On April 23, 2013, ESB 5104 was approved by the Washington State Legislature. The new legislation will allow schools to keep their own supply of “stock” epinephrine injectors (EpiPen®, Auvi-Q™). If a student has a severe allergic reaction at school, but does not have his or her own epinephrine available, this legislation increases the school’s ability to provide a life-saving injection. On May 16, 2013, Governor Inslee signed the bill into law at a ceremony at his office in Olympia.
Why make a new law?
For uncertain reasons, allergies have been on the rise in the past few decades. Increasingly, some students are at risk for a severe allergic reaction (e.g. food or insect sting), while at school. Currently, students having a severe allergic reaction may only receive life-saving epinephrine if they 1) have a formal allergy diagnosis, and 2) have their own designated epinephrine injector. There have been deaths in other states where allergic students either did not have their own epinephrine available during an emergency, or the student had their first-ever severe allergic reaction while at school.
Senate Bill 5104
In January 2013, a small group of food allergy advocates and I wrote a new bill, modeled after legislation already passed in other states such as Virginia and Illinois. Senator Mark Mullet (D, Issaquah) championed our bill, and introduced it as Senate Bill 5104. After public hearings, including input from school nurses and other professionals, the bill was passed on April 23, 2013. The new law will allow licensed health care professional (e.g. a doctor, nurse practitioner, or physician assistant) to prescribe epinephrine injectors directly to a school. Schools may keep a supply of “stock” epinephrine on hand at all times.
If a student with a known allergy has a severe reaction while at school, a school nurse (or designated trained school personnel) may administer the student’s own epinephrine or the school supply.
If a student has a first-ever severe reaction (not previously diagnosed with a severe allergy), only a school nurse may administer the school’s stock epinephrine.
School grounds, school buses, and field trips
Parents of children with allergies will be glad to learn that the new law will not only apply to school property, but also on school buses and field trips. For example, a nurse or designated trained school personnel can take the school’s stock epinephrine on a bus to a field trip.
Students who already have their own epinephrine injector
Nothing changes for students who have already been diagnosed with allergies and have their own epinephrine at school. Schools will still honor their food allergy action plans and give them their own epinephrine. However, the new law adds and extra level of safety – students with allergies will have a backup device at school, just in case their own injector is lost or expired.
Epinephrine is safe and effective
Epinephrine (aka adrenaline) is the first-line treatment for anaphylaxis, the most severe and potentially life-threatening form of an allergic reaction. Epinephrine is usually given as an injection in the muscle of the outer thigh with an “auto-injector” device like EpiPen® or Auvi-Q™. Rapid epinephrine use saves lives, and is generally safe in children — the most common side effect is a temporary increase in heart rate. Allergy experts agree that the benefits of epinephrine administration outweigh the risks. In other words, if a severe allergic reaction is suspected, it is better to give an epinephrine injection, even if it turns out to be an unnecessary dose. Allergists like to remind patients that during a severe allergic reaction, epinephrine (and NOT antihistamines like Benadryl) can be a life-saving medication.
Legal protection for schools and health care providers
In the unlikely event of an adverse reaction due to epinephrine use, the bill includes specific provisions to protect health care providers, nurses, school employees, and schools.
Schools and non-medical employees may opt out
Individual schools are not required to participate in this new law, and may opt out. Likewise, individual school employees (whose job description does not include administering epinephrine) may choose not to participate in this new program.
Public and private schools
The new law applies to both public and private schools in Washington State.
Helping reduce cost
To help defray the cost of supplying epinephrine injectors in schools, we are looking into free and reduced medication programs from Mylan and Sanofi-Aventis, the makers of EpiPen® and Auvi-Q™.
What needs to be done before September 2013?
Our goal is to have stock epinephrine in a majority of Washington State schools for the 2013/2014 school year. We need to spread the news to parents, schools, and health care providers. We anticipate placing approximately 4 epinephrine injector devices in most schools: 2 of the adult dose (student is >66 lbs), and 2 of the child dose (student is <66 lbs). Epinephrine injectors have a maximum shelf life of approximately 12-18 months. Schools will likely replace their injectors every fall before school starts.
Looking to the future
The new law requires the Office of the Superintendent of Public Instruction (OSPI) to study effects of bill. At hand is whether or not to increase the scope of the bill during the 2014 legislative session. There has been discussion to allow any designated trained school personnel (and herpes pictures not just nurses) to administer emergency stock epinephrine to students without a prior allergy diagnosis.
Click here for a more detailed history of the Senate Bill 5104.