Camp Anaphylaxis Management Policy
ALLERGY and ANAPHYLACTIC MANAGEMENT PLAN
The procedures that follow discuss the nature of anaphylaxis, and provide guidelines and expectations regarding managing anaphylaxis, including reducing the risk of anaphylactic attacks, epinephrine (EpiPen) use, emergency plans and related roles and responsibilities. It is important to note that Brick Works Academy cannot guarantee an environment free of allergens.
2.1 There is a need to ensure the safety of students who suffer from extreme allergies (anaphylaxis) and empower camp administrators to respond to their needs consistently but at the same time recognize individual differences from case to case. The following policy is in compliance with the Statutes of Ontario 2005, Chapter 7 (Sabrina’s Law).
2.2 Anaphylaxis is a severe allergic reaction that can lead to rapid death if untreated. Anaphylactic reactions occur when the body’s sensitized immune system overreacts in response to the presence of a particular allergen. Anaphylaxis affects multiple body systems including skin, upper and lower respiratory, gastro-intestinal and cardiovascular. Helping their children strike a balance between a necessary fear of exposure and an unhealthy fear of their expanding world is a difficult balancing act for parents – and one that requires the cooperation of all who are part of the child’s life, including the camp. Despite the best efforts of parents and camps, anaphylactic children live with a level of stress that most children do not experience. It’s a matter of life and death. A conservative estimate is that 40,000 Ontario students suffer from life-threatening allergies to certain foods (peanuts, tree nuts, seafood, egg, and milk, etc.), medications, insect stings, latex and/or to vigorous exercise. For them, exposure to even a minute amount of the substance to which they are allergic can trigger anaphylaxis. Peanuts are the most likely of all food allergens to trigger full-blown anaphylaxis and the most common cause of fatal food reactions. Peanuts have been the cause of a number of tragic incidents involving students at schools. Even trace amounts (1/1000 of a peanut) can cause a severe life-threatening reaction. Students have even developed reactions after coming into contact with residual peanut butter on tables wiped clean of visible material and with a basketball that had been contaminated with peanut butter. While ingestion of food allergens is the most commonly known cause of reactions, physical contact with a variety of allergens can also cause a similar anaphylactic response.
2.3 What does an anaphylactic reaction look like? An anaphylactic reaction can begin within seconds of exposure or after several hours. Any of the following symptoms may signal the onset of the reaction:
- Itchy eyes, itchy nose, flushed face, swollen lips, swollen tongue
- Airway: Trouble breathing or swallowing, hoarseness, choking, coughing, wheezing
- Stomach: Pain, vomiting, diarrhea
- Skin: Rash, itchiness, swelling, hives* – anywhere on the body
- General: Weakness, sense of doom, loss of consciousness
*Hives may be absent, especially in severe or near-fatal cases of anaphylaxis. Symptoms do not always occur in the same order, even in the same individuals. Time from onset of first symptoms to death can be as little as a few minutes if the reaction is not treated. Even when symptoms have subsided after initial treatment, they can return as much as 8 hours after exposure, regardless of the initial reaction severity.
3. Reducing the Risk
3.1 Avoidance of a specific allergen is the cornerstone of management in preventing anaphylaxis.
3.2 Eliminating allergens from areas within the camp where the anaphylactic student is likely to come into contact with the allergen may be the only way to reduce risk to an acceptable level. If less allergen is brought into the camp there should be less risk of anaphylactic reactions. While the camp cannot guarantee that an environment is completely safe, the Camp Anaphylaxis Management Policy will include necessary measures and procedures to reduce the risk of anaphylactic reactions and to assist staff in making the camp as “allergen aware” as possible.
3.3 The greatest risk of exposure is in new situations, or when normal daily routines are interrupted such as supply camp instructors in the classroom, shared birthday treats (shared treats are not permitted at camp, staff should not provide food items) or offsite trips. Young students are at the greatest risk of accidental exposure but studies have indicated that more deaths occur among teenagers due to their increased independence, peer pressure, and reluctance to carry medication.
Epinephrine is the only drug that should be administered to a student suffering an anaphylactic reaction. The epinephrine (adrenaline) is administered by an auto-injector called an EpiPen® and can be easily and safely administered by non-medical personnel with minimal training. If a reaction is severe, a single dose of the EpiPen® may not be sufficient to stop an anaphylactic reaction. If symptoms continue or worsen before medical help has arrived, a second EpiPen® must be administered. The student affected must be rushed to hospital to receive further medical attention, even if the symptoms improve with the administration of the EpiPen®.
5. Emergency Plan
5.1 Even when precautions are taken, an anaphylactic student may come into contact with an allergen while at camp. It is essential that the camp staff monitor the student and be prepared to administer medication if required.
5.2 Fatalities are more likely to occur away from home and are usually associated with delayed treatment or failure to treat with epinephrine. Those in positions of responsibility should never assume that the student will self-inject in the face of an emergency; a severe allergic reaction may be so incapacitating as to inhibit the ability to self-administer, regardless of age.
5.3 Anaphylactic students usually know when a reaction is taking place. Camp personnel should be encouraged to listen to the student. If it is suspected that the student has been exposed to his/her allergen and a suspected anaphylactic reaction is starting to take place, there should be no hesitation in administering the EpiPen®. Accidental administration of the EpiPen® is not a cause for concern, according to the Canadian Pediatric Society. There is little danger in reacting too quickly, and there may be grave danger in reacting too slowly.
5.4 In cases of an anaphylactic reaction:
5.4.1 Administer the EpiPen®, noting the time it is given.
5.4.2 The student should be maintained in a lying position.
5.4.3 Telephone 911. Inform the emergency operator that the student is having an anaphylactic reaction.
5.4.4 Contact the location manager.
5.4.5 Telephone the parents.
5.4.6 Have an adult accompany the student to the hospital.
5.4.7 Administer a second EpiPen® in 5-10 minutes only if the reaction continues or worsens. This procedure is to occur while waiting for an ambulance.
6. Roles and Responsibilities
6.1 Parent/Legal Guardian or Student (over the age of 18) • Provide a confirmation of diagnosis during registration, the allergy, its severity, and the medication to be taken by the student.
- Provide one EpiPen®, that must be located with the student at all times. Families may choose to provide two epipens, the second to be located with the manager. Renew EpiPens® before the expiry date.
- Be sure your child wears a Medic-Alert bracelet.
- Help your child develop coping skills to avoid the allergen and recognize and communicate the symptoms to a staff member.
6.2 Location Manager
- Each week obtain a list of anaphylactic students and their allergies.
- Identify students who are anaphylactic from registration forms.
- Provide each teacher (at the beginning of each week) with a list of students at risk.
- Ensure that parents/guardians provide a confirmation of diagnosis.
- Establish the anaphylactic student’s classroom as an allergy aware area.
- Ensure constant adult supervision during nutrition or lunch breaks.
- Ensure that peanut/nut avoidance signs are prominently displayed at all entrances, around allergen-aware areas and at all common areas.
- When supply teachers are covering classes with anaphylactic students, ensure that the supply staff is made aware of the emergency procedures for those students. Speak personally with the supply staff so that there are no questions about whether the staff has read and understood the information shared.
- Increase students’, parents’, and legal guardians’ awareness of anaphylaxis, its avoidance, and its treatment.
- Garbage containers should be removed from doorways to reduce the risk of insect induced anaphylaxis.
- Cafeteria food should not contain peanut/nut products. French fries, for example, can be made with oils that contain peanut products.
- Vending machines on site should not be used by students, we do not have control of their contents.
6.3 Classroom Staff (as age appropriate for the student)
- Ensure that the EpiPen® is taken on offsite trips.
- Continually provide a safe environment for the anaphylactic student, particularly during nutrition breaks and during offsite trips and special activities.
- Anaphylactic students should not be involved in garbage disposal, yard clean-ups, or other activities that could bring them into contact with food wrappers, containers, or debris.
- Conduct food safety discussions with all students at the beginning of the week while exercising sensitivity to impact on affected student’s need for privacy.
- Stress the importance of not sharing lunches, snacks, utensils or containers.
- Anaphylactic students should not eat any foods that do not have ingredient labels (i.e. bulk foods & home baking) or products that have “may contain peanuts/nuts” warnings on the labels. • Encourage/organize celebrations and activities that are not focused on food. Be aware of hidden allergens in play dough, bean bags, counting aids, pet foods and birdseed etc.