Section R7-2-809. Emergency Administration of Auto-Injectable Epinephrine

A.      Applicability. This rule applies to:

1.        Any  school  district  or  charter  school  that  voluntarily chooses to stock auto-injectable epinephrine pursuant to

A.R.S. § 15-157.

	2.     All school districts and charter schools when required to		3.     Training shall be conducted by a regulated health care
	stock auto-injectable epinephrine pursuant to A.R.S. §		professional whose competencies include the recognition
	15-157.		of anaphylactic shock symptoms and procedures to fol-
B.	Definitions. The following definitions are applicable to this		low when anaphylactic shock occurs, including but not
	rule:		limited to a licensed school nurse, certified emergency
	1.     “Anaphylactic shock” is a severe systemic allergic reac-		medical technician or licensed athletic trainer.
	tion, resulting from exposure to an allergen, which may	E.	Procedures for annually requesting a standing order for auto-
	result in death.		injectable epinephrine.
	2.     “Auto-injectable epinephrine” means a disposable drug		1.     Each school district or charter school shall obtain a stand-
	delivery device that is easily transportable and contains a		ing order from its designated district or charter school
	premeasured single dose of epinephrine used to treat ana-		physician licensed pursuant to Title 32, chapter 13 or 17,
	phylactic shock.		and if no such physician is available to provide a standing
	3.     “Standing  order”  means  a   prescription  protocol  or		order, from the chief medical officer of the Department of
	instructions issued by the chief medical officer of the		Health Services or the chief medical officer of a county
	department of health services, the chief medical officer of		health department.
	a county health department, a doctor of medicine licensed		2.     Standing orders shall be renewed annually and upon the
	pursuant to title 32, chapter 13, or a doctor of osteopathy		change of any designated school district or charter school
	licensed pursuant to title 32, chapter 17, for non-individ-		physician.
	ual specific epinephrine.		3.     Standing orders shall identify the appropriate dosage of
C.	Annual training in the administration of auto-injectable epi-		auto-injectable  epinephrine   to  administer  based  upon
	nephrine.		weight and the frequency at which auto-injectable epi-
	1.     Each school district and charter school shall designate at		nephrine may be administered if symptoms persist or
	least two school personnel, in addition to any school		return.
	nurse or athletic trainer, for each school site who shall be	F.	Procedures for the administration of auto-injectable epineph-
	required to receive annual training in the proper adminis-		rine in emergency situations.
	tration of auto-injectable epinephrine in cases of anaphy-		1.     All school districts and charters schools shall adopt pro-
	lactic shock pursuant to standing order.		cedures for the emergency administration of auto-inject-
	2.     Training in the administration of auto-injectable epineph-		able epinephrine by designated trained personnel.
	rine shall be conducted in accordance with minimum		2.     Procedures shall address, at a minimum, the following
	standards  and  curriculum  developed  by  the   Arizona		requirements:
	Department of Health Services in consultation with the		a.      Determining if symptoms indicate possible anaphy-
	Arizona Department of Education.		lactic shock.
	3.     At a minimum, training shall include procedures to fol-		b.     Selecting the appropriate dosage of auto-injectable
	low when responding to anaphylactic shock, including		epinephrine  to  administer   pursuant  to   a  standing
	direction regarding summoning appropriate emergency		order.
	care,  and  documenting,  tracking  and  reporting   of  the		c.      Injecting epinephrine via auto-injector pursuant to a
	event.		standing order, noting the time and dose given.
	4.     Training shall also include standards and procedures for		d.     Calling 911 to advise that anaphylactic shock is sus-
	acquiring a supply of at least two juvenile doses and two		pected and epinephrine was administered.
	adult  doses  of  auto-injectable   epinephrine,  restocking		e.      Keeping the person stable until emergency respond-
	auto-injectable epinephrine upon use or expiration, and		ers arrive.
	storing all auto-injectable epinephrine at room tempera-		f.      Advising school medical personnel and administra-
	ture and in secure, easily accessible locations on school		tion of the incident.
	sites.		g.     Repeating dose pursuant to a standing order when
	5.     Training shall be conducted by a regulated health care		symptoms persist and emergency responders have
	professional, whose competencies include the administra-		not arrived.
	tion of auto-injectable epinephrine, including but not lim-		h.     Providing emergency responders with used epineph-
	ited  to  a  licensed  school  nurse,  certified   emergency		rine auto-injector labeled with name, date and time
	medical technician or licensed athletic trainer.		administered.
	6.     School districts and charter schools shall maintain and		i.      Assuring that parents/guardians have been notified
	make available upon request a list of those school person-		and advised to promptly alert student’s primary care
	nel authorized and trained to administer auto-injectable		physician of the incident.
	epinephrine pursuant to a standing order.		j.      Completing written documentation of the incident,
D.	Annual  training   on  the  recognition  of  anaphylactic  shock		detailing who administered the injection, the ratio-
	symptoms and procedures to follow when anaphylactic shock		nale for administering the injection, the approximate
	occurs.		time of the injection(s), and notifications made to
	1.     Each school district and charter school shall require all		school  administration,  emergency  responders,   the
	school site personnel to receive an annual training on the		student’s parents/guardians, and the doctor or chief
	recognition of anaphylactic shock symptoms and proce-		medical officer who issued the standing order.
	dures to follow when anaphylactic shock occurs.		k.     Ordering replacement dose(s) of auto-injectable epi-
	2.     Training shall be conducted in accordance with minimum		nephrine.
	training standards developed by the Arizona Department		l.      Reviewing   any   incident   involving   emergency
	of  Health  Services   in  consultation   with  the   Arizona		administration of epinephrine to determine the ade-
	Department of Education and shall follow the most cur-		quacy of response.
	rent guidelines issued by the American Academy of Pedi-	G.	All school districts and charter schools shall report to the Ari-
	atrics.		zona Department of Health Services all incidents of use of

auto-injectable epinephrine pursuant to this rule in the format prescribed by the Arizona Department of Health Services.

Historical Note

Adopted effective July 30, 1992 (Supp. 92-3). Amended

effective April 9, 1993 (Supp. 93-2). Repealed effective

February 20, 1997 (Supp. 97-1). Amended by final exempt rulemaking at 21 A.A.R. 1784, effective February 24, 2014 (Supp. 15-3).