Seven-year-old girl dies of peanut allergy at school...

Esme12, ASN, BSN, RN · Jan 13, 2012

How sad.......my prayer for this family.

conscientiousnurse · Jan 13, 2012

It's very sad, of course. But perhaps some good might come of it for the sake of other kids.

In the state of WA, the death of a child at a school field trip triggered the life-threatening condition law. To my knowledge, WA is the only state so far that has such a law. Though it makes a lot of parents and school nurses' lives harder, it is a law that helps keep safe students who have any life-threatening condition: not only allergies, but asthma, unstable seizures, etc. It requires parents to provide doctors' orders and medications for any student with a potentially life-threatening condition. The school is not allowed to keep letting students stay at school if they don't comply with the law.

Perhaps such a terrible tragedy will help this state also to enact legislation that would help other children. I can see where allowing extra epi-pens to be kept at school and used on children in need may be helpful. The only complication is, if there's no nurse at the school there could be some hesitation on the part of the office staff to use it on someone with unknown allergies and unclear symptoms.

Jolie, BSN · Jan 13, 2012

caregiver1977,

I respectfully disagree with your comments. Having this child in a private school or homeschool setting would not have prevented the circumstances that led to her tragic death. Kids share food. Children are exposed to allergens at the grocery store, movie theater, dance studio, park, etc. It is unfortunate that she accepted the treat from her friend. Teaching her never to do so might have been a step toward preventing this fatal reaction, but her parents probably tried unsuccessfully to do so. Since we can't put kids in bubbles, the only real protection comes from teaching self care and preparedness by taking precautions to avoid allergens, always carrying an Epi-pen and making sure one's companions know how and are willing to use it.

As far as the school is concerned, they took the appropriate steps, taking the child to the health room, calling 911. The only effective treatment for anaphylaxis available in a school is an Epi-pen. The article doesn't explain why her parents and medical provider had not arranged for her to have one at school. It does accurately describe the unthinkable position a school nurse might find her/himself in by having access to another child's Epi-pen but no legal authorization to use it.

Nebraska has circumvented this dilemma by passing Rule 59, a state mandate that all schools (public & private, no exceptions) stock an emergency kit with adult and child Epi-pens and nebulized albuterol to be used by trained school staff in the event of a presumed severe asthma attack or anaphylactic reaction in a student, staff member or visitor. A local physician signs the protocol and parents are allowed to opt out, but I have never known any to choose to do so. This was implemented following the deaths of 2 students in Nebraska, one from asthma and one from a severe allergy. One child was literally just miles from a university medical center at the time he died, and couldn't reach help fast enough.

I am also intrigued by the WA law mentioned above which places the onus on parents to provide the necessary tools for their child's medical conditions to be safely managed at school, or enforce removing the chid from school. As a school nurse who has been placed in the position of being responsible for childrens' safety without the necessary tools (diabetics with no testing supplies, insulin or snacks) I am all for mandating parental responsibility, even if it comes under the threat of expulsion.

My prayers for all involved here.

HazelLPN, LPN · Jan 14, 2012

I am confused by caregiver1977's post. What do you mean by a "regular" school? To me a regular school is a public school which most children attend.

caregiver1977 · Jan 14, 2012

I meant your regular, run-of-the-mill, public school. I want to clarify that I am not saying I wouldn't send my child to school if they had a food allergy, on if they had one that could lead to their death. My son (3rd grade) is in class with a student that has allergies to peanuts, but not fatal. There are other students around there that have allergies to chocolate. And there are mistakes sometimes.

When I say I wouldn't send them, I also mean the school that my children go to now. Maybe some of the schools you all work at would handle fatal food allergies better. I am sorry if I sound like I want to stuff children in a bubble (I don't). At my school they can barely keep up with children that have medical problems with their bowels/bladder and allow them to go to the bathroom as needed. The consequences of that is only embarrassment and inconvience (sp), not a call to 911 or death. In some of those cases it was the fault of the school and the parents. Heaven forbid if there is a substitute teacher (like I am) who is not familiar with the protocol. I can tell you from experience that substitutes in my district are barely told who they are supposed to substitute for and what is to be done for the day.

jt43 · Jan 14, 2012

There is a lot of info undisclosed in this story imo. I live in this school district. Most "clinic assistants" are not RNs. The clinic is not staffed by the clinic assistant at all school hours. There is no info on how long the child spent in the clinic prior to the 911 call. Also, I heard the mother say in an interview that the epipen was refused by the school earlier in the year when she tried to leave it. If that's true, it was probably because of the county rule that all prescription medication be in its original packaging with the prescription or pharm label attached. I had a child in this district who needed an inhaler and they refused when i first tried to drop it because we no longer had the box it came in with the pharm label attached. We had to have a new script written and pick up a new one before they would take it.

caregiver1977 · Jan 14, 2012

There is a lot of info undisclosed in this story imo. I live in this school district. Most "clinic assistants" are not RNs. The clinic is not staffed by the clinic assistant at all school hours. There is no info on how long the child spent in the clinic prior to the 911 call. Also, I heard the mother say in an interview that the epipen was refused by the school earlier in the year when she tried to leave it. If that's true, it was probably because of the county rule that all prescription medication be in its original packaging with the prescription or pharm label attached. I had a child in this district who needed an inhaler and they refused when i first tried to drop it because we no longer had the box it came in with the pharm label attached. We had to have a new script written and pick up a new one before they would take it.

I wonder if the mother in this story had that option. I can't imagine sending a child to school with fatal food allergies and not having their epi-pen there. But if the epi-pen is in the office, and the child is somewhere far from the office (cafeteria, gym, etc.,) is there going to be enough time to use it? I don't have that much experience with epi-pens or food allergies, so I am just asking.

jt43 · Jan 14, 2012

Considering that there are trailers outside the school in this district, I would have a huge problem leaving the epi-pen in the office. It's not a short walk down a hall. This girl was at recess, which would also not have been a short walk. The district also has a rule that all meds must be kept in the clinic. It takes too long to get there imo for asthma and allergys.I also meant to include in my last post that I heard the mother was called before 911. There obviously needs to be some additional training in the schools around here. I can't help but wonder if the school had employed RNs, would there have been a different outcome?

Jolie, BSN · Jan 14, 2012

I'd like to respond to some of the points raised here. I live and work in NE, and can't speak to local or state laws, but the concepts covered in this topic are primarily answered in federal law.

A public school can not discriminate against a child with a disability (a severe allergy qualifies as a disability), meaning they must accept the student and provide care needed during the school day, using supplies and equipment provided by parents. This means that it is the parents' responsibility to provide a properly labeled Epi-pen, accompanied by a valid prescription/order from a healthcare provider. A previous poster mentioned not being able to leave an inhaler without the prescription box and label. While this may seem petty to a parent who uses the inhaler on a regular basis for his/her own child, it is a significant safety issue for any provider (RN, LPN, health assistant, teacher, etc.) administering medication to a child in a setting with hundreds of children and dozens of medications. Can you imagine being responsible for administering meds to 100 adults on a hall without those meds being in properly labeled containers? That is essentially what a school office medication cabinet would look like if parents had their way. Also, by some district's policies, the prescription label serves as the physician order. Without the label, parents are expecting school staff to administer a med for which there is no order.

School nurses begin prompting parents in the spring (prior to summer vacation) to make appointments over the summer so that they can provide the necessary medications and instructions before the start of school in the fall. This allows for proper training of school staff, planning of staffing for the health office, logistical considerations such as where to store medications for easy retrieval, etc. Yet most parents will send Johnny and Suzie to school on day 1 with absolutely nothing in hand. While full time nursing staff is an admirable goal in school, it isn't going to happen any time soon. Even those schools with a nurse present at all times may potentially experience multiple emergencies at once, in different areas. Any responsible school district plans for these events by having well trained lay staff. Epi-pens are designed for use by non health professionals and young people. It makes much more sense to prepare these people to use them than to rely on a single nurse whose duties are often stretched over many buildings every week.

As for the size of a school and time needed to retreive the Epi-pen, it is a rare situation when there is not time to call the office for immediate delivery of an Epi-pen to a location within the school. Believe me, when one is requested, people sprint from the woodwork to run it as fast as possible to the needed location. If a child is known to be so sensitive as to go into full blown anaphylaxis within seconds of an exposure, s/he needs to be carrying the pen on her person, which is not difficult to arrange.

Flare, ASN, BSN · Jan 15, 2012

We have stock epipens and epi jrs in our schools with standing orders to admin to any student or staff if necessary. also have standing benadryl prders and stock benadryl (which i use probably 2-3 times a year on average). I think without the standing orders and the stock pens, the legal/ethical debate would arise in such a situation: If you witnessed a child in anaphylaxis, would you administer another child's epi pen? Fortunately, i don't ever have to make that call, but it's a tough call to make.

jt43 · Jan 15, 2012

As far as the size of the school not being an issue, you might be surprised. My oldest daughter's school has multiple trailers outside the main building where classes are taught. There are no phone/intercom lines in the trailers. Once when I went to pick her up early, it took a staff member with a walkie-talkie 15 mins to FIND her trailer and tell her to come to the office. Now I assume most teachers have cell phones that they could call the main switchboard with, but still, it's a problem.