Training for first aiders in schools
People known to be allergic (1.5 hours) – MAJ-2013-2
Goal of program
• Reduce the morbidity and mortality associated with acute anaphylactic type allergic reactions.
Objectives of the training
• Understand the legal context of responding to an anaphylactic reaction.
• Know the roles and responsibilities of first aiders and schools.
• Understand the causes and mechanisms of anaphylaxis.
• Know the signs and symptoms of acute anaphylactic type allergic reactions.
• Know the protocol for administering epinephrine to a person who is known to be allergic.
• Know the mechanisms of action and side-effects of epinephrine.
• Know how to determine the right dose based on weight.
• Know how to use the auto-injector.
• First responder:
▫ Person who has taken and successfully completed a training course recognized by MSSS given by a recognized organization and works for a
recognized service.
• Ambulance technician paramedic:
▫ Person who has taken and successfully completed a college program in pre-hospital emergency care.
• First aider in a school:
▫ Teacher/other with no specific healthcare training.
• Health care professional:
▫ As per the Professional Code.
Legal context
• Section 3 of the Regulation respecting Professional
activities that may be engaged in within the framework of pre-hospital emergency services sets out the conditions for the intra-muscular administration of epinephrine (with an auto-injection device) in an emergency, notably in
schools:
'' In the absence of a first responder or ambulance
technician, any person may administer adrenalin with an auto-injection device to a person in the case of an acute anaphylactic allergic reaction. ''
• There is no longer an obligation to have followed training to be legally allowed to administer
epinephrine in a situation of a severe allergic reaction.
• A standardized training on the subject constitutes good practice.
• Allows the acquisition of knowledge required to intervene safely and adequately in the presence of such reactions.
First aider training in school
This course is designed for the need of a person whose:
- allergy is known
- which means that medication is prescribed
First aiders in schools
• A plus: CPR training with exposure to AED
• Adapted training – first aiders in schools and others
• Condition: hand in the pre-test at the beginning of the training
▫ Length: 1.5 hours
▫ Trainers: school nurses or trainers working for another accredited organization
▫ Length of certification: three years
▫ Annual review of first aid procedures
Roles and responsibilities
• Role of first aiders:
▫ Help reduce anaphylaxis-related mortality
• Responsibilities of first aiders:
▫ Comply with the clinical protocol
▫ Keep their skills and knowledge up to date
• Responsibilities of schools:
▫ Make sure that auto-injectors are available at all times and replace them before the expiration date.
▫ Create the conditions that allow employees to take the required 1.5 hours of training.
▫ Notify the regional medical director of pre-hospital emergency services when epinephrine is used under this program.
Definition: anaphylaxis
• Allergic reaction in which the immune system reacts in an exaggerated and disproportionate way to contact with an allergenic substance
(antigen).
• Generally multiple body systems affected.
• Generally very rapid after contact.
Common allergens – Causal agents
• Foods
• Venom – insects
• Medications
Intensity depends on the amount of allergen.
Allergens - Foods
• Peanuts
• Tree nuts
• Seafood
• Eggs
• Dairy products
• Fruits
• Sesame seeds, wheat and soy + often = respiratory distress
Stinging and biting insects
• Bees
• Wasps
• Ants
+ often = shock
Allergens - Pharmaceuticals
• Antibiotics:
▫ Penicillin
▫ Sulfas
• ASA and anti-inflammatories:
▫ Aspirin
▫ NSAIDS– numerous
• Iodine:
▫ Intravenous contrast
• Others
Signs and symptoms - Systems
• Respiratory:
▫ Difficulty, distress, respiratory arrest
• Cardiovascular:
▫ Shock, cardiopulmonary arrest (CPA)
• Gastro-intestinal:
▫ Nausea, vomiting, diarrhoea, abdominal pain
• Skin:
▫ Urticaria, angioedema (swelling), redness
• Other:
▫ Anxiety, feeling of imminent death
Presence of signs and symptoms
• No sign or symptom is always present during an anaphylactic reaction.
• During the reaction, a number of substances enter into play, including histamine.
• These substances cause:
▫ Narrowing of the bronchioles
▫ Dilation of blood vessels
▫ Skin lesions
Urticaria
• Generally raised
• Migratory
Source: http://www.4-men.org/images/hives.jpg
Angioedema: before and after
• Most worrisome
▫ Upper airway
• Most visible
▫ Eyes
▫ Lips
Epinephrine - Effects
• Opposite of the anaphylactic reaction
• Dilates the bronchioles
• Increases blood pressure
• Increases the heart rate – palpitations
• Anxiety, trembling, nausea and vomiting
• Effects of short duration
Inclusion criteria (known allergy)
• Recent contact with causal agent:
▫ < 12 hours
+
• First signs of an allergic reaction:
▫ Difficulty breathing
▫ Weakness, fainting
▫ Urticaria, itching
Exclusion Criterion
None in the case of an
anaphylactic type reaction.
• Evaluate safety
▫ Potential dangers? / Wear gloves
• Primary examination
▫ Call 911 at the same time if two first aiders are present
• Inclusion criteria?
• If present, administer prescribed epinephrine
• Monitoring and first aid
▫ Call 911 now if first aider is alone
▫ 2nd dose, after 15 minutes if needed
• Take to hospital – Always
• Repeat the dose every 15 minutes if the inclusion criteria are still present.
• There is no maximum number of doses.
• When in doubt, administer to children.
• Administer even if “expired” (past expiration date).
• For adults known to have a heart disease, be more careful.
Auto-injectors
• Intramuscular injection
• Automatic
• Automatic dose:
▫ Adults = 0.30 mg if > 25 kg
▫ Paediatric = 0.15 mg if < 25 kg
Administering using auto-injectors
• Demonstrations:
• The second dose of the Twinject cannot be administered because the Twinject is not an auto-injector.
Risks related to auto-injectors
• Accidental injection – soiled
▫ Squeeze to force bleeding
▫ Clean with soap + water or disinfectant without water
▫ Immediately go to emergency room
• Accidental injection – sterile, in a finger
▫ Apply hot compresses
▫ Place pointing down
▫ Immediately go to emergency room
Summary
• Anaphylaxis: disproportionate allergic reaction.
• First-line treatment: epinephrine.
• Doses:
▫ Adult: 0.30 mg
▫ Paediatric (under 25 kg): 0.15 mg
• Repeat: every 15 minutes as needed
• Always take to hospital
• AQAA
• Saint John Ambulance
• Canadian Red Cross
• CSST
• Heart and Stroke Foundation of Québec
• Canadian Ski Patrol
• OIIQ
• Lifesaving Society
• Table des directeurs médicaux régionaux des services préhospitaliers d’urgence
• EPIPEN
• TWINJECT
Questions?
Thank you for your attention.
Version – schools MAJ-2013-2
