O2021: A Newly Developed Web Based Anaphylaxis Curriculum Improves the Efficacy of Unassigned Epinephrine Administrators

Background: Anaphylaxis is a severe, life-threatening allergic reaction. Children often suffer from anaphylactic reactions at school. In 2014, Pennsylvania Legislature passed Act 195, which allows individuals to administer unassigned epinephrine (UE) in an emergency. This allows school staff to serve as unassigned epinephrine administrators (UEAs) during anaphylactic reactions. In areas where school nurses are limited, additional staff may benefit from receiving training in recognition and management of anaphylaxis. In Pennsylvania, Dauphin county school districts have reported limitations in the availability of school health officials. This places Dauphin county school children at risk for suffering worse outcomes related to anaphylaxis. We developed and integrated a program called “A Shot to Live” which aims to help Pennsylvania schools identify children at risk for anaphylaxis, train school staff to know when and how to administer epinephrine, and ensure that each school has access to unassigned epinephrine. The goal of this study is to measure the outcomes of our online curriculum.

Methods: A newly developed web-based curriculum was distributed to UEA’s within 24 Dauphin county schools. An anonymous pre/post online survey (20-item survey) was administered to participants (UEAs) (n = 190). Prior to the initiation of the online curriculum, UEA's were asked details about anaphylaxis events, comfort with recognizing signs and symptoms of anaphylaxis, comfort with epinephrine administration, and the availability of epinephrine auto-injector (EAI) devices. The 4 essential steps of EAI administration including removal of the cap, placing the needle end on the thigh, applying pressure until a click is heard, and then holding the auto-injector in place for 10 seconds were scored before and after the online curriculum.

Results: UEAs were identified as teachers (57%), administrators (15%), nurses (2%), and “other staff” (26%). 14% of survey responders had witnessed an anaphylactic reaction in the last academic year. Epinephrine was administered by ‘‘other staff’’ most frequently (55%) followed by teachers (30%) and school nurses (15%). Prior to the integration of our standardized online curriculum training, 24% were aware of the general signs/symptoms of anaphylaxis. 28% knew the first-line treatment for anaphylaxis. Only 12% felt comfortable with administering epinephrine, and only 17% of UEA's had correctly identified the 4 essential steps of epinephrine administration. Following the implementation of our online curriculum, follow-up surveys revealed significant improvement in anaphylaxis assessment scores. 88% were aware of signs/symptoms of anaphylaxis, 92% cited epinephrine as first-line therapy for anaphylaxis, and 79% of UEA’s correctly identified the 4 essential steps of treatment compared with 12% before the course.

Conclusion: Provision of online training for school staff increases the availability and effectiveness of UEAs.