The purchase, storage and use of adrenaline auto-injector devices in schools

Schools in the UK can now purchase adrenaline auto-injector (AAI) devices from their local pharmacy for emergency use on children at risk of experiencing anaphylaxis (a severe allergic reaction). See below our handy guide for head teachers, managers and staff, to clarify the rules and guidance around this. We also recommend printing and displaying our AAI information poster.

What are Adrenaline Auto-Injectors?

Adrenaline auto-injectors (AAIs) are devices to administer adrenaline to a child experiencing a severe allergic reaction. EpiPen®, Jext® and Emerade ® are some of the most popular brands of AAI.

What is the law on using Adrenaline Auto-Injectors in schools?

A new law called the Human Medicines Regulations 2017 came into force on 1 October 2017. The new law means a school nurse or first aider can have swift access to the school’s emergency stock of spare AAI devices, to give life-saving help to a child with a severe allergy.

Are schools obliged to store spare AAI devices?

No - buying and storing AAIs is an option for each school to consider. Doing so could bring greater peace of mind to parents of children with severe allergies.

Rules and guidance for storing AAI devices*

AAI devices should be kept in a safe and suitably central location where staff have access at all times, out of the reach and sight of children (e.g. in an office or staff room). They must not be locked away in a cupboard or room where access is restricted. Schools should ensure that AAIs are accessible, and not located more than 5 minutes away from where they may be needed.

In larger schools, it may be prudent to locate an emergency anaphylaxis kit near the central dining area and another near the playground. Spare AAI devices should be clearly labelled and kept separate from any pupil’s own prescribed AAI.

Rules and guidance on the use of AAI devices*

If someone is showing the symptoms of a severe allergic reaction (anaphylaxis), an ambulance MUST be called immediately - even if they have already used an AAI device. The school’s AAI can only be administered to a pupil at risk of anaphylaxis, where both medical authorisation and written parental consent for use of the spare AAI has been provided. In the event of a possible severe allergic reaction in a pupil who does not meet these criteria, emergency services (999) should be contacted, who will advise whether administration of the spare emergency AAI is appropriate.

Any AAI(s) held by a school are a spare/back-up device and not a replacement for a pupil’s own AAI(s). The school’s spare AAI can be administered to a pupil whose own prescribed AAI cannot be administered correctly without delay.

AAIs can be used through clothes and should be injected into the upper outer thigh, in line with manufacturer’s instructions. The use of adrenaline as an injection into the muscle is safe and can be life-saving. The adrenaline treats both the symptoms of the allergic reaction, stops the reaction and the further release of chemicals causing anaphylaxis. Severe allergic reactions may require more than one dose of adrenaline, and children can initially improve but then deteriorate later.

St John Ambulance’s Anaphylaxis First Aid training is a great way of ensuring staff are informed and ready to act in the case of an anaphylactic reaction.

Good practice: what should be in an anaphylaxis kit*?

Schools choosing to hold a spare AAI(s) should establish a policy or protocol for their use in line with ‘Supporting pupils at school with medical conditions: Statutory guidance for governing bodies of maintained schools and proprietors’

It is good practice for schools holding spare AAIs to store these as part of an emergency anaphylaxis kit which should include:

• • 1 or more AAI(s)
• • Instructions on how to use the adrenaline auto-injector
• • Instructions on storage of the AAI device(s)
• • Manufacturer’s information
• • A checklist of injectors, identified by their batch number and expiry date with monthly checks recorded
• • A note of the arrangements for replacing the injectors
• • A list of pupils to whom the AAI can be administered
• • An administration record.

Schools should strongly consider keeping the emergency anaphylaxis kit together with an emergency asthma inhaler kit (containing a salbutamol inhaler device and spacer), as asthma is a common symptom during food-induced anaphylaxis.

Useful Links

Department of Health: Guidance on the use of adrenaline auto-injectors in schools

Human Medicines Regulations 2017