Pupil Transportation

Emergency Epinephrine and EAIs in the School Setting: FAQ

Education Law Article 19 §921-a permits schools in accordance with Public Health Law § 3000c to purchase, acquire, possess and use epinephrine auto-injector devices. Such schools may permit an unlicensed person to administer epinephrine via auto-injector to any student or staff member on site having anaphylactic symptoms whether or not there is a previous history of severe allergic reaction, if they have successfully completed a training course in the use of epinephrine auto-injector devices approved by the New York State Department of Health (NYSDOH).

Education Law Article 19 §902b states that unlicensed personnel may be trained by a registered professional nurse(RN), nurse practitioner(NP), physician assistant (PA), or a physician to administer emergency epinephrine via auto-injector to a student with a patient specific order and written parent/guardian consent for such medication.

Option Chart for Administration of Epinephrine in School Settings: LINK

  1. Who are Unlicensed Personnel? District personnel, including contractors and volunteers, that are not licensed as an RN, NP, PA, or physician.
  2. Can Bus Drivers administer EAI to a student with an order? Unlicensed persons, including bus drivers, may be trained by a school nurse to administer Epinephrine Auto-Injectors (EAIs) to student with orders for the EAI. The bus driver will need a copy of the emergency care plan and know the location of the EAI. This should be noted in the student’s Electronic Communications Policy (ECP).
  3. What is a provider order? To protect the health and safety of all students, schools must have a written provider order and written parent/guardian consent in order for a student to be administered a medication, or to permit a student to self-administer their medication at school. A provider order is required for both prescription and non-prescription medications. A provider order is valid for 12 months, unless the provider changes the order, writes the order for a shorter period of time, or discontinues the order. If a school has concerns or questions regarding a provider’s order, the school’s medical director or school nurse should call the provider to resolve concerns and/or clarify the order.

A provider order must include the following information:

  • Date order is written
  • Student name and date of birth
  • Medication name
  • Medication dosage
  • Medication route
  • Time and frequency the medication is to be administered
  • The conditions under which the medication is to be administered
  • Attestation that the student has demonstrated they can self-administer the medication effectively, and the medication is needed in a rapid manner requiring the student to carry it with them at all times- if applicable
  • The provider’s name, title, and signature – A signature may be handwritten or electronic. Electronic signatures must be the authorized prescriber’s electronic signature. Office staff personnel’s electronic signatures stating they are signing electronically for the authorized prescriber (also known as the provider) are not acceptable. Schools uncertain about the validity of a signature should contact the provider for verification.
  • Provider’s telephone number and address
  • Diagnosis and ICD code if applicable (see Documentation in the Implementation section of the resource document)

Please Note: A pharmacy label is not an order and cannot be used in place of a written provider order. The pharmacy label should have the same information that is on the order unless there has been a recent dose change.

4. What training is required for unlicensed personnel to administer EAI on site to any student or staff member who appears to be suffering anaphylaxis, regardless of history? Unlicensed personnel must be trained annually using a course approved by the NYSDOH under PHL 3000c, and in accordance with the requirements of Commissioner’s Regulation 136.7(f)(1). This training is available on the New York Statewide School Heath Services Center (NYSCSH) website.

5. Who trains unlicensed personnel to administer EAI to a student with a patient specific order? Education Law §921 requires that such unlicensed personnel are trained by an RN, NP, PA, or physician to administer an EAI to a student with a patient specific order. This training must be completed annually. Using the NYSDOH approved training is recommended but not required and is available on the NYSCSH website.

6. Who trains unlicensed personnel to administer EAI to a student or staff under PHL 3000c (Administration of EAI for those that do not have a patient specific order)?

  • If school staff receive training from a nationally approved training course, the trainer certified to teach the content from that national course would complete the school staff training. NYSED strongly encourages schools to utilize or supplement the national training with the NYSDOH approved training program Managing Allergies & Anaphylaxis at School; Training for School Personnel, found on the NYSCSH website.
  • If the training used is the NYSDOH approved training program Managing Allergies & Anaphylaxis at School; Training for School Personnel, found on the NYSCSH website, the trainer must be a licensed professional (ie. Registered Nurse or Physician).

7. Can unlicensed personnel who are trained in accordance with PHL 3000c administer non-patient specific EAI to students or staff outside the instructional facility (school building)? No, Education Law 921-a limits unlicensed personnel trained in accordance with PHL 3000c to administering EAI in a school building.

8. What requirements are needed to implement an EAI program for volunteer unlicensed staff? NYSDOH approved training, post-test, checklist, and district policy. Policies and protocols for storing and track stock EAI should be developed and implemented. Parent/guardians must be notified of any administration, and the student or staff member should be transported to the emergency room as secondary reactions occur frequently. Administration to a student must be documented in the student’s cumulative health record. It is strongly recommended when an EAI is administered to notify the district medical director and ordering prescriber.  

There are two instances in schools in which an unlicensed staff member may administer epinephrine via auto-injectors:

  • Students with a Provider Order

Education Law Article 19 section 921 authorizes schools to allow, but are not obligated to, an RN, NP, PA, or physician to train unlicensed school personnel to administer epinephrine via auto- injector where an appropriate licensed health professional is not available, to students with both a written provider order and parent/guardian consent- during the school day on school property and at any school function. If the provider order states the student is to receive more than one dose of epinephrine within a specified time frame, the unlicensed person may be trained to administer a second dose of epinephrine auto-injector in accordance with the student’s provider order while awaiting emergency medical services transportation.

  • Students and Staff Member, with or without Provider Order

Section 921-a of Article 19 of Education Law permits both public and non-public schools to choose to provide and maintain epinephrine auto-injectors, and to permit trained school employees to administer an epinephrine auto-injector to any student or staff member on site with symptoms of anaphylaxis regardless of whether or not there is a previous history of severe allergic reaction. Schools choosing to do so must meet the requirements of Public Health Law 3000c. This law requires unlicensed employees or contractors of the school who will administer an epinephrine auto-injector must have taken a Department of Health approved course. This must be completed prior to administering an epinephrine auto-injector pursuant to this law.

The practice protocols, policies, and procedures in the school regarding unlicensed personnel administering epinephrine via auto injectors should include the following:

  • the curriculum used to train authorized individuals; the curriculum must be approved by the Commissioner of Health;
  • designation of who will conduct the training of the authorized individuals.
  • designation of staff to be trained to use, acquire and dispose of the auto-injector.

This will include maintaining a record of those trained with training dates, training refresher dates, and curriculum followed;

  • a schedule for periodic refreshment of the course material at least annually;
  • a protocol for use of the auto-injector for both pediatric and adult cases;
  • a plan of action when an auto-injector is used, including calling for emergency transport per district policy, reporting to the medical director and notification of parent/guardian (or for staff- his/her designated emergency contact), and;
  • a procedure for obtaining, storing, and accounting for the drug.

Please Note: For students with provider orders every effort should be made to ensure the unlicensed personnel trained by an RN, NP, PA or physician is available to administer the student’s own epinephrine auto-injector to the student. However, in an emergency, an unlicensed person trained under a collaborative agreement as noted above, may administer the stock epinephrine auto-injector to the student.

Pursuant to Education Law §922 re: opioid antagonists, and Education Law § 921-a re: epinephrine auto-injectors- unlicensed personnel may not administer these medications off site. However, unlicensed personnel trained by school nurse or other appropriate licensed personnel to administer epinephrine auto-injector to a student with a patient specific order may administer the medication on school property and at any school function.

Resources:

School Healthy NY Frequently Ask Questions: https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/EAI%20FAQs%209-21-17.pdf

New York State Education Department Guidelines for Medication Management in Schools: http://www.p12.nysed.gov/sss/documents/MedicationManagement-DEC2017.pdf

Option Chart for Administration of Epinephrine in School Settings: https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/PDFApprovedRevisedEpiOptionsChartAdminSchool0217.pdf

 

 

 

 

 

     

     

Last Updated: January 10, 2018