or (c) suffers a trauma.
• A Centre must ensure that a parent of a child is notified as soon as practicable, but not later than 24 hours after an occurrence, if the child is involved in any incident, injury, trauma or illness
• The details of the occurrence must be correctly and accurately recorded within 24 hours
• The occurrence records are stored safely and securely until the child is aged 25 years
• That the Regulatory Authority is notified of a serious incident which includes:
  (a) death of a child; or (b) where medical assistance was required; or (c) attendance of emergency services at the education and care service premises was sought, or ought reasonably to have been sought.

Early Advanced Care

Early advanced care means the sooner a paramedic can attend to the casualty; the greater chance a casualty can be stabilised. As such, it is important that you call 000 as soon as possible. The sooner you contact emergency services, the sooner a paramedic will be on the scene, which dramatically increases the casualties’ chance of survival.

It is important to calmly provide accurate and detailed information about the casualty and the incident to Paramedics and emergency workers when they arrive. The actions taken and treatment you have provided, the time of the incident, any medications involved, and the behaviour of the casualty, are all important things emergency workers will want to know. Provide details in a way that recognises that it is time critical.

It is important that all first aid incidents, inside or outside of work, be recorded in writing.

Each workplace should have appropriate documentation for the reporting of illness or injury.

These documents need to be completed in full and should not be altered. Therefore, correction fluid or pencil should not be used on these documents.

Outside of the workplace, if an incident occurs, first aiders should take accurate, brief, and clear notes and keep them on hand in case an investigation takes place.

Notes should include:

1. The time of the incident
2. The date of the incident
3. The location of the incident
4. What the first aider found upon arrival
5. What actions the first aider carried out
6. Any changes in the casualty’s condition
7. Any witness details
8. Handover to medical professional’s details
9. Did the casualty recover and relieve the first aider of their duty of care?

All documentation should be signed and dated by the first aider and stored securely to maintain confidentiality. Keep your notes clear and easy to understand and ensure you write down exactly how things are presented to you.

Note: Incident reports should be thoroughly completed and submitted in a timely manner

Recurrent Episodes

It is not uncommon for recurrent episodes of anaphylaxis to occur following the first presentation of anaphylaxis. Studies show that 10-20% of these episodes may occur in the childcare setting. Under such circumstances, there should be an anaphylaxis action plan which can be followed.

For an event that has occurred, the Event Record Form (see image) can be used by the casualty, school staff and medical personnel.

Evaluate Incident Response

Once the documentation and reporting process has been completed it is vital that the following steps take place:

• The First aider’s and organisation’s responses to the incident and adherence to the casualty’s ASCIA Action Plan for Anaphylaxis are reviewed and assessed
• The effectiveness of risk minimisation strategies is reviewed
• The casualty’s individual anaphylaxis management plan is reviewed
• Reviews can generate improvements for processes and procedures. If so:
  o Implement improvements as soon as possible
  o Communicate improvements and updates to all stakeholders

Post-Incident Debriefing

Once you have provided first aid to a casualty and handed over responsibility to the paramedics, it is recommended that you undergo a debriefing.

• Talk through your actions with your manager, other first aiders, psychologists, doctors, family, or friends.
• Take time to calm down and reflect on your actions, don’t go straight back to work if the incident occurred in a workplace setting.

Note that anyone around the incident such as the casualty, the first aiders, and onlookers which may include children can be affected by stress from the trauma that had occurred. Psychological stress can badly affect people of all ages either during or after the incident. For example, talk with children about their emotions and responses to the incident. Provide support as required.

Post Incident Reactions

The following reactions are normal and help people come to terms with a critical incident.

Physical reactions

Disturbed sleep, nausea, nightmares, restlessness, headaches, excessive alertness, undue crying, and being easily startled.

Poor concentration, visual images of the event, intrusive thoughts, disorientation or confusion, poor attention, and memory.

Emotional reactions

Fear, numbness and detachment, avoidance, depression, guilt, over-sensitivity, anxiety and panic, withdrawal, and tearfulness.

Seek Professional Help

Traumatic stress can cause very strong reactions in some people. You should seek professional help if you:

• Are unable to handle the intense feelings or physical sensations
• Don’t have normal feelings but continue to feel numb and empty
• Feel that your emotions are not returning to normal after three or four weeks
• Continue to have physical symptoms
• Continue to have disturbed sleep or nightmares
• Find that relationships with family and friends are suffering
• Are becoming accident-prone and using more alcohol or drugs.
• Support can be accessed via counselling, educational material that explains the situation including stress-management techniques, professional help, wellness programmes