What you don’t know about… emergency medication in schools

In the latest instalment of our series looking at policies, funding pots and new initiatives that may have slipped your notice, Dr Toni Hazell explains about the use of salbutamol inhalers for emergencies at school

What is this all about?

A medical emergency can happen at any time but is more likely to occur when there is a known predisposition, such as an allergy or asthma. A child who has previously had an anaphylactic reaction may need an adrenaline auto-injector (AAI), and one who has an asthma attack may need a salbutamol inhaler. The word ‘EpiPen’ is often used as shorthand for any AAI, but in reality, there are three brands of AAI available in the UK – EpiPen®, Emerade® and Jext®. 

What don’t I know about emergency medication in schools? 

You probably know that children with a history of anaphylaxis carry an AAI in school, and some schools ask those with asthma to carry a salbutamol inhaler. You might not know that schools can also buy AAIs and salbutamol inhalers which are not restricted to use in a named child. 

What are the benefits of emergency medication in schools?

Anaphylaxis and acute asthma require rapid action to be taken, often before an ambulance will arrive. The school may have a policy that children need to carry their own AAI/inhaler at all times, but anyone who has a child will know that the reality might not meet the ideal! It’s possible that when the emergency occurs, the AAI/inhaler has been left in a locker or desk, lost, or forgotten at home or on the school bus. A generic AAI/inhaler for use in this situation might be lifesaving. 

How does this fit in with general practice – anything we need to look out for? 

A standard NHS practice won’t need to have anything to do with this – the school buys the AAI/inhaler and is responsible for keeping it safe and planning how and when it is to be used. Specifically, it can only be used in a child who is known to be at risk of anaphylaxis, and where parental consent has been provided in advance. Staff are not allowed to, for example, give an inhaler to a child who seems to be out of breath, but does not have a pre-existing diagnosis of asthma. Consent is from the parent, not the GP, so any request from the school for a GANFYD (get a letter from your doctor!) to give this permission can be politely declined. 

Some practices have extra roles within schools – if that is the case, then you might be asked for advice on this. Although the ability for schools to buy AAIs and salbutamol has been around for many years (since 2014 for inhalers and 2017 for AAIs), not all schools are aware of it, and a practice with a role supporting a school might be asked for help in writing their policy or training staff. It isn’t compulsory for schools to hold an inhaler or AAI, but if they choose to do so then they have to establish a policy or protocol for use of the medicine.

The emergency medicine held in school is a backup and not a replacement for children having their own inhaler or AAI, and so we should continue to replace expired or used inhalers/AAI as we do now. 

Dr Toni Hazell is a portfolio GP in London

Have you got an idea for this series? Something that might have flown beneath everyone else’s notice that you think would be interesting and helpful to share? If so, we want to know! Email [email protected] with your idea.