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DoDEA School Health Services Manual 2942.0 Volume 1 Revised: 2016 DRAFT
G-1-4-2-1
Anaphylaxis Protocol – Known Allergen
For students who have a known allergy to any substance that requires
immediate intervention, should there be exposure to the substance:
1.
The sponsor/parent/guardian complete either DoDEA School Health Form H-
1-1, Student Health History) or DoDEA School Health Form H-1-2, Returning
Student Health History Update) indicating that their dependent has an allergy
to a particular substance(s).
2.
School nurse contacts the sponsor/parent/guardian to complete School Health
Form H-3-6 (Student Allergic Reaction Information). Based on information
received, SHSM Form H-3-7 (Anaphylactic Emergency Information) may need
to be completed for the student. If emergency medications are indicated, the
sponsor/parent/guardian and primary care manager/provider will need to
complete SHSM Form H-3-2 (Medication During School Hours).
3.
School nurse completes page two of SHSM Form H-3-7 (Anaphylactic
Emergency Information). This becomes the beginning of the IHP/EAP. See
SHSM Form H-14-1 (Anaphylaxis EAP), SHSM Form H-15-1 (Anaphylaxis IHP),
and
Section I: I-11(What School Personnel should know about Anaphylaxis).
4.
School nurse develops an IHP/EAP based on information, Allergy Action Plan
provided by the primary care manager, and sponsor/parent/guardian’s input.
5.
School nurse documents information received, using the approved DoDEA
SIS, the “Medical Alert”, the “Health Conditions”, and the medication order.
6.
The school nurse should also contact the school Section 504 Accommodation
Team leader to convene a Section 504 Accommodation Team meeting to
ascertain if the student needs a Section 504 Accommodation Plan (AP).
Should the Section 504 Accommodation Team decide that a student qualifies
for a Section 504 AP, the EAP becomes part of the Section 504 AP.
7.
The Section 504 AP or the EAP are to be shared on a need-to-know basis
with all teachers and staff who service the student.
8.
The school nurse will train the UAP,
such as the classroom teacher, education
aide or other school staff to administer individually prescribed emergency
medication for a specific student with known allergies, using forms; SHSM
Form H-3-7-1 - Anaphylaxis Evaluation and SHSM Form 3-7-2 - Procedure for
epinephrine auto-injector.
9.
The school nurse follows best practice by obtaining backup medication from
sponsor/parent/guardian to keep in the health office for any emergency
medication a student has permission to carry.
10.For students whom the sponsor/parent/guardian and primary care
manager/provider consider mature enough to manage their emergency
medication, a SHSM Form H-3-9 (Permission for Student to Retain Control of
Medication) needs to be completed and signed by the primary care
manager/provider, the sponsor/parent/guardian and the student.