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Safe Access to Vital Epinephrine (SAVE Act)
SC H3725 | 2013-2014 | 120th General Assembly
South Carolina House Bill 3725
Status: Completed Legislative Action
Passed on June 14 2013 - 100% progress
Action: 2013-06-14 - Act No. 37
Website: http://www.scstatehouse.gov/sess120_2013-2014/bills/3725.htm
Summary
Allow School District And Private School Governing Authorities To Obtain And Store
Supplies Of Epinephrine Auto-injectors For Schools To Use In Certain Circumstances; To
Authorize Certain People To Prescribe And Dispense Prescriptions For Epinephrine Autoinjectors For Administration Or Self-administration By Students And Other People; To
Authorize Certain School Personnel To Provide Epinephrine Auto-injectors To Students
For Self-administration Of The Injector; To Authorize Certain Personnel To Administer
Epinephrine Auto-injectors To Students And Other People; To Require Certain Governing
Authorities Of School Districts And Private Schools, In Consultation With The
Department Of Health And Environmental Control And The State Department Of
Education, To Develop And Implement A Plan For Management Of Students With Lifethreatening Allergies, Including For Administration And Provision Of Epinephrine Autoinjectors To Students And Other People; To Provide That Schools Are Not Subject To The
South Carolina Pharmacy Act And Relevant Regulations Governing The Practice Of
Pharmacy For Purposes Of Certain Actions Taken Pursuant To The Section; And To
Provide For Immunity From Liability With Regard To Use Of Epinephrine Auto-injectors
By Schools
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Anaphylaxis is a sudden, severe allergic reaction, resulting from exposure to an allergen such as
an insect bite/sting, food, latex or medication but may also be idiopathic or exercise-induced.
Symptoms progress rapidly, within seconds or minutes, affecting multiple organ systems. This is
a medical emergency requiring immediate attention and can cause death if not reversed in a
timely manner.
Recognizing Anaphylaxis:
Organ System
Lungs
Common Sign/Symptom
Sudden difficulty breathing, shortness of breath, wheezing,
shallow cough
Mouth/Throat
Tingling, itching, swelling of lips or tongue, tightening in
throat, difficulty swallowing
Eyes/Nose
Watering, swelling of eyes, runny/itchy nose
Skin
Itching, redness/flushing or hives, swelling of face or
extremities, blue/gray discoloration with progression
Heart
Rapid/thready pulse, low blood pressure, dizziness or
fainting
Gastrointestinal (GI)
Nausea/vomiting, abdominal cramps, diarrhea
Mental/Other
Agitation, uneasiness/apprehension, unconsciousness
Treatment for Anaphylaxis - Epinephrine (also known as “adrenaline”) is the medication
used to treat and reverse the symptoms of anaphylaxis. Epinephrine is administered
intramuscularly by an auto-injector promptly at the first sign of anaphylaxis. It is safer to
administer epinephrine than to delay treatment. Epinephrine is fast-acting. Effects last only 515 minutes; therefore once administered, EMS must be called immediately. A second dose of
epinephrine may be required if symptoms continue or worsen while awaiting arrival of the
emergency response team.
Storage - Epinephrine auto-injectors should be stored in a safe, unlocked and accessible location
away from direct sunlight and in temperatures between 59 and 86 degrees F. Expiration dates of
the auto-injectors should be checked periodically; the medication should be discarded and
replaced if it is past the prescription expiration date. The solution in the auto-injector should be
clear; if it is discolored or contains solid particles, replace the unit.
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Recommended Action Protocol for Anderson School District Four
1. The school nurse and at least 5 first responders (certified in CPR/AED/First Aid) in every
school will be trained annually to administer epinephrine in the case of anaphylaxis.
2. Dr. Katherine Liddle of Allergy Partners of Anderson will prescribe epinephrine auto-injectors
for ASD4 and approve the Standing Orders for 2 doses of adult (0.3mg) and 2 doses of pediatric
(0.15 mg for students weighing less than 66 pounds) auto-injectors of epinephrine at each school
location unless the principal documents 100 % of the students in the school weigh over 66
pounds in which case 2 doses of 0.3 mg auto-injectors will suffice. (Reviewed annually)
3. Epinephrine auto-injectors will be stored on or near the side panel of the school’s centrally
located AED case as determined by the principal, maintenance supervisor and school nurse.
They should be unlocked, easily accessible to trained staff but not to students.
4. Epinephrine auto-injectors will be signed out by the registered nurse at each school and
checked monthly by the school nurse for clarity of the solution and expiration date.
5. Replacement requests for auto-injectors due to usage, expiration date, or discoloration of
solution will be made through the District Nursing Coordinator at 403-2208.
6. First responders will be trained in anaphylaxis and epinephrine administration via Get Trained:
A Program for School Nurses to Train School Staff in Epinephrine Administration (NASN 2014)
with an opportunity for a question and answer session with the registered professional nurse.
Demonstration of procedure, post-testing and knowledge-based skills check off will be facilitated
by the full time registered nurse at each school for named first responders.
7. Procedures are in place to document, track and report anaphylaxis requiring the administration
of stocked epinephrine.
8. It is the responsibility of parents/guardians of students known to have a severe allergy with a
history of anaphylaxis, or whose medical providers consider them at high risk for anaphylaxis, to
provide the school with specific medical orders and a supply of their own prescribed epinephrine
at the start of the school year or upon transfer to the school district. The school nurse will
provide an Individualized Healthcare Plan IHP) and Emergency Care Plan (ECP) for the student
per district policy.
9. If a student is believed to be experiencing anaphylaxis, the school nurse or other
trained employees (first responders) will administer the epinephrine via auto-injector. The
building administrator must designate who will perform the task in the absence of the school
nurse.
10. Stock epinephrine is intended for use on school premises and should not be carried offsite.
11. Annual practice drills related to anaphylaxis response are recommended.
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12. Initial distribution of auto-injectors will be completed and documented by the District
Nursing Coordinator/Nursing Services.
Response Protocol for Anderson School District Four
1. Based on symptoms, determine that an anaphylactic reaction is occurring. Act quickly.
Anaphylaxis is a life-threatening reaction. It is safer to administer epinephrine than to delay
treatment.
2. If you are alone and are able to provide epinephrine, call out or yell for help as you
immediately get the epinephrine. Do not seek help until after administering the epinephrine.
3. If you are alone and have not been trained in epinephrine administration, call or yell for help,
getting trained personnel and epinephrine on site quickly.
4. Call the school nurse/front office school personnel and advise of the situation. Dial 911 and
follow the dispatcher’s instructions until the school nurse or first responder arrives.
5. Select appropriate epinephrine auto-injector to administer, based on weight.
Dosage:
EpiPen Junior (0.15 mg) if less than 66 pounds
EpiPen (0.3 mg) if 66 pounds or greater
Frequency:
If symptoms persist or return, a second dose should be administered 5 to
15 minutes after first dose. This is a Biphasic reaction.
6. Inject epinephrine via auto-injector: Pull off safety release cap. Swing and jab firmly into
upper, outer thigh (through clothing if necessary). Hold in place for 10 seconds to deliver
medication and then remove. Note the time.
7. Call or have a bystander call 911 immediately or activate EMS. Notify 911 operator that
anaphylaxis is suspected and epinephrine was given. Stay with the individual until EMS arrives.
8. Keep the individual either lying down or seated. If individual loses consciousness, check
breathing and pulse. If no breathing or pulse, begin CPR, ask someone to get the AED, continue
CPR until the AED analyzes (following AED instructions), the individual regains a pulse and is
breathing, or until EMS arrives and takes over.
9. Provide EMS with epinephrine auto-injector labeled with name, date, and time
administered to transport to the ER with the student.
10. Notify parent/guardian of epinephrine administration and EMS transport.
11. Complete required documentation: Report of Anaphylaxis and Follow Up form.
12. Complete EpiPen Auto-Injector Re-order Form.
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STANDING ORDER – ASD4
Auto-Injector Epinephrine Administration For Anaphylaxis
In the event of anaphylaxis in an individual in the school setting, epinephrine will be
administered by the school nurse or trained unlicensed school personnel (first responders).
This Standing Order is for use of auto-injector epinephrine in such situations.
In the case of students with a history of anaphylaxis or other severe allergic reactions,
epinephrine should be administered according to specific individualized prescriptive orders
documented in their Individualized Healthcare Plans (IHPs) and Emergency Care Plans (ECPs).
If no such orders exist, the Standing Orders given in this document should be used.
DEFINITION: Anaphylaxis is a severe allergic reaction which can be life threatening and can
occur within minutes after a triggering event or up to hours later.
CAUSES: Extreme sensitivity to one or more of the following:
Medication Exercise-induced
Food Latex
Idiopathic (unknown)
Insect stings Asthma triggers
Other
PHYSICAL FINDINGS - Common symptoms associated with anaphylaxis:
1. Difficulty breathing, wheezing
2. Hives, generalized flushing, itching, or redness of the skin
3. Swelling of the throat, lips, tongue, throat; tightness/change of voice; difficulty swallowing
4. Tingling sensation, itching, or metallic taste in mouth
5. Feeling of apprehension, agitation
STANDING ORDER:
1. Based on symptoms, determine that an anaphylaxis is occurring. Act quickly.
Anaphylaxis is a life-threatening reaction. It is safer to give epinephrine than to delay
treatment.
2. If you are alone and are able to provide epinephrine, call out or yell for help as you
immediately get the epinephrine. Do not seek help until after administering the epinephrine.
3. If you are alone and have not been trained in epinephrine administration, call or yell for help,
getting trained personnel on site quickly.
4. Call the school nurse/front office school personnel and advise of the situation. Dial 911 and
follow the dispatcher’s instructions until the school nurse or first responder arrives.
5. Select appropriate epinephrine auto-injector to administer, based on weight. EpiPen Junior
(0.15 mg) if less than 66 pounds, EpiPen (0.3mg) if 66 pounds or greater.
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6. Inject epinephrine via auto-injector: Pull off safety release cap. Swing and jab firmly into
upper, outer thigh (through clothing if necessary). Hold in place for 10 seconds to deliver
medication and then remove. Note the time.
7. Call or have a bystander call 911 immediately or activate EMS. Notify 911 operator that
anaphylaxis is suspected and epinephrine was given. Stay with the individual, providing support
until EMS arrives.
8. Keep the individual either lying down or seated. If individual loses consciousness, check
breathing and pulse. If no breathing or pulse, begin CPR ask someone to get the AED, continue
CPR until the AED analyzes (following AED instructions), the individual regains a pulse and is
breathing, or until EMS arrives and takes over.
9. Provide EMS with epinephrine auto-injector labeled with name, date and time
administered to transport to the ER with the student.
10. Notify parent/guardian of epinephrine administration and EMS transport.
11. Complete required documentation: Report of Anaphylaxis and Follow Up form.
12. Complete EpiPen Auto-Injector Re-order Form.
_________________________________________________ Date________________________
Authorizing Licensed Healthcare Provider
Printed Name: _________________________________________________________________
Effective School Year____________________________________________________________
Note: Must be renewed annually and with any change in prescriber
cc: Superintendent; District Nursing Coordinator
Revised and used with permission of the Virginia Department of Health December 2013
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