Course in the

First Aid Management

Of

ANAPHYLAXIS

National Course Code 22300VIC

RTO: 20863

ACCREDITED FIRST AID COURSES Ph. 03 9850 6665

info@accreditedfirstaidcourses.com.au www.accreditedfirstaidcourses.com.au

Version: 3rd November 2016

FRANCES BREMNER

Has produced this book.

DISCLAIMER

The information contained in this workbook is according to the latest up to date Guidelines and Policies according to the Australian Resuscitation Council. If however there are changes not reflected in the workbook the latest Policies and Guidelines of the Australian Resuscitation Council will be used as the final reference point. Accredited First Aid Courses has prepared this workbook to be used as a training guide to assist a person in giving First Aid Treatment until Medical Aid can be obtained. It is not intended to include every emergency situation and it is not to be used instead of getting Medical Aid. This workbook does not substitute for any formal practical theory and practical training. It is to be used in conjunction with classroom training. The author accepts no responsibility for any injury and/or damage that may occur as a result of following any advice and procedures within this workbook.

Frances Bremner Director Accredited First Aid Courses Copyright @ F. Bremner. This work is copyright. No part may be reproduced in any way without the written permission of the author.

F. Bremner Pty Ltd (ABN 041 080 730 150) Trading as:

Accredited First Aid Courses Phones 03 9850 6665

Email: info@accreditedfirstaidcourses.com.au Web site: www.accreditedfirstaidcourses.com.au

Registered Training Organisation: No. 20863

ANAPHYLAXIS What is an Allergy? An allergy is an overreaction of the Immune System to a common substance. These allergic reactions are not normally Life Threatening. Common allergies include: Hay fever, Eczema Asthma, and Allergic Rhinitis. These allergies are normally treated with an Antihistamine. Asthma is treated with Bronchodilator. What is Food Intolerance? Food intolerances are different to food allergies, because they do not involve the immune system. The most common sort of food intolerance is lactose intolerance. Lactose intolerance means the person lacks an enzyme that is needed to digest milk. This affects the gastrointestinal tract and can lead to symptoms such as vomiting, diarrhea, and abdominal pain after drinking milk or eating products containing milk. What is Anaphylaxis? Anaphylaxis is an acute, severe allergic reaction, which can be triggered by a variety of substances and can be life threatening. Various body systems can be involved: skin, respiratory or cardiovascular systems, and the gastro-intestinal system. It must be treated as a medical emergency – requiring immediate treatment and urgent medical attention. These reactions usually appear rapidly – within seconds or minutes after exposure to an allergen. In rare cases, reactions have been delayed for as much as 12 hours. What is an Allergen? An Allergen is a substance that is usually ingested, injected, absorbed or inhaled into the body, which the immune system recognises as a substance that may cause damage. These allergens stimulate a response from the immune system that presents itself as various forms of an allergic reaction The most common allergens are:

Foods (especially peanuts, nuts, eggs, dairy and shellfish) Certain drugs e.g. penicillin, aspirin Venom of certain stinging insects such as bees, wasps or ants Allergies to latex and substances containing latex are

becoming a serious problem especially among health care workers.

Rare causes of an allergic reaction are: Herbal remedies such as Echinacea and Royal jelly. Exercise may sometimes stimulate anaphylaxis Cold Urticaria – Individuals who get hives when exposed to cold air or water. Some experience a drop in

blood pressure when exposed and develop hypovolemic shock. Idiopathic- Sometimes the cause is never discovered or resolved.

Allergic reactions to food are common in children. Some children do outgrow their allergies. It is important to know that the venom of bees, wasps and ants are different to each other. So being allergic to bees does not necessarily mean that you are going to have an allergic reaction to other biting/stinging insects. Some people with allergies to certain insect venom can be desensitised. Severe Allergic Reactions to Peanuts, Bee Stings and Seafood Allergies are normally life-long. Reading food labels becomes an everyday practice for parents and carers of children with food allergies, but initially the task seems daunting. While contamination of foods will never be eliminated, the lists on the following page are a starting place for those who are embarking on the task of reading every label. It is important to know whether the person with an Allergic Reaction, reacts to ingesting the Allergen or ingesting a product that may contain traces of the Allergen. E.g., Chocolate & Salada Crackers both state “May Contain Traces of Nuts”

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Anaphylaxis to food may occur by: - Being in the same room as the allergen or breathing in its vapours - Touching the Allergen - Being in contact with a person who has handled or eaten the allergen e.g. Kissing - Ingesting the allergen

HIDDEN INGREDIENTS

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COWS MILK EGGS Milk, protein, solids, pasteurised, skim

powder dried, condensed, whole, low fat, non-fat, whey, casein, caseinate, curds, rennet casein, butter, butter fat, buttermilk, yoghurt, cheese, cream, sour cream, custard.

Egg white, egg yolk, whole egg, powdered egg, meringue, eggnog, albumin, ovomucoid, ovalbumin.

Egg wash is often used as a glaze on baked goods, such as scones and sausage rolls, to give them a shiny appearance.

Margarines and drink mixes (e.g. Milo) often contain milk powder

Some Ice-creams contain egg.

Soy cheese may contain milk, in the labeled forms given above.

Seafood extender products may contain egg as a binder.

Cow milk is sometimes found in caramel flavouring.

Mayonnaise and Lemon Butter spread usually contain egg.

SOYBEANS PEANUTS Soy flour, nuts, protein, albumin, soy

milk, ice-cream, yoghurt, cheese, soy sauce, miso, tofu, bean curd, textured vegetable protein, Soy Oil.

Prepared meats such as sausages and meat stuffing may contain peanuts.

Soy may be contained in vegetable flavouring, starches or broths.

Renflax: Peanuts are often substituted for more expensive nuts in confectionery, sauces and pastries.

FISH Some Asian sauces may contain peanuts.

Fish roe or caviar, Fish Sauce

Anchovies are in Worcestershire sauce and Caesar Salad

Peanut, peanut butter, satay sauce, oriental sauce, mixed nuts, ground nuts, peanut oil, vegetable oil.

Some shaving creams contain peanut oil

WHEAT TREE NUTS Flour, (plain or self-raising, enriched,

whole grain, whole meal, graham, high gluten or protein), farina, durum semolina, gluten, wheat (bran, germ, gluten, starch), bread, bread crumbs, cornstarch (may be made from wheat or corn), couscous, bulgur.

Common nuts are almond, brazil, cashew, hazelnut or filbert, walnut, pecan, pistachio, macadamia, pine or pinyon- any ingredient including the word “NUT”

Sesame seeds often cause problems in people who are allergic to nuts

Marzipan, nougat

Some vegetable starches contain wheat.

Breakfast spreads e.g. Nutella

Most soy sauce brands contain wheat Nut oils or ‘meals’ e.g. almond meal as a substitute for flour in some baking

Coconuts and chestnuts are tree nuts but are the least ‘reactive’ nuts

Hand Creams may contain almond oil, coconut oil, peanut oil etc.

ALLERGIC REACTIONS -Mild to Moderate Signs & Symptoms could include:

Swelling of lips, face eyes

Tingling of the lips, mouth, abdominal pain, vomiting (Signs of Anaphylaxis to Bee Stings)

Sensations of warmth, itching or prickliness, (groin, armpits, inside mouth)

Rash, hives or welts

Feelings of anxiety and panic

First Aid Treatment: Follow the child’s Allergy/Anaphylaxis Action Plan.

Stay with the child and call for assistance from another Adult.

Locate the child’s Anaphylaxis Medical Kit.

The child may have other prescribed medication for Mild to Moderate reactions, such as an

antihistamine and/or Ventolin. It is not uncommon to have an Asthma Attack with an Allergic Reaction

The child should be assessed very quickly for the above signs and symptoms and give their

prescribed medication as quickly as possible. If required, treat the Asthma Attack after the Antihistamine.

Contact the child’s parents/guardians and inform them of what has happened. Follow your basic First Aid training and monitor the child’s airway, breathing and

consciousness level and check for signs of Anaphylaxis. If the child starts having difficulty in breathing, then immediately follow the Anaphylaxis Management plan and inject the prescribed EpiPen into the outer thigh and call for an Ambulance immediately.

Keep talking to the child and address any First Aid needs, e.g. if the child is complaining that

they are cold – get a blanket to keep them warm.

Write a report as soon as practical after the event.

IF IN DOUBT USE THEIR EPIPEN AND CALL AN AMBULANCE

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What is an EpiPen?

An EpiPen is ONE SINGLE USE automatic injecting device that delivers a measured dose of adrenalin. The EpiPen is designed to be self-administered or delivered by a person in the event of a life-threatening, anaphylactic reaction.

Junior EpiPen: Auto injecting devices with Green writing have .15mg of adrenaline and are used on Children under 20 kilos EpiPen: Auto injecting devices with Yellow writing have .3mg of Adrenaline and are for children/Adults over 20 kilos

The Medication in the EpiPen is Epinephrine - Adrenalin. Adrenalin is the first line treatment for anaphylaxis. The Medication attempts to counteract the effects of the allergic reaction to buy the casualty time until Medical treatment is available. The Adrenalin must be clear. The liquid can be viewed through a window on the EpiPen. The EpiPen usually has a shelf life of 12 – 18 months. The expiry date is written on the EpiPen. It is advised to diarize the renewal of the EpiPen 1 month prior to the expiry date. The EpiPen should be stored in a dry place at room temperature below 25 degrees Celsius and protected from light, preferably stored in an insulated container. It must not be refrigerated or kept below 4 degrees Celsius. The EpiPen should be readily available for use and not locked away in a cupboard. A person who is Anaphylactic to insect stings, should always have their EpiPen with them when outdoors. The EpiPen works within minutes of being injected. The needle is strong and sturdy approx. 15mm in length. It is very difficult to break the needle. The injection does hurt, so when injecting, keep the patient’s thigh still as it is a “one use only” device and cannot be re-injected. Thick clothing should be removed before injecting. The most common side effects may include increase in heart rate, stronger or irregular heartbeat, sweating, nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness, headache, apprehension, nervousness or anxiety. These side effects usually go away quickly, especially if you rest. The Adrenaline is not dangerous. It is better to inject than not inject if you are not sure on how severe the condition is. Do not inject into buttock, hands, feet, ear, nose or genitalia as the resultant decrease in blood flow to the area may cause tissue damage. Do not inject intravenously. Seek medical advice should this occur.

DO NOT USE THE ADRENALINE AUTOINJECTOR IF IT IS:

OUT OF DATE (EXPIRED) CLOUDED CONTAINS SEDIMENT

In an Extreme Anaphylaxis Emergency, if the expired EpiPen is all that you have and you cannot

contact 000, then you may inject the expired EpiPen. You cannot use another person’s EpiPen without permission from 000 4

ANAPHYLAXIS - Severe Allergic Reaction Signs & Symptoms may include:

Difficulty talking and/or hoarse voice

Difficulty breathing and swallowing Wheezing, Persistent Cough

Swelling of the throat and tongue

Stridor breathing (obvious in young children)

Abdominal cramping, nausea and /or vomiting (common in insect stings) Feeling faint or fainting

Losing Consciousness or Unconscious

Pale Floppy (young children)

These symptoms can lead to Cardiac Arrest. It is vital to know the child’s anaphylactic reaction signs and symptoms, as everyone is different and they may have unusual signs and symptoms.

These Action Plans are designed to assist children service’s staff and teachers recognise the Signs and Symptoms of the child in their care and what action to take.

Deaths caused by Anaphylaxis are rare:

Evidence from hospitals suggests that less than 1% of Anaphylaxis Attacks are at risk of death. In Australia, approx. 10 people per year, die from anaphylaxis The most common fatal reactions are caused by Medications, Blood Transfusions and Insect stings Most insect sting deaths occur to Adults over the age of 35yrs of age. Death from Anaphylaxis is very rare in children less than 5 years of age.

Deaths from reactions to food allergens are most common in teenagers or young adults with Asthma as a pre-existing condition and who do not receive adrenaline shortly after the onset of any sign or symptom of an Anaphylactic reaction.

First Time Anaphylaxis: Some people will have a sudden anaphylactic reaction for the first time. This can be life threatening. In these situations, apply first aid principles DRSABCD and call 000 urgently. 000

may advise you to use a backup EpiPen if available. 5

FIRST AID TREATMENT FOR AN ANAPHYLACTIC REACTION:

Locate the Child’s Auto Injector Kit (EpiPen)

Follow the Action Required on their Action Plan

Pull the blue cap off and inject the orange tip of the child’s EpiPen into their outer thigh on bare skin or thin layer of clothing only. Remove thick clothing.

Hold the EpiPen into the thigh for 10 seconds and then rub for 10 seconds

Call an ambulance (000 or 112 on mobile phone with No Service)

Lay the child down. Do not allow them to stand or walk.

If they are having difficulty Breathing, raise their shoulders off the ground or allow them to sit

up.

Note the time you gave the EpiPen (You can write the time on top of their hand)

Contact the child’s parents/guardians and inform them of what has happened

Monitor the child’s condition. Follow basic First Aid principles until the ambulance arrives. The child may become unconscious, so manage in accordance with the current best practices for an unconscious casualty.

If no improvement after 5 minutes, a further EpiPen can be injected if available.

Write a Report as soon as practical after the event

If you are not sure if the child symptoms are Asthma or Anaphylaxis, inject the EpiPen first, call 000 and then give Ventolin with a spacer.

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Tip to remember when injecting an EpiPen. “Blue to the Sky, orange to the thigh” 6

An EpiPen must be stored below 25 degrees Celsius. But not below 4 degrees Celsius. An insulated container, such as lunch box is commonly used to store the EpiPen and other medication such as an Antihistamine, Ventolin and Spacer. It must be clearly labelled with the child’s name and room name.

This insulated carry case can be strapped to a belt. It makes it convenient for older children to carry while on camp and excursions.

EPIPEN KITS FOR CHILDREN IN CARE/SCHOOL

An EpiPen kit MUST BE supplied by the parents/guardians for a child who has been prescribed an EpiPen. It should be made available to the staff every time the child is at the school/children’s centre.

The kit should be a portable, insulated container and should contain:

The child’s EpiPen

A copy of the child’s Anaphylaxis Action Plan

Telephone contact details for the child’s parents/guardian, doctor/medical service

A second contact person in case the parents/guardians cannot be contacted

Other medication for the allergic reaction if prescribed: Antihistamines Ventolin and a Spacer if the Child is known to have Asthma Permanent marker to note the time of injecting the EpiPen

When a kit from a parent is received, note the expiry date of the Auto Injecting Device in a Diary. Preferably 1 month prior to the expiry date to remind the parents to replace the EpiPen before that date. The EpiPen should be checked regularly to ensure the adrenaline has not discoloured.

What is an Anaphylaxis Action Plan? An Anaphylaxis Action Plan is a WRITTEN INSTRUCTION by their Doctor, that details the child’s Allergic signs and symptoms and what action to take in the event of exposure to their allergens. Each child with Anaphylaxis MUST have an Anaphylaxis Action Plan SIGNED BY THEIR DOCTOR. The Anaphylaxis Action Plan MUST include:

Recent photograph of the child – supplied by the parents.

The child’s known allergies should be recorded on the child’s Anaphylaxis Action plan.

The First Aid Response. There may be other medications (usually an antihistamine) used to treat mild to moderate allergic reactions prior to the use of an EpiPen.

Name and contact numbers of parents/guardians and doctors. The doctor’s signature and the date that the

Anaphylaxis Action Plan was prepared.

The Action Plan must be updated every year upon enrolment and if there should be any changes to the child’s Anaphylaxis Signs & symptoms and / or Allergens.

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8

Should Schools/Children’s Services purchase and store a Backup Emergency EpiPen to be used in an emergency?

Ministerial Order 706 (1st January 2016) Page 5 10.1. A school’s Anaphylaxis Management Policy must prescribe the purchase of adrenaline autoinjector(s) for general use as follows: - 10.1.1 The principal is responsible for arranging for the purchase of additional adrenaline autoinjector(s) for general use and as a back up to those supplied by parents;

The Guide to the Education and Care Services National Law and National Regulations Has information to help decide what items to include and procedures for keeping kits (see pages 61-64). There are no Regulations that state a Children’s Service must have an Emergency Backup EpiPen. Contact ACECQA on 1300 422 327 Or go to ACECQA’s website www.acecqa.gov.au If a Centre decides to purchase a Back Up EpiPen for Emergency use only, then it must be included in your policy and procedures written for its use.

Children’s Protection Act August 2015 All educators and teachers, must ensure that every reasonable precaution is taken to Keep the children safe from harm. Each workplace will have their own Policies and Procedures on Anaphylaxis. If an Emergency Backup EpiPen is purchased for the Centre, then clear instructions on Policy & Procedures must be written. All Staff need to know these Policies and procedures, where the Backup EpiPen is stored, and when to use the Emergency Backup EpiPen.

THE BACK UP EPIPEN IS TO BE USED IN AN EMERGENCY SITUATION ONLY.

The EpiPen must be clearly labelled “EMERGENCY BACK UP EPIPEN ONLY”

ANAPHYLAXIS POLICY - Procedures to Implement

Every School/Children’s Service, must have an Anaphylaxis Policy. All staff must read the Anaphylaxis policy. A copy of the Policy must be given to the parents of a Child who is at Risk of Anaphylaxis. All parents of the Children’s Service/schools must be made aware that they have an Anaphylaxis

Policy All parents with a child at Risk of Anaphylaxis must be issued with a copy of the Anaphylaxis

Policy. The Policy must include Anaphylaxis staff training & regular training on the use of an EpiPen. For Children’s Services: Training on the use of an EpiPen at quarterly intervals to be officially

documented annually. Each Centre must have at least one person trained on duty at all times. For Victorian Government Schools, All School staff must complete Anaphylaxis E-training through Anaphylaxis Australia. Then at least 2 staff members must complete the Anaphylaxis course 22303VIC Course in Verifying the Correct Use of Adrenaline Autoinjector Devices. These staff will be known as the Anaphylaxis Supervisors. Their responsibility is to deliver EpiPen training to all school staff within 30 days of completing the on line Anaphylaxis course. This training must be delivered every 6 months. Alternatively, the staff can complete this course. 22300VIC First Aid Management of Anaphylaxis.

Trainer EpiPens can be purchase through Anaphylaxis Australia: www.allergy.org.au

When a child or children with known anaphylaxis to an allergen are at School or a Children’s service, it is important for the service to conduct an assessment to assess the potential risk of accidental exposure to the allergens specific to that child. This would also include Anaphylaxis training. Children Service Centres and Family Day Care educators, must have at least one person on duty at all times trained in First Aid Management of Anaphylaxis. Several staff should be trained to cover holidays, sick leave and training seminars. Most managers of Centres, insist that all their staff are trained in First Aid Management of Anaphylaxis to eliminate any roster problems with untrained staff. 9

Children’s Services Sample Model Policy: www.education.vic.gov.au/Documents/childhood/.../anaphylaxismodelpolicy.doc

Victorian Government Schools sample of Model Policy”

www.education.vic.gov.au/.../health/Pages/anaphylaxisschools.aspx

INDIVIDUAL RISK MINIMISATION PLAN The Principal/Director/Nominee of a Child Care Centre/School, must ensure that the Parents/Guardian of the child must fill in the Risk Minimisation Plan together with the Director/Principal/Teacher. This Plan is to be signed by both the Parent/s and Director/Teacher/Principal. It is the Duty of the Parent/s of the Child at Risk of Anaphylaxis, to advise the School/Centre Staff of any relevant information to help keep the Child “Safe from harm” while under their care. It is the parent/s and/or carer/s responsibility to advise the centre/School of any changes to the child’s condition and/or treatment. As all children react differently and their Allergen triggers can be very different, their individual Risk Minimization Plan will assist the staff to understand how to minimise the Risk of Contamination by knowing:

What the Child is Allergic to

How to avoid the Risk of contamination

How quick will they react?

Do they have an Adrenalin Auto-Injecting Device?

Do they have any further medical condition, if yes what medication is kept at the service?

Does the child react by ingesting the allergen or can they react by touching it? ALL STAFF WHO HAVE CONTACT WITH THE CHILD AT RISK OF ANAPHYLAXIS, MUST FAMILARIZE THEMSELVES WITH THE INFORMATION IN THE RISK MINIMISATION PLAN, AND BE GUIDED BY THIS INFORMATION TO AVOID ANY RISK TO THE CHILD. The Risk Minimisation Plan will change as the child and their allergens change. The plan should be reviewed on a regular basis. The following questions should be asked when developing or reviewing a Risk Minimisation Plan:

How have we planned for meeting the needs of the children with allergies who are at risk of anaphylaxis?

Are all staff and families aware of how the service/ Policy aims to minimize the risk of a child who is at risk of Anaphylaxis?

Do relevant people know what the emergency procedures are, if a child has an anaphylactic reaction?

How effective is the service/’s Risk minimisation Plan and is it review and evaluated regularly?

Do all staff know where the EpiPen kits are kept? Regularly Practice your Emergency procedures to an Anaphylaxis Emergency, to observe and improve the response time. This way any problems/issues delaying assistance reaching the child can be sorted out.

REPORT WRITING As soon as possible, after the incident, a Full Report must be written. This report must be written in Black or Dark Blue ink only as it is a Legal Document. The Parents/Guardians of the child and the Appropriate Authorities must be notified of the incident. Counselling and Debriefing Children and staff, who witnessed or were part of the incident, may need to have counselling organised. Staff debriefing, is a good way to help the staff involved deal with their emotions. It also allow the staff to assess their emergency procedures. 10

When preparing a Risk Minimisation Plan the following should be considered:

How many Children with Allergies/Anaphylaxis?

Is washing of hands before and after eating instigated?

Are food scraps and wrappings appropriately disposed of?

What food is kept in the Kitchen and Canteen?

Excursions and Camps – Do we carry the EpiPen kits when we are outdoors? Are staff trained in EpiPen administration present?

Could Playground and/or Play equipment be contaminated?

Art Room: - Do we store Egg Cartons, Milk Containers, and Cereal Boxes etc.?

What is the play dough made of?

Do we carry Cordless phones, Mobile phones or Walkie-Talkies in the playground?

Who does what and when in an emergency, and who looks after the other children?

Special events: Do you have Allergen Free Treats in the centre, to give to the allergic child, when other children bring in treats to share?

Do you have a “No sharing food policy” and are all children and parents aware of it?

Do we have signs up on the entrance door to the room, as a reminder not to bring any items that may cause an Anaphylactic Reaction?

You cannot put up a signs up on walls and door stating “THIS IS A NUT FREE ZONE” because you cannot guarantee that your workplace is totally nut free. Some childcare centres place a picture of the allergen they do not want brought into the centre, with a Ban Symbol superimposed on it. This way, those who do not understand English too well, can recognize what the picture means. Examples of signs below:

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Sample Anaphylaxis Management Plan

Cover Sheet

This Plan is to be completed by the principal or nominee on the basis of information from the Child’s medical

practitioner provided by the parent/carer

School/Centre:

Phone:

Child’s name:

Date of birth:

Room/Year level:

Severely allergic to:

Other health conditions:

Medication at /Centre:

Parent/carer contact: Parent/carer information (1) Parent/carer information (2)

Name: Name:

Relationship: Relationship:

Home phone: Home phone:

Work phone: Work phone:

Mobile: Mobile:

Address: Address:

Other emergency contacts (if parent/carer not available):

Medical practitioner contact:

Emergency care to be provided at /Centre:

EpiPen® storage:

The following Anaphylaxis Management Plan has been developed with my knowledge and input and will be reviewed on

........................................................... (Insert date of proposed review).

Signature of parent: Date:

Signature of principal/Director/nominee: Date:

ANNUAL REVIEW DATE DUE

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Strategies to Avoid Allergens

Child’s name:

Date of birth: Year level/Room:

Severe allergies:

Other known allergies:

Name of environment/area

Risk identified Action Required to minimise the Risk Who is responsible? Completion date

Name of environment/area

Name of environment/area

Name of environment/area

Name of environment/area

The Following pages may be useful in assisting your workplace in developing a Risk minimisation Plan for a child

care setting - at Risk of Anaphylaxis 13

Schedule 1 Risk minimisation plan sample for Children’s Services

The following procedures should be developed in consultation with the parent or guardian and implemented to help protect the child diagnosed at risk of anaphylaxis from accidental exposure to food allergens:

In relation to the child at risk:

This child should only eat food that has been specifically prepared for him/her

o Where the service is preparing food for the child, ensure that it has been prepared according to the parent’s instructions

o Some parents will choose to provide all food for their child

All food for this child should be checked and approved by the child’s parent/guardian and be in accordance with the risk minimisation plan

Bottles, other drinks and lunch boxes, including any treats, provided by the parents/guardians for this child should be clearly labeled with the child’s name

There should be no trading or sharing of food, food utensils and containers with this child

In some circumstances it may be appropriate that a highly allergic child does not sit at the same table when others consume food or drink containing or potentially containing the allergen. However, children with allergies should not be separated from all children and should be socially included in all activities

Parents/guardians should provide a safe treat box for their child

Where this child is very young, provide his/her own high chair to minimise the risk of cross-contamination

When the child diagnosed at risk of anaphylaxis is allergic to milk, ensure non-allergic babies are held when they drink formula/milk

Increase supervision of this child on special occasions such as excursions, incursions or family days

In relation to other practices at the service/family day carer’s home:

Ensure tables, high chairs and bench tops are washed down after eating

Ensure hand washing for all children before and after eating and, if the requirement is included in a particular child’s anaphylaxis medical management action plan, on arrival at the children’s service

Restrict use of food and food containers, boxes and packaging in crafts, cooking and science experiments, depending on the allergies of particular children

Staff should discuss the use of foods in activities with the parent/guardian of a child at risk of anaphylaxis and these foods should be consistent with the risk minimisation plan

All children need to be closely supervised at meal and snack times and consume food in specified areas. To minimise risk children should not ‘wander around’ the centre with food

Staff should use non-food rewards, for example stickers, for all children

The risk minimisation plan will inform the children’s service’s food purchases and menu planning

Food preparation personnel (staff and volunteers) should be instructed about measures necessary to prevent cross contamination between foods during the handling, preparation and serving of food – such as careful cleaning of food preparation areas and utensils

Where food is brought from home to the service, all parents/guardians will be asked not to send food containing specified allergens or ingredients as determined in the risk minimisation plan.

14

Schedule 2 Enrolment Check list for Children at Risk of Anaphylaxis

A risk minimisation plan is completed in consultation with the parent/guardian, which includes strategies to address the particular needs of each child at risk of anaphylaxis, and this plan is implemented.

Parents/guardians of a child diagnosed at risk of anaphylaxis have been provided with a copy of the service’s Anaphylaxis management policy.

All parents/guardians are made aware of the Anaphylaxis management policy.

Anaphylaxis medical management action plan for the child is signed by the child’s Registered Medical Practitioner and is visible to all staff. A copy of the anaphylaxis medical management action plan is included in the child’s auto-injection device kit.

Adrenaline auto-injection device (within expiry date) is available for use at any time the child is in the care of the service.

Adrenaline auto-injection device is stored in an insulated container (auto-injection device kit), in a location easily accessible to adults (not locked away), inaccessible to children and away from direct sources of heat.

All staff, including relief staff, are aware of each auto-injection device kit location and the location of the anaphylaxis medical management action plan.

Staff who are responsible for the children diagnosed at risk of anaphylaxis undertake accredited anaphylaxis management training, which includes strategies for anaphylaxis management, risk minimisation, recognition of allergic reactions, emergency treatment and practice with an auto-injection device trainer, and is reinforced at quarterly intervals and recorded annually.

The service’s emergency action plan for the management of anaphylaxis is in place and all staff understand the plan.

A treat box is available for special occasions (if relevant) and is clearly marked as belonging to the child at risk of anaphylaxis.

Parent/guardian’s current contact details are available.

Information regarding any other medications or medical conditions (for example asthma) is available to staff.

If food is prepared at the service, measures are in place to prevent contamination of the food given to the child at risk of anaphylaxis.

15

Schedule 3 Sample Risk Minimisation Plan for Anaphylaxis

The following suggestions may be considered when developing or reviewing a child’s risk minimisation plan in consultation with the parent/guardian.

How well has the Children’s Service planned for meeting the needs of children with allergies who are at risk of anaphylaxis?

1. Who are the children? List names and room locations of each of the at risk children

2. What are they allergic to?

List all of the known allergens for each of the at risk children

List potential sources of exposure to each known allergen and strategies to minimise the risk of exposure. This will include requesting that certain foods/items not be brought to the service

3. Does everyone recognise the at risk children?

List the strategies for ensuring that all staff, including relief staff and cooks, recognise each of the at risk children

Confirm where each child’s Action Plan (including the child’s photograph) will be displayed

Do families and staff know how the Service manages the risk of anaphylaxis?

Record when each family of an at risk child is provided a copy of the service’s Anaphylaxis management policy.

Record when each family member provides a complete auto-injection device kit.

Test that all staff, including relief staff, know where the auto-injection device kit is kept for each at risk child.

Regular checks of the expiry date of each adrenaline auto-injection device are undertaken by a nominated staff member and the families of each at risk child.

Service writes to all families requesting that specific procedures be followed to minimise the risk of exposure to a known allergen. This may include requesting the following are not sent to the service:

o Food containing the major sources of allergens, or foods where transfer from one child to another is likely, for example peanut, nut products, whole egg, chocolate, sesame.

o Food packaging of risk foods (see known allergens at point 2), for example cereal boxes, egg cartons and so on.

A new written request is sent to families if the food allergens change.

Ensure all families are aware of the policy that no child who has been prescribed an adrenaline auto-injection device is permitted to attend the service without that device.

The service displays the ASCIA generic poster, an action plan for anaphylaxis, in a key location and locates a completed emergency contact card by the telephone/s.

The auto-injection device kit including a copy of the anaphylaxis medical management action plan is carried by a staff member when a child is removed from the service e.g. excursions.

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USEFUL INFORMATION AND WEBSITES ANAPHYLAXIS ACTION PLANS www.allergy.org.au A MODEL CHILDREN’S SERVICES ANAPHYLAXIS POLICY www.education.vic.gov.au/Documents/childhood/.../anaphylaxismodelpolicy.doc EDUCATION & CARE NATIONAL LAW & REGULATIONS www.acecqa.com.au Samples of Risk Minimisation Plans can be found in the ’s MINISTERIAL ORDER 706 which can also be used in the Children’s services MINISTERIAL ORDER 706 (for schools) These links have all the information for a school to be compliant with the Ministerial Order. School Anaphylaxis Policy, Management Plans, Action Plans, School Training Guides http://www.education.vic.gov.au//principals/health/Pages/anaphylaxiss.aspx#link1

http://www.education.vic.gov.au/school/principals/health/Pages/anaphylaxisschools.aspx Anaphylaxis Australia: - www.allergyfacts.org.au Royal Children’s Hospital: - www.rch.org.au/allergy Australasian Society of Clinical Immunology and Allergy (ASCIA): www.allergy.org.au THE ASTHMA FOUNDATION – VICTORIA www.asthma.org.au ACTIVEAIDE Purchase of an Adrenaline Auto-Injecting Device Pouch www.activeaide.com

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