I. Introduction.
A. With no prior notice, life-threatening asthma attacks or systemic allergic reactions (anaphylaxis) that leave only minutes to save a life could necessitate an emergency response by school personnel. To maximize the chances that such an emergency response will result in full recovery, trained designated school personnel will administer epinephrine ("Epi-Pens, Auvi-Q ") and nebulized albuterol treatments according to procedures that have been approved by the District’s Executive Director of Student Services or designee.
B. Epinephrine auto injectors, nebulizers, and nebulized albuterol for emergency use will be distributed to every school within the District. Each District school will have epinephrine auto injectors, nebulizers, and nebulized albuterol readily accessible in the health room or other designated area. These medications will be secured in a manner approved by the Executive Director of Student Services to prevent unauthorized access.
C. Standing orders for District emergency supplies of epinephrine auto injectors and nebulized albuterol will be signed by at least one (1 prescribing health care practitioner from the District’s Medical Advisory Committee.
D. Selected school personnel will be trained by qualified personnel to administer emergency nebulized albuterol and epinephrine auto injectors under the supervision of the registered school nurse.
E. Epinephrine auto injectors and nebulized albuterol may be administered to students for life-saving purposes.
F. If parents, guardians, and emancipated students are aware of any medical condition that causes an epinephrine auto injector or nebulized albuterol to be dangerous to a student, they should indicate on online registration the exact nature of the danger and provide the District with the name and address of the medical provider who has made this determination.
G. Healthcare staff will follow protocols outlined in the student’s Asthma Anaphylaxis Action Plan.
II. Availability, Storage, Use and Destruction. Each District school will have emergency supplies of epinephrine auto injectors, nebulizers, and nebulized albuterol readily accessible. The following will govern the availability, storage, and use of the same:
A. All elementary schools will have both adult and pediatric emergency epinephrine auto injectors available.
B. Emergency supplies of epinephrine auto injectors and nebulized albuterol will be kept current and will be disposed of on the reaching of the recommended shelf life or when there is a color change in the epinephrine due to reaching or exceeding the expiration date or improper temperature control.
C. Unless the subject's medical condition and/or circumstances dictate otherwise, the following standing procedures for emergency response to life-threatening asthma attacks or anaphylaxis will be followed.
1. Call 911.
2. Summon the school nurse if available. If not, summon designated trained, non-medical staff to implement emergency protocol.
3. Check airway patency, breathing, respiratory rate, and pulse.
4. Administer medications epinephrine auto injector and nebulized albuterol per standing order.
a. Administer an adult epinephrine auto injector IM for a child over (60) sixty pounds and epinephrine auto injector IM Junior for a child under (60) sixty pounds. The container for each dose and the container holding all dosages shall be marked "FOR EMERGENCY USE ONLY" in bold print.
b. Administer a nebulized albuterol, .05 percent, 0.5cc plus 2.5cc of saline administered by oral mask or mouthpiece. After the original administration, if not better, this dosage may be repeated two (2) more times. The container for individual dosages and containers holding non-individual dosages shall be marked "FOR EMERGENCY USE ONLY" in bold print.
5. Determine cause as quickly as possible.
6. Monitor vital signs (pulse, respiration, etc.).
7. Contact parents immediately and Prescribing Health Care Practitioner as soon as possible.
8. Any individual treated for symptoms with epinephrine at school will be transferred to a medical facility.
D. Emergency supplies of epinephrine auto injectors, nebulized albuterol, and nebulizers will be under controlled access and maintained between fifty-nine (59) and eighty-five (85) degrees Fahrenheit as measured by a thermometer maintained in the same location in an air conditioned nurse's office or other air conditioned area designated by the school principal. Access will be limited to those individuals trained to administer these medications.
E. District emergency epinephrine auto injectors and nebulizers will be administered to students or staff members for emergency use only. Students who need nebulized albuterol on a regular schedule must bring their own prescription and equipment for application in accordance with District Rule 5600.2. Emergency epinephrine auto injectors, albuterol nebulized albuterol, and nebulizers may not be used under any circumstances other than emergency use.
F. District emergency epinephrine auto injectors, nebulized albuterol, and nebulizers will not be used on field trips or other activities away from the school. District emergency medications are to be maintained at school during regular school hours so that the largest population of students may be served.
G. The school nurse will inspect the nebulizer monthly in their assigned area after each use to ensure that the equipment is in proper working order and is ready for the next usage. The school nurse will also periodically inspect the nebulizer to ensure that it is in working order and supplies of nebulized albuterol and epinephrine auto injectors have not exceeded the recommended shelf life or when there is a color change in the epinephrine due to reaching or exceeding the expiration date or improper temperature control. The school nurse will provide an inventory which includes lot number of medications and the recommended shelf life.
H. All nebulized albuterol and epinephrine auto injectors which have exceeded the recommended shelf life will be destroyed. The school nurse and principal shall keep a list which records when and how the nebulized albuterol and epinephrine auto injectors were destroyed, and which District staff member oversaw the destruction.
III. Implementation and Training. Three (3) designated staff members from each school in addition to the school nurse will be trained in CPR, and in the administration of emergency epinephrine auto injectors and nebulized albuterol in life-threatening situations. Implementation and training shall include:
A. Designated staff members from each school will be appointed by a team consisting of the building principal or designee, the head nurse, the nurse serving the building, and approved by the Executive Director of Student Services. No staff member other than District employed school nurses, certified nursing assistants, or health paraprofessionals shall be compelled through their employment status to serve as a designated staff member.
B. Training of the designated staff members will be conducted and completed prior to the distribution of epinephrine auto injectors, nebulized albuterol, and nebulizers within the schools. Designated and trained staff members must complete annual training in order to continue serving as a designated staff member.
C. Training for the administration of epinephrine auto injectors, nebulized albuterol, and use of nebulizers will be completed in compliance with manufacturer’s instructions.
D. A certified CPR instructor will provide CPR training.
E. Designated staff members will successfully pass the competency assessment required by the Medication Aide Act no less than every three (3) years.
IV. In-Service Training. The procedure for the delegation of the administration of epinephrine auto injectors and nebulizer treatments to trained special care providers should be followed in accordance with Health Services Guidelines. At a minimum, the training shall consist of the following:
A. A minimum of three (3) designated staff members in each school in addition to the school nurse trained in CPR should be in-serviced by the school nurse to:
1. Identify the signs and symptoms of a life-threatening asthma attack or systemic allergic reaction;
2. Follow District procedures for emergency treatment including required 911 calls and the administration of epinephrine auto injectors and/or nebulizer treatments;
3. Complete, as time permits, an Emergency Form for paramedics;
4. Review District procedures with the designated staff members a minimum of two (2) times during the school year;
5. At a minimum, training will be provided semi-annually for designated staff members who have already been trained and staff members who are newly appointed to the emergency team; and
6. Identify and record all students whose parents or guardian have indicated that use of epinephrine auto injectors or nebulizer treatments increases danger or is ineffective, and to provide follow-up investigation with medical providers to determine the exact nature of the danger.
B. At the conclusion of the training, a document recording competency should be completed.
C. The Executive Director of Student Services will be responsible for overseeing what forms should be used to most effectively carry out the training required under this Rule.
V. Baseline Training for Epinephrine Auto Injectors and Anaphylaxis. Orientation and instruction for the administration of epinephrine auto injectors for life-threatening asthma or systemic allergic reactions should include:
A. Basic principles of the immune system and anaphylaxis;
B. Administration of epinephrine auto injectors using an epinephrine auto injector trainer;
C. Assessing vital signs;
D. Establishing and maintaining vital body functions and summoning emergency personnel; and
E. Proper documentation.
VI. Baseline Training for Nebulizers and Nebulized Albuterol. Orientation and instruction for administering nebulizers and nebulized albuterol should include:
A. Basic principles of the anatomy and physiology of the respiratory system;
B. Procedures for using nebulizers and nebulized albuterol including set-up, administration, and storage;
C. Signs and symptoms of respiratory distress and reporting; and
D. Proper documentation.
VII. Post-Use Record. As soon as reasonably practicable following the emergency administration of an epinephrine auto injectors or nebulized albuterol, the designated staff members shall provide the Executive Director of Student Services with a written report that should include, at a minimum, the following:
A. The circumstances giving rise to the administration of the epinephrine auto injector or nebulized albuterol;
B. The results; and
C. The recommended changes in the procedures or forms used by the District in its administration of epinephrine auto injectors and/or nebulized albuterol, if any.
VIII. Annual Review. On an annual basis, the Executive Director of Student Services or designee will conduct a review of the effectiveness of this Rule, procedures utilized, forms adopted pursuant to this Rule, the post-use records of the District's designated staff members, and any other materials relevant to improving the District's use of epinephrine auto injectors, nebulized albuterol, and other emergency medications. The review will include, if practicable, the following:
A. A tabulation of the number of uses of epinephrine auto injectors and nebulized albuterol per school year;
B. The results of the use;
C. The recommendations from the District's Medical Advisory Committee or other qualified organization as it pertains to epinephrine auto injectors and nebulized albuterol; and
D. Upon the completion of the review, the Executive Director of Student Services shall provide the Board with the Director's findings and recommendations.
IX. Definitions.
A. CPR. CPR shall mean cardiopulmonary resuscitation.
B. Qualified Personnel. Qualified personnel shall mean individuals who have met an educational and/or legal requirement necessary to provide instruction on the use of the epinephrine auto injectors and nebulized albuterol.
Related Polices and/or Rules: 5600, 5600.2
Rule Approved: May 17, 1999
Revised: December 4, 2000; December 15, 2003; June 15, 2009; May 5, 2014; July 8, 2019; May 19, 2025
Millard Public Schools
Omaha, NE