RCW 28A.210.370 Students with Asthma
I. Introduction
The 2005 Legislature passed a school health related law that places additional
requirements on Washington State public schools. The statute took effect prior to the start
of the 2005–06 school year and requires changes in district policies, procedures, and
practice. The Washington State Department of Health (DOH) and the American Lung
Association of Washington provided preliminary information on these new statutes (see
Attachment A); and the Office of Superintendent of Public Instruction (OSPI)
disseminated the information. The purpose here is to further address the requirements of
the new statute.
RCW 28A.210.370 Students with Asthma (previously Substitute Senate Bill 5841—
Asthma) directs the Office of Superintendent of Public Instruction (OSPI) and the
Secretary of the Department of Health (DOH) to develop a uniform staff training policy for
school districts. The uniform policy is to address in-service training for school staff
regarding students with asthma.
The statute further requires school districts to adopt policies regarding asthma rescue
procedures. School district policy must allow for any student to possess and selfadminister medication to treat the student’s asthma or anaphylaxis if specified conditions
are met.
This document addresses the following:
Section II: RCW 28A.210.370 Students with Asthma
Uniform Staff Training Policy: Students with Asthma.
School District Responsibilities.
Parent Responsibilities.
Definitions.
Applicable Laws.
Liability.
For workshop distribution only, Not an Official OSPI or DOH Document
Page 2
May, 2006
II. Students with Asthma (RCW 28A.210.370)
Uniform Staff Training Policy: Students with Asthma
RCW 28A.210.370 (1) directs OSPI and DOH to develop a uniform staff training policy for
all school districts. The uniform policy is to address in-service training for school staff on
symptoms, treatment, and monitoring of students with asthma. The staff training policy
must encompass the additional observations that may be needed in different situations
that may arise during the school day and during school-sponsored events. Additionally,
the uniform policy is required to incorporate the standards and skills that must be in place
for in-service training of school staff.
The Uniform Staff Training Policy: Students with Asthma (Attachment C) refers to the
Asthma Management in Educational Settings™ (AMES) manual as a framework for
training school staff. This document was developed in 2001 by the Public Health and
Advocacy Committee of the Washington Asthma Initiative (WAI). The AMES Guidelines
were updated in 2004 by the WAI Community Based Activities Committee. Additional
updates to materials were provided in 2005. The purpose of AMES is to provide all
members of the school staff with guidelines for the care of students who have asthma.
The manual provides:
 An overview of asthma and asthma management to aid in educating school
personnel about the disease.
 Information regarding optimal care for the student with asthma in the school
setting.
 Tools to standardize communication between the student and family, health care
providers, and school personnel.
 Additional resources for school personnel, students and parents.
(AMES, 2004).
School District Responsibilities
Many students with asthma or anaphylaxis currently attending school have an emergency
care plan for an asthma or anaphylaxis episode or an Individual Health Plan (IHP) in
place. The new statute adds school district responsibilities regarding:
 Adopting policies addressing asthma rescue procedures.
 Training staff about asthma.
 Allowing for students to self-administer medication for asthma and anaphylaxis if
conditions of the statute are met.
Each component is discussed further below.
For workshop distribution only, Not an Official OSPI or DOH Document
Page 3
May, 2006
A. RCW 28A.210.370 (2) directs all school districts to adopt policies regarding
asthma rescue procedures for each school within the district. The Washington
State School Directors Association (WSSDA) offers model policies and
procedures for local school districts (Policy No. 3419—Self Administration of
Asthma and Anaphylaxis Medications, and Self-Administration of Asthma and
Anaphylaxis Medications—Procedure 3419). Contact WSSDA regarding other
health related sample policies. See the Resources section of the Uniform Staff
Training Policy: Students with Asthma for contact information.
It is recognized there are circumstances such as school staff not being informed of
a student’s asthma or allergy. We suggest school districts may want to consider
modifying the WSSDA sample Asthma Rescue Procedures to reflect “providing
care as designed in the student’s emergency care plan [if the student has one].”
Additionally, we recommend that school district administrators consult with the
district attorney when developing district policy.
B. All districts must have a policy granting authorization for a student to selfadminister medication to treat asthma or anaphylaxis providing that the following
criteria have been met:

A health care practitioner (HCP) prescribed the medication for use by the
student during school hours and instructed the student on responsible use of
the medication.

The student has demonstrated to the HCP or designee, and a professional
registered nurse at the school the skill level necessary to self-administer the
medication and any device that is necessary to administer the medication as
prescribed.

The HCP has formulated a written treatment plan for the student to manage
asthma or anaphylaxis episodes including medication use during school hours.

The student’s parent or guardian has completed and submitted to the school
any written documentation required by the school, including the written
treatment plan formulated by the HCP and other documents related to liability.

The school district authorization granted to the student must allow the identified
student to use the medication while attending school, while at a school
sponsored activity, and in transit to or from the school or the sponsored the
activity.
For workshop distribution only, Not an Official OSPI or DOH Document
Page 4
May, 2006

The authorization for a student to self-administer medication to treat asthma or
anaphylaxis must be effective only for the same school year it was written and
must be renewed each subsequent school year.

School districts must require that any backup medication provided by the parent
or guardian must be kept at the student’s school in a location to which the
student has immediate access in the event of an asthma or anaphylaxis
emergency.
Previous guidance jointly developed by the Department of Health and OSPI
states, “Medications should be stored in locked cabinets or lacked drawers with
access limited to those who need access to receive medications for use at
school… (OSPI Bulletin NO. 34—01). Clarification on how to reconcile
“immediate access” and the previous guidance for securing medications is
being reviewed by the State Department of Health State Board of Pharmacy,
the Nursing Care Quality Assurance Commission, and OSPI. Additional
assistance will be provided following the review.
C. The student’s treatment plan and any other documents required by the school
must be kept on file at the school in a location that is easily accessible in the event
of an asthma or anaphylaxis emergency.
D. Included in being prepared for asthma rescue procedures school districts should
provide for the in-service training for school staff following the Uniform Staff
Training Policy: Students with Asthma developed jointly by OSPI and DOH. The
uniform policy directs school districts to refer to the most current version of the
AMES guidelines which may be accessed at the American Lung Association of
Washington Web site: http://wai.alaw.org/ames.
E. It is recommended that school districts annually inform parents of all incoming
students about the requirements of RCW 28A.210.370 Students with Asthma.
Notification of the statute may be accomplished in a manner similar to that used to
notify parents of immunizations and other requirements for school entry.
F. Additionally, it is recommended that school staff be assigned to review student
health records of currently enrolled students to identify children with asthma.
Annually, upon identifying these students, it is recommended that a letter be sent
to the parents addressing the need for a medication or treatment order and an
asthma or anaphylaxis management plan.
G. In order for the family, school nurse, and HCP to create an asthma management
plan for school, a partnership must be established between the child, the parent of
For workshop distribution only, Not an Official OSPI or DOH Document
Page 5
May, 2006
the child with asthma or an anaphylaxis condition, the chief administrator of the
school, the school nurse responsible for the care of the child, and the child’s HCP
to accomplish this requirement.
Parent Responsibilities
Parents are key partners in providing for the safety and health of their children during the
school day. In order to fully implement the statute, parents should:





Provide written asthma or anaphylaxis management plan, including treatment
orders and/or medication orders prepared by the student’s HCP acting within the
scope of his or her license.
Complete and submit to the school any additional written documentation required
by the school, such as a school emergency care plan or IHP and/or authorization
for the student to self-administer medication for treatment of asthma or
anaphylaxis.
Coordinate and consult with the district designated licensed physician, osteopathic
physician, A.R.N.P, or R.N.
Provide a current signed consent to exchange information with the child’s HCP.
Provide medication and equipment per HCP written orders, including any back up
medications.
Definitions
A. Anaphylaxis: “Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic
reaction that can involve various areas of the body (such as the skin, respiratory
tract, gastrointestinal tract, and cardiovascular system).” As defined by the Food
Allergy & Anaphylaxis Network.
B. Asthma: Asthma is a chronic lung condition with ongoing tightening
(bronchospasm) and inflammation of the airways, or “bronchial tubes.” Asthma
causes episodes of breathing problems such as coughing, wheezing, chest
tightness, or shortness of breath. The inflammation of asthma causes the lining of
the airways to swell and produce more mucus. When this happens, the airways
narrow and obstruct the flow of air out of the lungs. Many different factors, referred
to as asthma triggers, can worsen bronchospasm and inflammation.” (AMES,
2004)
C. Treatment Plan: A treatment plan for asthma (asthma management plan) or
anaphylaxis is a written, easy to understand description of how to manage an
asthma exacerbation, or an anaphylaxis episode and describes routine
medications and delivery methods. The treatment plan will most often include a
written treatment or medication order which is defined as "the authority that a
For workshop distribution only, Not an Official OSPI or DOH Document
Page 6
May, 2006
registered nurse (R.N.) obtains under a licensed physician and surgeon, dentist,
osteopathic physician and surgeon, naturopathic physician, podiatric physician and
surgeon, physician assistant, osteopathic physician assistant, or advanced
registered nurse practitioner acting within the scope of his or her license." (RCW
18.79.260 [2]). The "authority that a R.N. obtains" refers to the licensed nurse
having the authority to perform nursing care for compensation. This includes
executing a medical regimen ordered by a listed HCP. Medication or treatment
orders are specific to the health condition. The AMES Manual recommends that a
written asthma management plan should include:
• Medications needed at school.
• Licensed health care provide name & phone number.
• Usual triggers and asthma symptoms.
• Peak flow measurements (if used for monitoring).
• An emergency plan for an acute asthma attack.
• Parent signature.
D. Health Care Practitioner (HCP) is as defined in RCW 18.79.260(2) “a licensed
physicians and surgeon, dentist osteopathic physician and surgeon, naturopathic
physician, podiatric physician and surgeon, physician assistant, osteopathic
physician assistant, or advanced registered nurse practitioner acting within the
scope of his or her license” RCW 28A.210.260 and 270 regarding oral medication
administration and RCW 28A.210.330 addressing students with diabetes refer to a
licensed health professional (LHP) prescribing within the scope of his or her
prescriptive authority for administration of the medication. Previous technical
assistance refers to a Licensed Health Care Provider (LHCP). The terms HCP,
LHP, and LHCP are interchangeable when seeking written medical treatment or
medication plans for students from a practitioner acting within the scope of their
practice.
E. Professional Registered Nurse (R.N.): Defined in RCW 18.79.040 (1) “registered
nurse practice” means the performance of acts requiring substantial specialized
knowledge, judgment, and skill based on the principles of the biological,
physiological, behavioral, and sociological sciences in either:
(a) The observation, assessment, diagnosis, care or counsel, and health
teaching of individuals with illnesses, injuries, or disabilities, or in the maintenance
of health or prevention of illness of others;
(b) The performance of such additional acts requiring education and training
and that are recognized by the medical and nursing professions as proper and
recognized by the commission to be performed by registered nurses licensed
For workshop distribution only, Not an Official OSPI or DOH Document
Page 7
May, 2006
under this chapter and that are authorized by the commission through its rules;
(c) The administration, supervision, delegation, and evaluation of nursing
practice….”
As defined in WAC 246-840-700, “the purpose of defining standards of nursing
conduct or practice is to identify responsibilities of the professional registered
nurse in health care settings and as provided in the Nursing Practice Act, chapter
18.79 RCW. Each individual, upon entering the practice of nursing, assumes a
measure of responsibility and public trust and the corresponding obligation to
adhere to the professional and ethical standards of nursing practice.”
Applicable Laws
Districts need to consider such existing laws as Section 504 of the Rehabilitation Act of
1973 and the Individuals with Disabilities Education Act (IDEA). It is recommended that
district administrators consult district legal counsel, special education directors, and
school nurses in preparing district procedures to implement this statute.
Liability
RCW 28A.210.370 (8) Students with Asthma states the following. “Nothing in this section
creates a cause of action or in any way increases or diminishes the liability of any person
under any other law.”
This information is being reviewed for accuracy by the Washington State Department of
Health Asthma Program, Washington State Nursing Care Quality Assurance Commission
and the Office of the Attorney General. If you have any questions, please contact Gayle
Thronson, Program Supervisor, Health Services, at (360) 725-6040 or TTY (360) 6643631.
For workshop distribution only, Not an Official OSPI or DOH Document