A recent media report has revealed that a 14-year-old boy died after suffering from anaphylactic shock in reaction to the milk in his tandoori chicken lunch, provided by his London school while he was in detention. The inquest into his death heard that the teenager had a history of severe asthma and food allergies. The inquest also heard how school staff had no idea about the child’s allergies and failed to administer an EpiPen, which may have saved his life.
Although this tragic case occurred in the UK, the facts are easily transferable to Australian circumstances, with Australian children still dying from the condition.
In November 2016, Nasar Ahmed died after suffering an allergic reaction to the milk in a tandoori chicken lunch. Staff at the school gave Nasar the tandoori lunch while he was in detention. School staff failed to administer his EpiPen, which may have saved his life, according to the coroner. Nasar died four days later in Royal London Hospital.
Coroner Mary Hassell stated: “The staff saw Nasar's EpiPen and considered using it, but did not. If the EpiPen had been used promptly and Nasar had been administered adrenaline, there is a possibility but not a probability that this would have changed the outcome.”
Coroner Hassell heard how staff were told by paramedics not to administer the EpiPen until they arrived because there were no classic symptoms of anaphylaxis. However, Coroner Hassell’s Prevention of Future Death report stated that “the reality of giving a dose of adrenaline is that it is unlikely to do any significant harm, whereas the potential good of giving an EpiPen is lifesaving.”
The inquest also found that the child’s asthma was incorrectly listed on his action plan as ''mild to moderate'' when it should have been listed as “severe” and did not mention the use of an EpiPen or adrenaline to deal with the Nasar's allergies. Coroner Hassell heard that even one of Nasar's former teachers was not aware of Nasar's food allergies or that he even had an allergy action plan.
Coroner Hassell stated: “Staff at the school were encouraged to familiarise themselves with pupils’ care plans but often did not unless there was a school excursion.”
Under section 100 of the Children and Families Act 2014 (UK), UK schools must make arrangements for supporting students at the school with medical conditions. This means UK schools must accommodate for students with conditions such as anaphylaxis by making sure the appropriate requirements and measures are in place to manage the condition. In the UK, this typically requires schools to have appropriate care plans in place, accurate classification of the child’s allergies and up-to-date training and first aid kits.
Anaphylaxis Management in Australian Schools
An anaphylactic reaction is an allergic reaction to a food, sting, or medication which causes the body to become hypersensitive, requiring urgent medical attention.
As part of a school’s common law duty of care for their pupils, schools must provide a safe environment in which students can learn. This includes making sure that school staff are aware of all students’ allergies and of students who may suffer an anaphylactic reaction to an allergen (nuts, milk and/or eggs). This also extends to the school having measures in place to reduce the risk of a child suffering an allergic reaction; such as not allowing certain foods to cause an allergic reaction or being aware of a child’s allergy and making sure they are not exposed to that allergen.
Staff need to always be aware of care plans and students’ medical conditions, not just for anaphylaxis but for other medical conditions such as asthma. These care plans should state what allergies the student has, so staff are aware and know how to deal with the student’s allergic or anaphylactic reaction.
Each state and territory’s education department have their own policies or guidelines regarding the management of student health conditions, including anaphylaxis management requirements, providing useful guidance on how to deal with the condition. In Victoria for example, Ministerial Order No. 706 mandates that any Victorian school with enrolled student/s at risk of anaphylaxis is required by law to have a School Anaphylaxis Management Policy.
A Policy is Not Enough
However, as the UK incident reminds us, a policy can only go so far, proper training and communication must be paramount so that staff know how to manage and treat students who have an anaphylactic reaction. Under the Victorian Anaphylaxis Guidelines (the Guidelines), schools must have a communication plan in place to help provide information to all school staff, students and parents about anaphylaxis and the school's Anaphylaxis Management Policy. For more information about Ministerial Order No. 706 see our article Victorian anaphylaxis update: Is your school up to date?
Perhaps what is most disheartening about the UK example is the view that staff only familiarised themselves with students care plans when an excursion was planned. This meant that for the rest of the school year staff may not have known what to do if they suffered an anaphylactic reaction. This reflects a cultural issue at the school and one that must be rectified so that student safety is ensured. Perhaps all schools, Australia and overseas, should be required by law to follow similar legislative frameworks as prescribed in Victoria which has set a high threshold for compliance.
Staff notifications and regular first-aid training will enable staff to know how to respond to a child’s anaphylactic reaction. School first-aid officers need to make sure that all medications used for treatment (such as an EpiPen) have not expired.