Published Online: October 29, 2013
Published in Print: October 30, 2013, as More States Allow Schools to Stock Epinephrine Injectors

New Laws Permit Schools to Stock Epinephrine

New laws enacted by 16 states in 2013

When a 3rd grade student who had been stung by a wasp developed welts on his neck and had trouble breathing, school nurse Amanda Williams had the necessary dose of epinephrine to counter the allergic reaction.

A law Tennessee enacted this year makes it easier for schools to stock the life-saving drug. Ms. Williams said the emergency-room doctor told the boy's parents that he probably wouldn't have survived without the injection at Tellico Plains Elementary School because it's a 30-minute drive to the nearest hospital.

"It would have been tragic," she said.

Fifteen other states enacted similar laws in 2013, joining 11 others that already had them, according to the Asthma and Allergy Foundation of America, based in Landover, Md.

While only four of the states require schools to have the medication on hand, all the laws allow schools to stock it without a prescription for an individual—a legal hurdle in many places—and provide legal protection for staff members who administer it.

The most common form of the medication is packaged inside a device called an auto-injector. The tip of the device is placed firmly against the thigh, which releases a short, spring-activated needle that injects the epinephrine.

Charlotte Collins is the senior vice president of public policy and advocacy for the allergy foundation and has been keeping track of which states are enacting laws to encourage schools to stock the devices. She believes the trend was sparked by last year's death of a Virginia 1st grader who had an allergic reaction on a playground after eating a nut. The girl went into cardiac arrest and died at a local hospital.

Medical experts have said the little girl, who had a peanut allergy, would probably be alive if her elementary school had been able to give her an epinephrine injection.

"Epinephrine is the first-line treatment for these severe reactions," said Dr. Michael Pistiner, a Massachusetts-based pediatric allergist. "Studies show that delays in treatment with epinephrine increase risk of death."

States Take Action

Shortly after the girl's death, Virginia passed a law requiring all its schools to stock the medication.

Fifteen other states followed suit, mostly with legislation that allows schools to have the epinephrine. Bills are also pending in Ohio and Michigan. So far, Maryland, Nebraska, Nevada, and Virginia are the only states to require it.

"I think that was just a major trigger in the public consciousness," Ms. Collins said of the girl's death, which made national news.

In July, the U.S. House of Representatives passed legislation that would give states that adopt policies to make epinephrine available in schools special preference when they apply for asthma-related federal grants. The law could give states an additional incentive to pass such laws.

The bill was sponsored by Rep. Phil Roe, a Tennessee Republican and medical doctor, and Rep. Steny Hoyer of Maryland, the House's second-ranking Democrat. One requirement for a state to qualify for a preference is to make sure adequate legal protection is provided to personnel trained to administer epinephrine.

Ms. Collins said she believes more states don't require that epinephrine be stocked in schools to avoid placing a burden on often cash-strapped districts to buy the drug. Still, it's an important step to simply allow schools to stock the medication without a prescription for an individual.

"Typical state laws can otherwise make it impossible for school districts that want to stock to avoid sanctions against dispensing prescription-only medications to an institution rather than a person," said Ms. Collins, adding that all the laws contain some form of legal protection for those administering the drug.

Beyond School Nurses

While the protections vary, the laws generally shield nonmedical staff trained by a nurse to administer the epinephrine.

"A nurse can't be everywhere," said Sally Schoessler, the director of nursing education for the National Association of School Nurses in Silver Spring, Md. "You need a very quick response when it comes to administering epinephrine for anaphylaxis," which is the medical term for a rapidly progressing, life-threatening allergic reaction.

Aside from bee stings, anaphylactic shock can be a reaction to such foods as peanuts, wheat, shellfish, milk, or eggs. The epinephrine is particularly effective in stopping swelling in the throat or of the tongue that can be deadly, as well as preventing respiratory or cardiac failure.

According to the American College of Allergy, Asthma and Immunology, some 8 percent of children younger than 18, or about 6 million, have at least one food allergy.

Tammy Edwards said those figures are why she and her son lobbied for the legislation in Tennessee. Her 12-year-old son Tyler, who carries an epinephrine auto-injector to school, attended legislative meetings with her and testified.

"It's hard for some people to understand that one little peanut ... could take a life," Ms. Edwards said.

About a quarter of anaphylaxis cases in schools occur among students who are not aware they have an allergy.

Related Blog

Ms. Williams, the nurse, said that was the case with the boy stung by a wasp at her school in Monroe County, Tenn., where the district now allows epinephrine injectors to be placed in all 13 of its schools.

Sonia Hardin is the health supervisor for Monroe County schools. Nurses at each school there have collectively trained more than 100 people to administer the epinephrine, as the state law allows.

She said having the medication available at schools in isolated rural areas, as Tellico Plains Elementary is, is important because time is valuable.

"It took the ambulance about 15 minutes to get there from the time we placed the 911 call," said Ms. Hardin, referring to the incident involving the 3rd grader. "We are just thankful ... we had that (epinephrine) and were able to use it."

Vol. 33, Issue 10, Page 7

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