Appendix 11
SEVERE ALLERGIC REACTIONS
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY. IT IS IMPORTANT
TO BE PREPARED BEFORE YOUR CAMP OR MISSION BEGINS.
Children attending your camp or mission may suffer from severe allergies. In the case of a child
with a severe nut allergy you may need to take preventative action, such as making your camp or
missions a nut free zone, or you may need to help administer medication that counteracts the
effects of an allergic reaction should it occur.
In the case of a mild allergic reaction you may need to help a child take an inhaler or an
antihistamine tablet. In the case of a severe allergic reaction you may need to use an epi-pen, an
injection that helps to counteract the effects of a severe allergic reaction. It may help save a child’s
life should they take a severe allergic reaction. The following forms should be used if a child at
your camp or mission suffers from a severe known allergy.
In the case of Scripture Union Missions, copies of this form should be kept in all your registration
files. Please be vigilant about asking parents, who register their children as having allergies,
whether or not their child carries an epi-pen with them. In the majority of cases a parent will let you
know anyway.
If a child attending your camp or mission has a nut allergy please follow the instructions below:
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Please ask the parent or guardian to complete the following form.
Please ensure that a member of your team WHO WILL BE WITH THE CHILD AT ALL
TIMES is trained in the use of an epi-pen.* If you know in advance of your camp or mission
that a child who will be attending has a severe allergy please ensure that your designated First
Aider or the leader of the child’s section has been trained in the use of an epi-pen. If a child
arrives at your mission or camp with an epi-pen without any prior warning please ask the
parent to stay with the child until a member of your team has sought advice on how to use an
epi-pen.
*Below are some possible ways of training a member of your team in the use of an epi-pen.
PLEASE NOTE THAT ALTHOUGH USING AN EPI-PEN IS RELATIVELY STRAIGHT
FORWARD WE CANNOT GUARANTEE THAT IT WILL ALWAYS BE RISK FREE.
PLEASE ENSURE THAT THE TEAM MEMBER WHO IS BEING TRAINED IS
PREPARED TO TAKE THIS RISK.
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A member of your team may visit their local health centre before the camp or mission (or the
centre closest to their mission) and ask a medical professional, such as a nurse, to show them
how to use an epi-pen. We cannot guarantee that they will be happy to do this.
A member of your team may visit a local pharmacy and ask the pharmacist to show them how
to use the epi-pen. We cannot guarantee that they will be happy to do this.
As a last resort you may ask the child’s parent/guardian to show how to use an epi-pen.
If you need any help getting training or have any concerns feel free to contact the SU office.
Ver Feb 2014
Please ask any of the above people to sign Form 2, if they are willing.
PLEASE NOTE THAT IF FORM 1 IS NOT FILLED OUT, OR IF YOU HAVE NO TEAM
MEMBER WILLING TO UNDERGO TRAINING, THE CHILD CANNOT ATTEND YOUR
ACTIVITY UNLESS ACCOMPANIED BY THEIR PARENT OR GUARDIAN.
FORM 1
The child’s parent or guardian should complete this form.
Name of Child:
Details of Allergy
Name of Parent or Guardian
Home Address:
Emergency Contact 1
Name
Relationship
Landline Num:
Mobile:
Emergency Contact 2
Name
Relationship
Landline Num:
Mobile:
Dear (SUNI Team Leader)
I give permission for the appointed person for First Aid or a suitably trained team member,
to administer the following medication to my child should the need occur. I have
completed this form as accurately as possible.
Signed (Parent/Guardian) __________________________________________________
In the case of a mild allergic reaction:
Warning signs and symptoms (please state warning signs and symptoms):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Ver Feb 2014
Action:
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Never leave the child without an adult
Summon a trained team member
Phone 999 asking for a paramedic ambulance stating that we have a young child
suffering from anaphylactic shock
Bring the medication to the scene
Give (please state medication to be given to child):
_____________________________________________________________________
_____________________________________________________________________
Contact the parent at the above number
Lie the child in the recovery position, reassuring him/her constantly
Loosen any tight clothing around the neck
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If any of the following occur:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
FOLLOW THE INSTRUCTIONS FOR A SEVERE REACTION
In the case of a severe allergic reaction:
Warning signs and symptoms (please state warning signs and symptoms):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Action:
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Never leave the child without an adult
Summon a trained team member
Administer the Epi-pen and note the time. __________
Phone 999 asking for a paramedic ambulance stating that we have a young child
suffering from anaphylactic shock.
Phone GP
Name _____________________ Tel ____________________________
stating the child’s name ( _________) and details and that he/she is suffering form
anaphylactic shock.
Contact the parent at the above number
Lie the child in the recovery position, reassuring him/her constantly
Loosen any tight clothing around the neck
If there is no improvement in the child’s condition within 10 minutes administer a
second Epi-pen.
If Epi-pen is used, hand used pen to paramedics when they arrive.
Ver Feb 2014
FORM 2
Proof of training.
I have shown the people listed below how to administer an epi-pen
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
Signed (Medical Practitioner/Pharmacist/Parent) _______________________
Name (Print) ____________________________________________________
Ver Feb 2014