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Anaphylaxis: Emergency Treatment
Health Issue Category
Date of Issue
Revision Date
February, 2006
Related Policies, Administrative Procedures and Forms:

Emergency Treatment - Anaphylaxis  A.C.T. (Administer, Call, Transport)

Administer epinephrine (i.e. EpiPen®, Twin-Ject) at the first indication of a reaction. Lay individual down and elevate feet.

To Inoculate:

Remove EpiPen from case.
Pull off BLUE safety cap.
Anchor child’s leg firmly to avoid pulling away and disengaging needle from child's thigh, to ensure injecting the child’s thigh.
Firmly push down on OUTER MID THIGH of child’s leg with the orange tip end of the needle until click is heard.
Continue to hold child’s leg firmly to avoid disengagement of needle.
Wait for drug (fluid) to enter body for 10 seconds. (Count one-one thousand, two-one thousand etc.)
Massage area for 10 seconds.

Ensure second EpiPen is on hand in the event a second dose is required.
If symptoms do not improve or if symptoms reoccur, administer a second Epinephrine after an approximate duration of 5-10 minutes or sooner. “Signs that the reaction is not under control are that the patient’s breathing becomes more laboured or there is a decreased level of consciousness.” Anaphylaxis in Schools & Other Settings p. 10 # 4 (This Handbook was distributed to every school Principal by the Ontario Ministry of Education, February 8, 2006)


• If food or drink is suspect, rinse out the mouth.
• If inhaled reliever medication is available, give it.
• Keep individual lying down on his/her back with feet elevated until emergency help arrives - do not allow the individual to sit up.
• Epinephrine must be administered promptly at the first warning symptoms, such as itching or swelling of the lips or mouth, tightening of the throat or nausea, sudden breathing difficulty (mouth drawn downwards in corners) and before respiratory distress, stridor or wheezing occur.
• Although epinephrine devices are designed for self-injection, it is dangerous to assume that any person, of any age, will be able to self-inject if the reaction is proceeding rapidly.
• In other words, if there is any reason to suspect an anaphylactic reaction is taking place, and if epinephrine has been prescribed as the treatment protocol, care givers should not hesitate to administer the medication.
Call 911 or local emergency number.
Advise dispatcher that a child is having an anaphylactic reaction.
• Ask for an ambulance and ETA (estimated time of arrival). Identify yourself, give the child’s name. IF the ETA is too long and you are going to meet the ambulance enroute, give the name of the hospital that you are on your way to.
• Indicate child’s doctor’s name.  Give used auto-injector to ambulance personnel.
• If school is in a rural area, or ambulatory service advises you that the ambulance is too far away, plan to meet ambulance enroute. Give description of transport vehicle, make, colour, licence, driver’s name, and route to the hospital. Take along additional Epinephrine.  See Driving Crew*
• Indicate whether the driver does have or does not have Epinephrine with them.
• Tell them you will have four way flashers and headlights on and will honk horn upon sighting ambulance.
Transport the child to hospital by ambulance, or transport the child and meet the ambulance enroute to the hospital, or transport the child directly to hospital immediately. Go to the hospital even if symptoms subside. Take along additional Epinephrine.

• If transporting child directly to the hospital or meeting ambulance en route, a minimum of two adults are required (driver and child first-aider).
• Administer additional dosages of epinephrine every 5-10 minutes or sooner as required en route if symptoms do not improve or if symptoms reoccur. See Part A of this section # 8

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