Anaphylaxis in children: using an EpiPen

If you’re allergic to a specific substance - be that dairy, peanuts, pollen or something else - your immune system can overreact, triggering the release of chemicals that lead to allergy symptoms. While these symptoms usually manifest in just one area of the body, individuals can sometimes experience a severe, widespread reaction known as anaphylaxis.

Anaphylaxis can be very serious and even potentially life-threatening. It can strike swiftly and without warning, particularly in children with known food allergies. When faced with such a medical emergency, knowing how to inject adrenaline using an auto-injector such as an EpiPen can quite literally mean the difference between life and death.

In this guide, we outline the essential steps of administering an EpiPen in cases of anaphylaxis. We also answer a few other commonly asked questions surrounding its use, reporting and medical tracking in schools and other educational settings.

Please note: There are three common types of Adrenaline Auto-Injectors (AAIs) used in the UK, made by three different brands: EpiPen, Emerade and Jext. For the purpose of this guide, we will be using the terms ‘auto-injectors’ and EpiPen (the most commonly used brand) interchangeably to refer to all AAIs.

How to use an EpiPen

Allergic reactions can happen anywhere, from the dinner hall to the classroom. This means that in the event of an anaphylactic emergency, understanding how to properly administer an adrenaline auto-injector for anaphylaxis - such as EpiPens and Jext pens - is paramount. After all, by acting decisively, you can effectively manage the situation and potentially save a life.

However, there are a number of things you must be able to do before using an adrenaline auto-injector. Firstly, and most importantly, is simply recognising the signs of anaphylaxis when it starts to occur. In children, symptoms can vary. However, patients will typically experience difficulty breathing, swelling of the face, lips, or throat, rapid heartbeat, and a sudden drop in blood pressure.

If any or all of these symptoms are being experienced, before doing anything else, it’s vital to call 999 and request urgent medical assistance. Anaphylaxis in children can develop very quickly, meaning time is absolutely of the essence in such situations.

While medical assistance is being called for, you may need to administer an EpiPen, should one be available. As stated above, not all AAIs are the same and not every individual/school will carry an EpiPen branded injector. However, most of these devices work in a very similar way.

Below we run through the six basic steps you need to take when administering an adrenaline auto-injector:

• Lie the child down and hold one leg firmly in place. This is to ensure the child receives the whole dose and to stop them injuring themselves.
• Place the tip of the injector - with EpiPens, this is typically orange - on the middle of the child’s outer thigh. The pen should be held at a right angle to the surface of the child’s leg.
• Take the pen and swing back around 6 inches (15cm) before pushing it against their thigh. As the tip makes contact, you should hear a clicking sound. This indicates the injection has started.
• After hearing the click, hold the pen in place for five seconds. Try to keep the injector as still as possible for this period.
• Remove the injector from the child’s thigh and massage the injection site gently for around 10 seconds.
• Wait for medical assistance to arrive. Even after the injector is used and symptoms have subsided, it’s important for the child to still receive professional medical attention.

If the child’s symptoms have not improved after 5 minutes, and professional medical assistance has still not arrived, use a second AAI, repeating the process above.

Is anaphylaxis a reportable incident under RIDDOR?

Put simply, yes. Anaphylaxis falls under the category of 'dangerous occurrences' as defined by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) in the UK. This requires employers and responsible persons (including teachers and school staff) to report such incidents to the relevant authorities. It includes any incident that occurs at workplace/school involving exposures to allergens or when specific allergic reactions occur on site.

For example, if a child experiences anaphylaxis due to an allergen present in a school dinner hall, this is a reportable incident under relevant health and safety regulations. Similarly, if a student experiences a severe allergic reaction in a science laboratory or art room, this will likely fall under RIDDOR reporting requirements.

If in doubt, it’s always safer to report an allergic reaction incident involving a child. For full and detailed regulations when it comes to RIDDOR reporting requirements, visit the HSE's RIDDOR website here.

Following on from any incidents of this nature, we would always also recommend carrying out a detailed accident investigation. Medical Tracker’s specialist incident report and accident investigation software can make this process clear, quick and very straightforward.

Who is allowed to administer an EpiPen in an emergency?

Although trained healthcare professionals will always be in the best position to AAIs, in an emergency situation involving anaphylaxis, immediate action is vital. For this reason, anyone is legally allowed to administer these medical devices in emergency situations. This includes parents, teachers, caregivers and even passers-by. This is detailed in the Human Medicines Regulations 2012.

However, this is not to say schools and childcare facilities should not prepare for this eventuality. These organisations should have policies in place to address emergency situations to ensure that all members of staff members are equipped to respond safely and effectively.

At Medical Tracker, we understand the importance of staff training on topics such as AAI administration, as well as ensuring medical tracking and reporting procedures are in place. To find out more about how we can help you improve your school’s reporting and tracking systems, get in touch today.