Guidelines

First Aid Management of Anaphylaxis - Guidelines

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1.0 Purpose and Scope

This guideline gives effect to PPL 2.10.03 Health, Safety and Wellness Policy in assisting First Aid Officers (FAO) at UQ manage the risk of anaphylaxis events occurring in the workplace. The guideline outlines the process for UQ appointed FAOs of obtaining an epiPen to hold in a workplace first aid kit and also provides general information for all staff and students about recognizing and managing life-threatening allergic reactions.

2.0 Key Requirements

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, tree nuts and shellfish or insect venom, for example, from bees or ticks. Emergency treatment of anaphylaxis includes administration of intramuscular adrenaline. At The University of Queensland, the epiPen is recommended when an adrenaline auto-injector is required as part of a first aid kit.

In keeping with Section 18(1) of the Health (Drugs and Poisons) Regulation 1996, an appropriately-qualified FAO can apply to Queensland Health for an approval to obtain, possess and administer adrenaline auto-injectors for the purpose of providing emergency medication for the acute management of an anaphylaxis event in the workplace. UQ FAOs who possess and administer adrenaline auto-injector devices must comply with the conditions as specified in the approval from Queensland Health and in accordance with this guideline. This approval does not relate to adrenaline auto-injector devices that have been obtained from a doctor or pharmacist for individual use by students or staff.

2.1 Risk assessment

Provision of an epiPen in a workplace first aid kit is subject to a risk assessment. The risk assessment should consider whether there is an increased risk in the workplace of the following:

  • A person being exposed to workplace allergens known to trigger anaphylaxis in susceptible individuals e.g. bee house?
  • A person, previously undiagnosed, presenting with anaphylaxis e.g. during a large-scale catered event?
  • A person 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 to treat anaphylaxis prior to secondary medical assistance arriving at the scene?
  • Difficult access to a worksite for emergency services or the geographical location of worksite is remote?

2.2 Approval conditions

Approval for UQ FAO's to possess and administer adrenaline auto-injectors is limited to campuses or sites where University of Queensland operations or activities occur.

Adrenaline auto-injectors for workplace first aid kits can only be obtained by a UQ FAO if the following conditions are met: 

  • The UQ FAO obtaining the adrenaline auto-injector possesses a current QH approval in accordance with Section 18(1) of the Health (Drugs and Poisons) Regulation 1996,
  • The adrenaline auto-injector is obtained, possessed and administered only for the purpose of providing emergency medication to treat anaphylaxis.
  • The adrenaline auto-injector is only administered by an appropriately qualified UQ FAO in accordance with this UQ guideline -  see Section 5.0 - Training and Resources.

3.0 Obtaining an Adrenaline Auto-Injector

  • A risk assessment is undertaken by the workplace FAO to identify whether there is an increased risk of anaphylaxis occurring in the workplace (see Section 2.1). 
  • The Director of the HSW Division has nominated the Occupational Health Nurse Advisor (OHNA) to administer the process for UQ FAO's to obtain epiPens for workplace first aid kits. 
  • On the written order of the FAO approval holder, the OHNA obtains the required adrenaline auto injectors from a pharmacist with a wholesaler licence or a licensed wholesaler of drugs or poisons. 
  • Without a current approval from Queensland Health, UQ FAOs are not authorised to obtain epiPens for workplace first aid kits.

3.1 First aid Officers

  • Contact the UQ OHNA and provide a copy of the relevant risk assessment and certified copies of relevant first aid training - see section 5.
  • The OHNA will provide the relevant approval form for the FAO to complete. The OHNA will submit the form on the FAOs behalf with a current copy of this PPL Guideline to Queensland Health (via the Medicines Regulation and Quality Unit).
  • On notification of the FAOs approval being granted, the OHNA will obtain the required number of epiPens from a wholesale pharmacist or other drugs and poisons wholesaler.
  • The epiPen can only be collected by, or delivered to, a FAO Approval holder.

3.2 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 HSW Division. Expired auto-injectors should be returned to a 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.

3.3 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 campus health service. 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 FAOs where necessary.
  • Students attending field trips with a severe nut allergy 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 bring their personal medication (adrenaline auto-injector) and a copy of their anaphylaxis action plan.
  • The nominated FAO 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.

4.0 Emergency procedure

  • At St Lucia and Gatton campuses, Security should be contacted on 336-53333. The emergency should be explained to Security and an ambulance requested urgently. If the event occurs at another campus  follow local emergency procedures or if off-campus ring 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.
  • Anaphylaxis occurring in the workplace is a serious incident. All persons requiring administration of an adrenaline auto-injector in the workplace must be assessed by a medical practitioner as soon as possible after administration.

4.1 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,
  • persistent dizziness or feeling 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 precede anaphylaxis and can 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 or abdominal pain (except in insect sting allergy where vomiting and/or abdominal pain indicate an anaphylactic reaction).

4.2 Records

Records must be kept in relation to the emergency administration of scheduled drugs or poisons. These records must, as a minimum, include:

  • The name of the person to whom the epiPen was administered.
  • The name of the person who administered the dose.
  • The date and time of administration.
  • The dose administered.

Such records must be retained for a minimum of two years.

5.0 Training and Resources

The 'Provide First Aid' (HLTAID003) training course provides basic training in recognising an anaphylaxis situation and administering an adrenaline auto-injector. Where epiPens are maintained in UQ workplace first aid kits, training must be provided by appropriately qualified professionals such as doctors, allergy nurse educators or a registered first aid training organisation. It is recommended that UQ FAOs obtaining epiPens for workplace first aid kits complete an accredited course in the first aid management of anaphylaxis to obtain enhanced knowledge and skills in managing a severe life threatening allergic reaction. The UQ Staff Development Program provides training courses for UQ FAOs in Provide First Aid, CPR and in the management of  anaphylaxis and asthma. 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 an allergy?
  • What is a mild to moderate allergy?
  • What is anaphylaxis?
  • What are the triggers for an 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.

The Australasian Society of Clinical Immunology and Allergy (ASCIA) website provides resources and information on managing anaphylaxis including Action Plans for Anaphylaxis. 

It is advised that training is refreshed on an annual basis. The ASCIA website provides video instruction on the use of an adrenaline auto-injector.

E-training programme and anaphylaxis fact sheets can also be found on the ASCIA website.

6.0 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.


 

 

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