Guidelines

First Aid Management of Anaphylaxis - Guidelines

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1. Purpose and Objectives

This guideline has been developed to assist First Aid Officers at UQ in managing the risk of an anaphylaxis event occurring in the workplace.  This guideline also provides information for all staff and students at UQ about the recommended first aid management of life-threatening allergic reactions.

2. Definitions, Terms, Acronyms

Allergen -  A substance which can cause an allergic reaction.

Allergy - An irritating or harmful immune system response to a foreign substance that is harmless to most people.

Anaphylaxis -  An acute, severe allergic response involving multiple organs of the body. If untreated anaphylaxis can be fatal.

ASCIA - Australian Society of Clinical Immunology and Allergy

Auto-injector - A pre-filled injection device that can be activated by a simple self-release mechanism.

OHNA - Occupational Health Nurse Advisor.

3. Guidelines Scope/Coverage

These guidelines apply to all First Aid Officers at the University of Queensland. These guidelines also provide general information and resources for managing anaphylaxis for all staff and students at UQ.

4. Guidelines Statement

The University of Queensland has been granted approval under section 18(1) of the Health (Drugs and Poisons) Regulation 1996 for appropriately-qualified UQ First Aid Officers to possess and administer adrenaline auto-injectors for the purpose of providing emergency medication in the acute management of an anaphylaxis event in the workplace.

First Aid Officers at UQ who possess and administer adrenaline auto-injector devices must comply with the conditions as specified in the approval from the Chief Executive, Queensland Health and in accordance with this University of Queensland guideline.

5. Managing Anaphylactic Reactions at The University of Queensland

Anaphylactic reactions are becoming increasingly common. There are many potential allergens that can trigger anaphylaxis in susceptible people. Allergens can include foods such as peanuts and shellfish or insect venom, for example, from bees or ticks.

Emergency treatment of anaphylaxis includes administration of intramuscular adrenaline.  There are a variety of auto-injector products available that contain adrenaline for emergency treatment of anaphylaxis. At the University of Queensland, the EpiPen is recommended when an adrenaline auto-injector is required as part of a first aid kit. 

Appropriately trained First Aid Officers at UQ have been granted approval under section 18(1) of the Health (Drugs and Poisons) Regulation 1996 to possess and administer adrenaline auto-injectors for the purpose of providing emergency medication in the acute management of an anaphylaxis event.

First Aid Officers at UQ who possess and administer adrenaline auto-injectors must comply with the conditions as specified in the approval granted by the Chief Executive, Queensland Health. 

5.1 Approval conditions

  • Approval for UQ First Aid Officers to possess and administer adrenaline auto-injectors is limited to campuses or sites where University of Queensland operations or activities occur.
  • Adrenaline auto-injectors can be administered only for the acute management of anaphylaxis in accordance with this UQ guideline.
  • Adrenaline auto-injectors are obtained from a pharmacist or licensed wholesaler of drugs or poisons on the written order of the approval holder.
  • Adrenaline auto-injectors can only be issued to qualified UQ First Aid Officers for the purposes of performing their official functions under this approval.
  • Adrenaline auto-injectors must only be administered by qualified UQ First Aid Officers in accordance with this UQ guideline.
  • UQ First Aid Officers under this approval must be trained in the use of an adrenaline auto-injector for the acute management of anaphylaxis - see Section 8.0 - Training and Resources.
  • This approval does not relate to adrenaline auto-injector devices that have been obtained from a doctor or pharmacist for individual use by the student or staff member.

5.2 Risk assessment

Provision of an EpiPen in a workplace first aid kit is subject to a risk assessment. The following issues should be considered as part of the risk assessment process.

Is there an increased risk in the workplace of:

  • a student or worker being exposed to workplace allergens known to trigger anaphylaxis in susceptible individuals e.g. bee house?
  • a student or worker previously undiagnosed presenting with signs and symptoms of anaphylaxis e.g. during a large-scale catered event?
  • a student or worker known to be at risk of anaphylaxis not having their personal device available or accidently misfiring the device or of the device having expired?
  • a second dose of adrenaline being required before an ambulance or secondary medical assistance arrives?
  • difficulty in emergency services accessing the workplace or the geographical location of workplace being remote?

Risk assessments should be documented in The University of Queensland Risk Management Database http://www.uq.edu.au/ohs/risk-management-assessment

6. Obtaining an Adrenaline Auto-Injector

The University has been granted approval from Queensland Health for UQ First Aid Officers to obtain and administer a workplace held EpiPen (see Section 5). Without this approval, first aid officers are not authorised to obtain EpiPens for workplace first aid kits.  First Aid Officers should initially complete a risk assessment for their workplace (see Section 5.2). 

If the risk of anaphylaxis occurring in the workplace is moderate to high, an adrenaline auto-injector in the workplace first aid kit is advised. Adrenaline auto injectors can be obtained from a pharmacist or licensed wholesaler of drugs or poisons on the signed written order of the approval holder. The Director of the Occupational Health and Safety Division is the approval holder for the University. The Director has nominated the Occupational Health Nurse Advisor (OHNA)  to administer the process for UQ First Aid Officers to obtain EpiPens for workplace first aid kits.

6.1 How to obtain an adrenaline auto-injector

  • Provide a copy of the relevant risk assessment or reference ID to the OHNA at the Occupational Health and Safety Division.
  • The OHNA will contact the UQ Campus Pharmacy or other drugs and poisons wholesaler in writing to request the EpiPen.
  • The EpiPen can only be collected by, or delivered to, an appropriately trained First Aid Officer.

6.2 Field trips

Enquiries should be made about medical conditions when field trips are being planned.  Students and staff with known serious allergic conditions should be asked to provide a workplace anaphylaxis action plan. 

Action plans can be obtained from a person's own general practitioner or from a doctor at the University Health Service. Example Anaphylaxis Action Plan templates can be downloaded from the ASCIA website.

Details of specific medical requirements during a field trip should be provided to supervisors and First Aid Officers where necessary.

Students with a severe nut allergy who are attending a field trip should be asked to bring their own food and cooking utensils and to prepare their food separately to other students.  Students with a severe allergy should also bring their personal medication (adrenaline auto-injector) and Anaphylaxis Action Plan.

The nominated First Aid Officer must be made aware of the increased risk of anaphylaxis occurring on the field trip and should review the Anaphylaxis Action Plan prior to the field trip proceeding.

6.3 Storage

The EpiPen must be stored in the workplace first aid kit, protected from light, at room temperature (between 15-25 degrees).  An Anaphylaxis Action Plan should always be stored with the adrenaline auto-injector.

The shelf life of the auto-injector is normally 1 - 2 years from the date of manufacture. The expiry date marked on the side of the device should be clearly marked on the outside of the first aid kit.

Stolen or lost auto-injectors must be reported to the Director of OHS Division for notification with Queensland Health protection directorate. Expired auto-injectors should be returned to the pharmacy or disposed of in accordance with the UQ waste disposal guidelines for clinical waste. The batch number and date of disposal must be recorded in the first aid kit contents documentation.

7. Emergency Procedure

Anaphylaxis is an emergency event. All persons requiring first aid administration of an adrenaline auto-injector in the workplace must be assessed by a medical practitioner as soon as possible after administration.

In an emergency at UQ, Security should be contacted on 336-53333. The emergency should be explained to Security and an ambulance requested urgently. If away from the main campuses, follow local procedures or call an ambulance directly on 000.

After use, an adrenaline auto-injector should be placed in a container with the time of administration clearly marked on the side of the container. This container should be handed to emergency services personnel on arrival.

7.1 Signs and symptoms of anaphylaxis

The signs and symptoms of anaphylaxis usually, but not always, occur within the first 20 minutes after exposure to an allergen. In some cases, however, the delay can be up to two hours or more. Rapid onset and development of potentially life-threatening clinical effects are characteristic markers of anaphylaxis.

Signs and symptoms of anaphylaxis (a severe allergic reaction) may include one or more of the following:

  • difficulty talking and/or hoarse voice
  • difficult and/or noisy breathing
  • swelling of the tongue
  • swelling or tightness in the throat, difficulty in swallowing
  • confusion
  • pale and floppy (young children)
  • shortness of breath, repetitive coughing and/or wheezing
  • chest tightness
  • faint, rapid pulse, low blood pressure (may also have cool sweaty skin)
  • loss of consciousness and/or collapse.

Signs and symptoms of a mild to moderate allergic reaction may include one or more of the following:

  • tingling of the mouth
  • hives, welts or body redness
  • flushing and/or swelling of the face, lips, eyes
  • vomiting, abdominal pain (except in insect sting allergy where vomiting and/or abdominal pain indicate an anaphylactic reaction).

8. Training and Resources

Training for First Aid Officers at UQ must be provided by appropriately qualified professionals such as doctors, allergy nurse educators or qualified first aid trainers. Appropriate training is coordinated by the UQ Staff Development Program.

The 'Apply First Aid' (HLTFA311A) training course provides basic training in recognising an anaphylaxis situation and administering an adrenaline auto-injector.

Where EpiPens are maintained in workplace first aid kits, it is also recommended that the nominated First Aid Officer for the area completes 'First Aid Management of Anaphylaxis' (22099VIC) to obtain enhanced knowledge and skills in managing a severe life threatening allergic reaction.

General anaphylaxis training for all staff in a workplace may sometimes be necessary to raise awareness in workplaces where an increased risk of anaphylaxis occurring exists (e.g. a bee house), or if it is known that individuals in the workplace have previously experienced an anaphylaxis event.

An anaphylaxis training program should cover the following topics:

  • What is allergy?
  • What is mild to moderate allergy?
  • What is anaphylaxis?
  • What are the triggers for allergy and anaphylaxis?
  • How is anaphylaxis recognised?
  • How can anaphylaxis be prevented?
  • What should be done in the event of a student or staff member having a severe allergic reaction?
  • How to administer an EpiPen
  • How to administer an Anapen.

The Australasian Society of Clinical Immunology and Allergy (ASCIA) website http://www.allergy.org.au/ provides resources and information on managing anaphylaxis including Action Plans for Anaphylaxis.  

Training must be updated on an annual basis. Video instruction on the use of an adrenaline auto-injector (EpiPen or Anapen) can be found at:

http://www.allergy.org.au/health-professionals/anaphylaxis-resources/how-to-give-epipen

E-training programme and anaphylaxis fact sheets can also be found at:

http://www.allergy.org.au/health-professionals/anaphylaxis-resources/first-aid-for-anaphylaxis.

Custodians
Director, Occupational Health and Safety
Mr Jim Carmichael
Custodians
Director, Occupational Health and Safety
Mr Jim Carmichael