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Landmark findings on anaphylaxis: Are your students protected?

18/01/17
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Anaphylaxis research: new understanding

With the recent release of two high-profile publications, Australia’s understanding of anaphylaxis - acute allergic reactions - is becoming more sophisticated.

The first publication is of new clinical guidelines by the American National Institute of Allergy and Infectious Diseases, based on landmark research finding that early exposure to peanut-containing foods during infancy can dramatically lower a person's chances of becoming allergic.

This has particular relevance for Australia, which has one of the highest rates of food allergies in the world, with hospital admissions doubling over the last decade.

The second involves a University of Melbourne study published in the Internal Medicine Journal which found that bees and other insects pose a bigger public health threat to Australians than other venomous animals such as snakes, spiders, or even jellyfish.

The analysis of 13 years’ data from 2000 to 2013 on bites and stings incidents in Australia concluded bees and wasps often had the most dangerous effect, being responsible for 33% of all hospitalisations and causing 27 deaths (tied with snakes). Dr Ronelle Welton, the report’s author, said that national guidelines for treatment of stings and bites remains inadequate and requires updating. The West Australian reported that WA (9), followed by SA (8), had the highest rate of deaths from anaphylactic shock caused by bites and stings from insects such as bees.

The impact of the research

Recent academic research, both local and international, is clearly demonstrating that our understanding of allergies and anaphylactic incidents is continuing to evolve. However, it also shows that there is significant uncertainty on the complexity of anaphylaxis risks and a general lack of understanding on how to best prevent/manage such incidents.

Although research continues to reveal new complexities associated with allergies, there is authoritative guidance in Australia, provided by state/territory governments and national bodies (most prominently the Australian Society of Clinical Immunology and Allergy (ASCIA)) on how to manage allergies and prevent allergic reactions. Because this guidance exists, a lack of understanding cannot justify poor anaphylaxis management.

This is clearly demonstrated by recent legal action against an import company following the death of a 10-year-old boy, who had an allergic reaction after consuming a mislabelled ‘coconut drink’ containing an undeclared milk ingredient.  The boy's death has prompted claims for a mandatory reporting system for hospitals to report all cases of children suffering anaphylaxis to the Department of Health and Human Services’ food safety unit so the cause can be identified.

As a primary care organisation for Australian children, schools should be aware of recent developments and use the start of 2017 as a time to review their anaphylactic management policies and procedures.

The Victorian Anaphylaxis Guidelines: a possible solution

With Melbourne being named food allergy capital of the world last year, the Victorian Department of Education and Training (DET)’s advice regarding anaphylaxis management would likely form best practice in terms of understanding the ideal school approach for prevention and anaphylactic incident management. And as we reported last year, the DET has released comprehensive Anaphylaxis Guidelines (the Guidelines) to help Victorian schools manage severe allergies.

As a result of the Children’s Services and Education Legislation (Anaphylaxis Amendment Act) 2008 (Vic), all schools across Victoria must by law have an anaphylaxis management policy when an enrolled student has been diagnosed as susceptible to anaphylaxis. The steps outlined in Ministerial Order 706 – Anaphylaxis Management in School (the Order) form the basis of a minimum standard for a school’s registration under Part IV of the Education and Training Reform Act 2006 (Vic).

The Guidelines were developed to assist Victorian schools to meet their duty of care obligations, by complying with the following requirements in the Order:

  • an Anaphylaxis Management Policy (the Policy);
  • Individual Management Plans for each student at risk of anaphylaxis;
  • prevention strategies to minimise the risks;
  • integration with general first aid and emergency response procedures;
  • purchase procedures for adrenaline autoinjectors for general use;
  • a Communication Plan;
  • regular staff training in anaphylaxis management; and
  • completion of an annual Risk Management Checklist.

The Guidelines provide a framework for the development of the Policy and other procedures, going beyond the Order to include a number of recommendations:

Staff Training

It is a requirement for the Policy to state that current anaphylaxis training is undertaken by school staff who conduct classes attended by students at risk of anaphylaxis and any further school staff identified by the Principal. But the DET recommends that all staff undertake training.

To reduce the burden of undertaking face-to-face training, an online training course has been developed in consultation with ASCIA. However, completion of this e-training is not sufficient to meet the requirements of the Order - a person’s understanding and competency in administration of an adrenaline autoinjector must be checked by an appropriately qualified supervisor.

Communication Plan

The Communication Plan must include arrangements for relevant staff to be briefed twice annually by a staff member with current anaphylaxis management training. However, it is best practice to brief all staff on a regular basis.

Further, the Guidelines recommend additional procedures are developed to brief all volunteers, casual relief staff and new staff during induction on the school’s Policy and their roles in responding to an anaphylactic incident.

School Anaphylaxis Supervisors

With additional requirements introduced with respect to staff briefings and training, the Guidelines recommend that Principals identify two staff members per school/campus to become School Anaphylaxis Supervisors (Supervisors).

Supervisors may be nurses, first-aiders, health and wellbeing staff or senior teachers. Their main role will be to undertake competency checks on all staff that have successfully completed the online training course. This will require them to complete an accredited short course on how to conduct a competency check.

The role of a Supervisor will also include:

  • liaising with the Principal in developing Individual Anaphylaxis Management Plans;
  • sending periodic reminders/information regarding training requirements;
  • assisting with record keeping;
  • leading staff and induction briefings;
  • providing regular advice and guidance about allergy and anaphylaxis management as required; and
  • assisting the school as a whole in understanding roles and responsibilities regarding anaphylaxis management, through completion of a School Anaphylaxis Supervisor Checklist.

Conclusion: what steps should schools take?

The Act, Order and the Guidelines are only directly relevant and mandatory for Victorian schools. As mandated by the Order, Victorian schools should now be completing and reviewing their annual Risk Management Checklist for anaphylaxis.

However, as the Guidelines reiterate, all schools have a legal duty to take reasonable steps to protect students from reasonably foreseeable risks. With the wealth of information available, newly published research and the regularity of anaphylactic events, it is clear that anaphylaxis is a reasonably foreseeable risk. Therefore, all schools, not just Victorian ones, have a duty to take reasonable steps with respect to students at risk of anaphylaxis.

Further, under the Disability Standards for Education 2005 (Cth), all schools have an obligation to make reasonable adjustments to accommodate a student with a disability. Anaphylaxis falls squarely within the definition of disability, not only for the purposes of the Victorian Equal Opportunity Act 2010 (Vic), but also under the national Disability Discrimination Act 1992 (Cth). Hence the obligation to make reasonable adjustments, such to avoid unlawfully discriminating against students with anaphylaxis, exists for all schools across Australia.

Any school uncertain about their duty of care obligations, or taking a risk management approach to anaphylaxis management, should treat the Guidelines as being indicative of current best practice.

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About the Author

Kieran Seed

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