I.ÌýÌý ÌýIntroduction.
A.ÌýÌý ÌýWith no prior notice, life-threatening asthma attacks or systemic allergic reactions (anaphylaxis) that leave only minutes to save a life could necessitate an emergency response by school personnel. ÌýTo maximize the chances that such an emergency response will result in full recovery, trained designated school personnel will administer epinephrine ("Epi-Pens, Auvi-Q ") and nebulized albuterol treatments according to procedures that have been approved by the District’s Executive Director of Student Services or designee. Ìý
B.ÌýÌý ÌýEpinephrine auto injectors, nebulizers, and nebulized albuterol for emergency use will be distributed to every school within the District. ÌýEach District school will have epinephrine auto injectors, nebulizers, and nebulized albuterol readily accessible in the health room or other designated area. These medications will be secured in a manner approved by the Executive Director of Student Services to prevent unauthorized access.
C.ÌýÌý ÌýStanding orders for District emergency supplies of epinephrine auto injectors and nebulized albuterol will be signed by at least one (1 prescribing health care practitioner from the District’s Medical Advisory Committee.
D.ÌýÌý ÌýSelected school personnel will be trained by qualified personnel to administer emergency nebulized albuterol and epinephrine auto injectors under the supervision of the registered school nurse.
E.ÌýÌý ÌýEpinephrine auto injectors and nebulized albuterol may be administered to students for life-saving purposes.Ìý
F.ÌýÌý ÌýIf parents, guardians, and emancipated students are aware of any medical condition that causes an epinephrine auto injector or nebulized albuterol to be dangerous to a student, they should indicate on online registration the exact nature of the danger and provide the District with the name and address of the medical provider who has made this determination.
G.ÌýÌý ÌýHealthcare staff will follow protocols outlined in the student’s Asthma Anaphylaxis Action Plan.
II.ÌýÌý ÌýAvailability, Storage, Use and Destruction. ÌýEach District school will have emergency supplies of epinephrine auto injectors, nebulizers, and nebulized albuterol readily accessible. ÌýThe following will govern the availability, storage, and use of the same:Ìý
A.ÌýÌý ÌýAll elementary schools will have both adult and pediatric emergency epinephrine auto injectors available.Ìý
B.ÌýÌý ÌýEmergency supplies of epinephrine auto injectors and nebulized albuterol will be kept current and will be disposed of on the reaching of the recommended shelf life or when there is a color change in the epinephrine due to reaching or exceeding the expiration date or improper temperature control.
C.ÌýÌý ÌýUnless the subject's medical condition and/or circumstances dictate otherwise, the following standing procedures for emergency response to life-threatening asthma attacks or anaphylaxis will be followed.
1.ÌýÌý ÌýCall 911.
2.ÌýÌý ÌýSummon the school nurse if available. ÌýIf not, summon designated trained, non-medical staff to implement emergency protocol.
3.ÌýÌý ÌýCheck airway patency, breathing, respiratory rate, and pulse.
4.ÌýÌý ÌýAdminister medications epinephrine auto injector and nebulized albuterol per standing order.
a.ÌýÌý ÌýAdminister an adult epinephrine auto injector IM for a child over (60) sixty pounds and epinephrine auto injector IM Junior for a child under (60) sixty pounds. ÌýThe container for each dose and the container holding all dosages shall be marked "FOR EMERGENCY USE ONLY" in bold print.
b.ÌýÌý ÌýAdminister a nebulized albuterol, .05 percent, 0.5cc plus 2.5cc of saline administered by oral mask or mouthpiece. ÌýAfter the original administration, if not better, this dosage may be repeated two (2) more times. ÌýThe container for individual dosages and containers holding non-individual dosages shall be marked "FOR EMERGENCY USE ONLY" in bold print.Ìý
5.ÌýÌý ÌýDetermine cause as quickly as possible.
6.ÌýÌý ÌýMonitor vital signs (pulse, respiration, etc.).
7.ÌýÌý ÌýContact parents immediately and Prescribing Health Care Practitioner as soon as possible.
8.ÌýÌý ÌýAny individual treated for symptoms with epinephrine at school will be transferred to a medical facility.
D.ÌýÌý ÌýEmergency supplies of epinephrine auto injectors, Ìýnebulized albuterol, and nebulizers will be under controlled access and maintained between fifty-nine (59) and eighty-five (85) degrees Fahrenheit as measured by a thermometer maintained in the same location in an air conditioned nurse's office or other air conditioned area designated by the school principal. ÌýAccess will be limited to those individuals trained to administer these medications.Ìý
E.ÌýÌý ÌýDistrict emergency epinephrine auto injectors and nebulizers will be administered to students or staff members for emergency use only. ÌýStudents who need nebulized albuterol on a regular schedule must bring their own prescription and equipment for application in accordance with District Rule 5600.2. ÌýEmergency epinephrine auto injectors, albuterol nebulized albuterol, and nebulizers may not be used under any circumstances other than emergency use.
F.ÌýÌý ÌýDistrict emergency epinephrine auto injectors, Ìýnebulized albuterol, and nebulizers will not be used on field trips or other activities away from the school. ÌýDistrict emergency medications are to be maintained at school during regular school hours so that the largest population of students may be served.Ìý
G.ÌýÌý ÌýThe school nurse will inspect the nebulizer monthly in their assigned area after each use to ensure that the equipment is in proper working order and is ready for the next usage. ÌýThe school nurse will also periodically inspect the nebulizer to ensure that it is in working order and supplies of nebulized albuterol and epinephrine auto injectors have not exceeded the recommended shelf life or when there is a color change in the epinephrine due to reaching or exceeding the expiration date or improper temperature control. ÌýThe school nurse will provide an inventory which includes lot number of medications and the recommended shelf life.
H.ÌýÌý ÌýAll nebulized albuterol and epinephrine auto injectors which have exceeded the recommended shelf life will be destroyed. ÌýThe school nurse and principal shall keep a list which records when and how the nebulized albuterol and epinephrine auto injectors were destroyed, and which District staff member oversaw the destruction.
III.ÌýÌý ÌýImplementation and Training. ÌýThree (3) designated staff members from each school in addition to the school nurse will be trained in CPR, and in the administration of emergency epinephrine auto injectors and nebulized albuterol in life-threatening situations. Implementation and training shall include:Ìý
A.ÌýÌý ÌýDesignated staff members from each school will be appointed by a team consisting of the building principal or designee, the head nurse, the nurse serving the building, and approved by the Executive Director of Student Services. ÌýNo staff member other than District employed school nurses, certified nursing assistants, or health paraprofessionals shall be compelled through their employment status to serve as a designated staff member.
B.ÌýÌý ÌýTraining of the designated staff members will be conducted and completed prior to the distribution of epinephrine auto injectors, nebulized albuterol, and nebulizers within the schools. ÌýDesignated and trained staff members must complete annual training in order to continue serving as a designated staff member.
C.ÌýÌý ÌýTraining for the administration of epinephrine auto injectors, nebulized albuterol, and use of nebulizers will be completed in compliance with manufacturer’s instructions.
D.ÌýÌý ÌýA certified CPR instructor will provide CPR training.
E.ÌýÌý ÌýDesignated staff members will successfully pass the competency assessment required by the Medication Aide Act no less than every three (3) years.
IV.ÌýÌý ÌýIn-Service Training. ÌýThe procedure for the delegation of the administration of epinephrine auto injectors and nebulizer treatments to trained special care providers should be followed in accordance with Health Services Guidelines. ÌýAt a minimum, the training shall consist of the following:
A.ÌýÌý ÌýA minimum of three (3) designated staff members in each school in addition to the school nurse trained in CPR should be in-serviced by the school nurse to:
1.ÌýÌý ÌýIdentify the signs and symptoms of a life-threatening asthma attack or systemic allergic reaction;
2.ÌýÌý ÌýFollow District procedures for emergency treatment including required 911 calls and the administration of epinephrine auto injectors and/or nebulizer treatments;
3.ÌýÌý ÌýComplete, as time permits, an Emergency Form for paramedics; Ìý
4.ÌýÌý ÌýReview District procedures with the designated staff members a minimum of two (2) times during the school year;Ìý
5.ÌýÌý ÌýAt a minimum, training will be provided semi-annually for designated staff members who have already been trained and staff members who are newly appointed to the emergency team; and
6.ÌýÌý ÌýIdentify and record all students whose parents or guardian have indicated that use of epinephrine auto injectors or nebulizer treatments increases danger or is ineffective, and to provide follow-up investigation with medical providers to determine the exact nature of the danger.Ìý
B.ÌýÌý ÌýAt the conclusion of the training, a document recording competency should be completed.
C.ÌýÌý ÌýThe Executive Director of Student Services will be responsible for overseeing what forms should be used to most effectively carry out the training required under this Rule.
V.ÌýÌý ÌýBaseline Training for Epinephrine Auto Injectors and Anaphylaxis. ÌýOrientation and instruction for the administration of epinephrine auto injectors for life-threatening asthma or systemic allergic reactions should include:Ìý
A.ÌýÌý ÌýBasic principles of the immune system and anaphylaxis;
B.ÌýÌý ÌýAdministration of epinephrine auto injectors using an epinephrine auto injector trainer;
C.ÌýÌý ÌýAssessing vital signs;
D.ÌýÌý ÌýEstablishing and maintaining vital body functions and summoning emergency personnel; and Ìý
E.ÌýÌý ÌýProper documentation.
VI.ÌýÌý ÌýBaseline Training for Nebulizers and Nebulized Albuterol. ÌýOrientation and instruction for administering nebulizers and nebulized albuterol should include:
A.ÌýÌý ÌýBasic principles of the anatomy and physiology of the respiratory system;Ìý
B.ÌýÌý ÌýProcedures for using nebulizers and nebulized albuterol including set-up, administration, and storage;Ìý
C.ÌýÌý ÌýSigns and symptoms of respiratory distress and reporting; and
D.ÌýÌý ÌýProper documentation.
VII.ÌýÌý ÌýPost-Use Record. ÌýAs soon as reasonably practicable following the emergency administration of an epinephrine auto injectors or Ìýnebulized albuterol, the designated staff members shall provide the Executive Director of Student Services with a written report that should include, at a minimum, the following:
A.ÌýÌý ÌýThe circumstances giving rise to the administration of the epinephrine auto injector or Ìýnebulized albuterol;Ìý
B.ÌýÌý ÌýThe results; andÌý
C.ÌýÌý ÌýThe recommended changes in the procedures or forms used by the District in its administration of epinephrine auto injectors and/or Ìýnebulized albuterol, if any.Ìý
VIII.ÌýÌý ÌýAnnual Review. ÌýOn an annual basis, the Executive Director of Student Services or designee will conduct a review of the effectiveness of this Rule, procedures utilized, forms adopted pursuant to this Rule, the post-use records of the District's designated staff members, and any other materials relevant to improving the District's use of epinephrine auto injectors, nebulized albuterol, and other emergency medications. ÌýThe review will include, if practicable, the following:
A.ÌýÌý ÌýA tabulation of the number of uses of epinephrine auto injectors and nebulized albuterol per school year;Ìý
B.ÌýÌý ÌýThe results of the use;
C.ÌýÌý ÌýThe recommendations from the District's Medical Advisory Committee or other qualified organization as it pertains to epinephrine auto injectors and nebulized albuterol; andÌý
D.ÌýÌý ÌýUpon the completion of the review, the Executive Director of Student Services shall provide the Board with the Director's findings and recommendations.
IX.ÌýÌý ÌýDefinitions.Ìý
A.ÌýÌý ÌýCPR. ÌýCPR shall mean cardiopulmonary resuscitation.Ìý
B.ÌýÌý ÌýQualified Personnel. ÌýQualified personnel shall mean individuals who have met an educational and/or legal requirement necessary to provide instruction on the use of the epinephrine auto injectors and nebulized albuterol.
Related Polices and/or Rules: Ìý5600, 5600.2
Rule Approved: ÌýMay 17, 1999ÌýÌý Ìý
Revised: ÌýDecember 4, 2000; December 15, 2003; June 15, 2009; May 5, 2014; July 8, 2019; May 19, 2025
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Omaha, NE
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