Provision of epinephrine auto-injectors on K-12 public school buses

Background: Anaphylaxis is a serious medical condition. If left untreated, anaphylaxis can cause increased heart rate, low blood pressure, unconsciousness, or even death. The most common trigger of anaphylactic reactions are food proteins such as peanuts, eggs, and dairy. Food allergies affect between 4% and 8% of youths in developed countries. Other potential triggers include insect stings, medications, exercise, and (in rare cases) pollen. Provision of epinephrine via auto-injectors can mitigate anaphylactic reactions until emergency medical personnel arrive. Most school systems have established policies for stocking epinephrine auto-injectors in a centralized location for school personnel to use in the event of an anaphylactic reaction during normal school hours. What is less clear is the provision of epinephrine via auto-injectors on school buses where some students spend up to two hours or more each school day. Methods: 614 Directors of Transportation Services in K-12 public schools were contacted by telephone and interviewed about epinephrine auto-injector provision on public school buses. Directors were also asked about their perceptions of the problem, knowledge of how to use an auto-injector, and bus driver education about anaphylaxis. Results: Initial results suggest many school districts do not have policies for provision of epinephrine in the event of a serious allergic reaction by a student on a school bus. Furthermore, many districts lack appropriate training for drivers on how to recognize the warning signs of anaphylaxis and how to properly administer epinephrine using an auto-injector. Conclusions: Recommendations for policies aimed at protecting allergic youths on school buses will be discussed. The feasibility of stocking epinephrine auto-injectors on school buses will be examined.