Even so, the premise of the advice we provide in this article remains just as important: many school districts do have prohibitions against self-carrying epinephrine, have no stock epinephrine available on their buses, and no trained adult to administer when necessary. If you are unsure what your district policies are, we encourage you to call your board of education to discuss.
As we reported yesterday, 12 year-old Amanda Huynh suffered an anaphylactic reaction on the school bus home after consuming a granola bar her family thought was safe from peanuts. After complaining of feeling ill, the bus driver brought her to the next stop, a high school, where the school nurse administered an epinephrine auto-injector while waiting for the ambulance. Amanda was rushed to a local hospital, then airlifted to a children’s hospital in Atlanta where she died two days later.
Thanks to the community of food allergy advocates, we have more information gleaned from conversations with the family.
Before we wade into the details, understand that the sooner epinephrine is administered when anaphylaxis is expected, the better the outcome. By extension, longer waits before epinephrine is administered result in poorer outcomes.
Our understanding is that the rules regarding operation of the school bus prohibited the self-carrying of epinephrine by students, presumably due to some misguided safety concern. As there was no provision for stock epinephrine, there was no opportunity for the driver, trained or otherwise, to administer epinephrine in a timely fashion once Amanda complained of feeling ill.
We’ve learned that it took some 15-minutes for the bus to arrive at the high school after Amanda began experiencing anaphylactic symptoms. Though the school nurse astutely administered epinephrine, the delay in receiving the drug may well have contributed to Amanda’s death.
As we understand the details, everyone acted in good faith and in a timely fashion: The family was under the impression that the granola bar was safe for peanut allergy because there was no peanut warning on the label; the bus driver, with no other strategy, rushed Amanda to the high school where she knew the school nurse would be able to help; and the school nurse administered epinephrine once Amanda arrived and called for an ambulance.
Despite these good faith efforts, Amanda is no longer with us. Though we will never know for sure whether she would have survived, her chances would have been better had she received epinephrine immediately upon the onset of symptoms.
That leads us to the following common sense rules that should be in place for every school bus and driver responsible for transporting children:
- No eating on the bus, ever. Regardless of whether a child has been previously diagnosed with a food allergy, the bus is a venue with unique vulnerabilities in which to experience a reaction. Especially in rural areas, the school bus may be far from first responders when anaphylaxis presents itself. (Remember, 22% of allergic reactions in school are to children that have never been diagnosed with a food allergy.)
- Allergic children should be allowed to self-carry their epinephrine auto-injectors when their parents deem it appropriate, including children that may not yet be able to self-administer. Having epinephrine readily available when needed is of the utmost importance.
- The bus driver must be briefed regarding which children have food allergies and their respective emergency action plans prior to being deployed on a route. Understanding who is at risk and what to do in an emergency is as important on the bus as it is in the school.
- The bus driver must be trained to recognize the symptoms of anaphylaxis, how to properly administer an epinephrine auto-injector, and what to do when an anaphylactic emergency strikes. Likewise, they should be shielded from liability when acting in good faith on behalf of the child. Nothing should stand in the way of a child receiving epinephrine as soon as possible, and that means having a well trained adult present who has no concerns about acting quickly and decisively.
- The bus driver should call emergency services directly for help. Some districts require the driver to call their dispatcher who is then responsible for calling emergency services, adding extra time to the process. The time-to-response should be minimized to ensure prompt medical attention.
- Access to stock epinephrine is critical, especially when a child suffering anaphylaxis is not carrying epinephrine.
Which of these rules does your district have in place? If you aren’t sure, we strongly urge you to contact your board of education to discuss. If district regulations or state laws stand in the way of these common sense practices, organize, contact your legislators, and demand change.
Our thanks to Jessica Wilson Curran, an advocate for food allergy legislation, who was kind enough to reach out to us regarding our original article.