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Anaphylaxis: How Sabrina's Law Applies to Outdoor Education & Field Trips
Health Issue Category
Anaphylaxis
Date of Issue
Revision Date
February, 2006
Related Policies, Administrative Procedures and Forms:
 

How Sabrina’s Law applies to Outdoor Education and Field Trips
By Cindy Paskey


Outdoor Education and Field TripsSabrina’s Law, An Act to Protect Anaphylactic Pupils, came into effect on January 1, 2006 with the purpose of protecting students at risk of anaphylaxis.

Anaphylaxis is a severe, potentially life-threatening allergic reaction to any stimulus. Reactions are characterized by sudden onset, and involve one or more body systems with multiple symptoms. Allergens are the stimulus, or substances, that cause allergic reactions.

The most common anaphylaxis triggers are foods and insect stings, followed by medications, latex and on rare occasions even exercise. In Canada, the most common food allergens are peanut, tree nuts (e.g. almond, cashew, pistachio, walnut), milk, egg, fish, shellfish, and to a lesser extent, sesame seeds, mustard seeds, soy and wheat, as well as the food additive, sulphites.

Sabrina’s Law outlines specific requirements for Ontario school boards and school principals. All boards are required to have an anaphylaxis policy that sets minimum standards for managing anaphylaxis in school settings. For boards that already have comprehensive policies, a review and minor adjustments will be all that are necessary to ensure compliance.

The bill requires principals to implement strategies that are consistent with board policy. These include a process to identify at-risk students and to develop individual plans for them, strategies to reduce risk, a school-wide communication plan and regular training for all employees and others who are in regular contact with at-risk students. The individual student plans should identify student’s allergen(s) and the emergency protocol to be followed in the event of a reaction.

Parents and students must also be accountable by ensuring schools are provided with up-to-date medical and emergency information and epinephrine auto-injectors. Students themselves must learn how to self protect in age-appropriate ways. For example, young children are taught to ask a trusted adult about food ingredients before eating food that is not from home. Before entering high school, these students must be able to read food ingredients for themselves. As always, individual levels of ability and maturity must be accounted for when setting these expectations.

School boards will determine how training will be provided, and by whom. Such training should provide an understanding of anaphylaxis, familiarity with the signs and symptoms of a life threatening reaction, knowledge of emergency response, and familiarity with students at risk of severe allergic reactions. Ideally, everyone should practise how to give an epinephrine auto-injector with training devices.

There are two different auto-injectors on the market: EpiPen® and Twinject®. Both types contain life saving medication, epinephrine, also known as adrenaline. It needs to be given early in the course of a reaction and is administered by needle injected into the muscle on the outer side of the thigh. In normally healthy individuals, epinephrine will not cause harm if given unnecessarily. During a reaction, individuals may not be able to give themselves epinephrine. Assistance from others is crucial.  

Since life threatening allergic reactions are unpredictable and can progress quickly, early symptoms should never be ignored. They may appear alone or in any combination, regardless of the trigger. Symptoms may include:

Skin:  hives, swelling, itching, warmth, redness, rash
Respiratory (breathing):  wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, runny/itchy nose, watery eyes, sneezing, trouble swallowing  
Gastrointestinal:  nausea, pain/cramps, vomiting, diarrhea
Cardiovascular:  pale/blue colour, weak pulse, passing out, dizzy/lightheaded/shock
Other:  anxiety, feeling of “impending doom”, headache, uterine cramps

Medical research has lead experts to recommend the emergency protocol below in response to severe, potentially life threatening allergic reactions. The acronym ACT serves as a reminder of the steps to follow:

Administer epinephrine auto-injector – EpiPen® or Twinject®
Call 911
Transfer care to emergency responders and ensure transport to hospital
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Administer a 2nd auto-injector if life threatening symptoms (breathing, consciousness) do not subside.
People living with life threatening allergies must always be prepared for the unexpected. How can you help to ensure that practical risk reduction measures are in place during field trips and outdoor education? While your School Board Safety Guidelines should always be followed, listed below are tips to implement that will help keep allergic students safe. Insect sting allergies, in particular, are managed differently in outdoor compared to classroom settings.
 
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Think ahead! Know the students at risk and their allergens. Know the type of auto-injector the student carries, either EpiPen® or Twinject®.
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Be observant and alert to potential risks.
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Canvass school property and activity areas for stinging insect nests. Arrange for their professional removal.
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Canvass vehicles for stinging insects before boarding.
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Ensure proper training of people who will supervise – know the emergency protocol; practice with training device.
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Ensure quick access to an auto-injector.
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Know the location and ensure easy access to second back-up auto-injector.
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Establish a buddy system.
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Ensure an emergency communication system is in place – walkie talkies or cell phone.
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Ensure that parents/guardians have provided required medical information that is up-to-date, with  appropriate consents for emergency response and emergency contact information.
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Keep student’s medical information with you while on field trips.
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Know the location of the nearest medical facility.
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Know your location so you are able to correctly inform 911 responders.
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Enforce a ‘no eating’ rule on buses. On long trips, enforce restrictions on allergen-containing foods.
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Check, in advance, about food ingredients from food service providers.
Allergic students must always be mindful of their allergies. They should:
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Carry at least one epinephrine auto-injector, as age appropriate. Generally age 6 or 7. Otherwise, a supervising adult should carry the medication.
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Wear medical identification, e.g. MedicAlert.
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Inform others if he/she suspects a reaction is happening.
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Ensure that asthma is well controlled.
Self protection requires allergic students to practice avoidance strategies and avoid risk taking behaviour. For food, this includes:
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Hand washing before and after eating.
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Avoid putting food directly on surfaces. Use a napkin or place mat.
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Check ingredients before eating. If in doubt, do without.
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Do not trade or share food, utensils or food containers.
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Avoid eating if auto-injector is not readily available.
Students at risk of insect sting reactions should be encouraged to:
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Wear closed shoes.
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Wear light colours.
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Wear long hair tied back.
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Keep away from areas where stinging insects gather, such as gardens, hedges, fruit trees, garbage cans.
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Keep food covered.
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Drink from covered cups or straws.
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Stay with a buddy while outdoors.
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Avoid wearing scented products.
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Avoid loose flowing garments.

As always, different challenges to student safety arise because of differences between elementary and high school settings.The higher degree of elementary level supervision helps to protect young children who are more apt to engage in hand to mouth behaviour and are generally more trusting of statements made by others which might lead to sharing food.

The physical setting in middle and high school is larger, there is a greater number of students and student class locations change because of rotary. Vending machines and cafeterias are more prevalent. Students are more likely to be involved in extra-curricular activities outside of normal school hours and do not want to be ‘singled out’ because of their allergy.

Sabrina’s Law makes it clear that anaphylaxis management at school is a shared responsibility. The law provides a foundation for collaboration among school boards, principals, parents, at-risk students and the broader school community. Student safety is enhanced while roles and expectations are identified.

By ensuring that you know the students at risk of an allergic reaction, that auto-injectors are readily available in an unlocked location and by practicing emergency drills you should be able to provide prompt and effective emergency response in the case of a reaction. The end result is saving lives!
Ophea’s Asthma Education Initiative provides a wide variety of asthma/allergy and anaphylaxis education materials.

Other web-based and print resources are available from:

www.anaphylaxis.ca - books, videos, posters, auto-injector training devices
www.aaia.ca - books, videos, posters, auto-injector training devices

Cindy Paskey volunteers for Anaphylaxis Canada, AAIA (Asthma Allergy Information Association, and a Niagara-area nonprofit anaphylaxis group, NASK (Niagara Anaphylaxis Support and Knowledge). She advocates for anaphylaxis awareness as an educator, writer and consultant.


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