Student who was refusing epi-pen

ugh..what an awful scenario. You have to know that is probably the ONLY time that will ever happen again (unless it is her). This has been a miserable couple of years for us all. Hopefully you  have a Winter or March break coming up soon. Take that time to reflect when you are still not traumatized by this event.

This does sound like a nightmare. But I think you did everything you could under the circumstances! How were you supposed to anticipate this was going to be her emotional reaction?

I wonder if it would be worth your time/effort to establish a plan with her - who would be present if she needs another epi-pen at school, how that will look, and what happens if she refuses again.

I wonder, does your school/district special ED dept. offer restraint training? This was a life or death situation in which a temporary hold may have been appropriate - not only could she have died from the allergic reaction without getting this life-saving injection, but she could have seriously harmed herself and others with her fighting. Trained individuals could help to at least restrain her long enough to get the med into her. It is certainly a touchy subject, and you may not be able to do anything of this nature, but what would the ambulance have done, or ED Staff? And I know how hard this can be - I once had a patient who weighed less than 60lbs who was so violent it took 2 security officers and 2 nurses to hold him to receive his (very much needed) Haldol injection. 

Additionally, since she already has a needle phobia and anaphylaxis can heighten anxiety, it may be worth exploring a 504 for her, with a specific intervention for a hold if it becomes necessary to administer her epi-pen and she refuses. 

I had this happen only one time.  I had a middle school student with an undiagnosed allergy come in with all of the classic signs of anaphylaxis.  As soon as he realized that I was preparing to give him a shot in his leg, he began to panic and run from me.  Fortunately, an administrator came by and together we cornered him and I was able to put the epi in his leg.  After the dust settled, he said he felt silly for overreacting and recognized the gravity of the situation.  

What an awful experience!  When I started in school nursing I was so happy to tell students that nothing ever hurt when they came to the nurse's clinic (I didn't think about epi pens).  This last couple of years have broken my heart because we now give COVID vaccines in clinics and, of course, we are swabbing for COVID.  I now have students afraid to come to the clinic.  It breaks my heart.