How Sabrina’s Law applies to Outdoor Education and Field Trips
By Cindy Paskey
Sabrina’s Law, An Act to Protect Anaphylactic Pupils, came into effect on January 1, 2006 with the purpose of protecting students at risk of anaphylaxis.
Anaphylaxis is a severe, potentially life-threatening allergic reaction to any stimulus. Reactions are characterized by sudden onset, and involve one or more body systems with multiple symptoms. Allergens are the stimulus, or substances, that cause allergic reactions.
The most common anaphylaxis triggers are foods and insect stings, followed by medications, latex and on rare occasions even exercise. In Canada, the most common food allergens are peanut, tree nuts (e.g. almond, cashew, pistachio, walnut), milk, egg, fish, shellfish, and to a lesser extent, sesame seeds, mustard seeds, soy and wheat, as well as the food additive, sulphites.
Sabrina’s Law outlines specific requirements for Ontario school boards and school principals. All boards are required to have an anaphylaxis policy that sets minimum standards for managing anaphylaxis in school settings. For boards that already have comprehensive policies, a review and minor adjustments will be all that are necessary to ensure compliance.
The bill requires principals to implement strategies that are consistent with board policy. These include a process to identify at-risk students and to develop individual plans for them, strategies to reduce risk, a school-wide communication plan and regular training for all employees and others who are in regular contact with at-risk students. The individual student plans should identify student’s allergen(s) and the emergency protocol to be followed in the event of a reaction.
Parents and students must also be accountable by ensuring schools are provided with up-to-date medical and emergency information and epinephrine auto-injectors. Students themselves must learn how to self protect in age-appropriate ways. For example, young children are taught to ask a trusted adult about food ingredients before eating food that is not from home. Before entering high school, these students must be able to read food ingredients for themselves. As always, individual levels of ability and maturity must be accounted for when setting these expectations.
School boards will determine how training will be provided, and by whom. Such training should provide an understanding of anaphylaxis, familiarity with the signs and symptoms of a life threatening reaction, knowledge of emergency response, and familiarity with students at risk of severe allergic reactions. Ideally, everyone should practise how to give an epinephrine auto-injector with training devices.
There are two different auto-injectors on the market: EpiPen® and Twinject®. Both types contain life saving medication, epinephrine, also known as adrenaline. It needs to be given early in the course of a reaction and is administered by needle injected into the muscle on the outer side of the thigh. In normally healthy individuals, epinephrine will not cause harm if given unnecessarily. During a reaction, individuals may not be able to give themselves epinephrine. Assistance from others is crucial.
Since life threatening allergic reactions are unpredictable and can progress quickly, early symptoms should never be ignored. They may appear alone or in any combination, regardless of the trigger. Symptoms may include:
• Skin: hives, swelling, itching, warmth, redness, rash
• Respiratory (breathing): wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, runny/itchy nose, watery eyes, sneezing, trouble swallowing
• Gastrointestinal: nausea, pain/cramps, vomiting, diarrhea
• Cardiovascular: pale/blue colour, weak pulse, passing out, dizzy/lightheaded/shock
• Other: anxiety, feeling of “impending doom”, headache, uterine cramps
Medical research has lead experts to recommend the emergency protocol below in response to severe, potentially life threatening allergic reactions. The acronym ACT serves as a reminder of the steps to follow:
Administer epinephrine auto-injector – EpiPen® or Twinject®
Transfer care to emergency responders and ensure transport to hospital