Bravo!!

Considering the number of asthmatics and kids with severe allergies, this is a necessity. Anaphylaxis can kill very quickly.

Hopefully, the days are gone when PE teachers referred to kids with asthma as wimps. They are the very ones who need to have EpiPens in their possession the most!

I have a young nephew in another state where the school is giving his mother great grief over her son's severe allergies. She's used an epipen on several occasions to save his life. This should be available to everyone, and school staff should have the basic training to recognize when it is needed and how to use it. This doesn't take medical training.

It was only about a year ago that we were told that we needed to supply schools, libraries and other public buildings with defibrillation equipment because the time for the local fire department/EMS units of generally less than four minutes was unacceptably slow! So .. how many of these units have been installed, and how many people have actually been saved by having this equipment available? Zero? That's probably a good guess.

Now we're moving on to the next "life saving" equipment that every class room, and restroom in the school district will need to make these people happy. Interestingly, there doesn't seem to be any effort by the Weekly to provide an estimate of the number of people who need this sort of medication. Is it a hand full, or hundreds?

Which raises the question--why shouldn't the parents of these children provide the district with these applicators? Why shouldn't the children be expected to have a couple in their backpacks? Why should the taxpayers be on the line for providing this equipment?

And then there is the question of liability. What is the shelf live of one of the applicators? And who becomes liable if an applicator is used after its effective life time? No to mention who is liable if the applicator is not used because no one knows exactly where it is, or how to use it?

Given how litigious this society is--it's likely that the schools will end up being sued no matter what happens, if it claims it is now going to stock these applicators.

Expecting the taxpayers to provide this level of medical care for parents who know fully well that their children are susceptible to these sorts of attacks is simply unacceptable.

Time for the Board to stand their ground, and send this suggestion back to its proponents with a "No Action" stamp on it.

During the first Aid training that all coaches must complete, there is a segment devoted to administering an Epi Pen injection. I think it's a great idea to keep a stock on hand.

Parents are responsible for their children-
1. Kids are not allowed to carry epi pens in backpacks
2. Kids who do not have epi pen prescriptions are the ones who will be saved here
3. 25% of the anaphylaxis that happens in schools are in kids and adults who have had no prior allergy diagnosis
4. In the USA one in every thirteen children have a food allergy this has skyrocketed since 1997
5. There are programs to get this medication free and at a discount from manufacturers
6. Anaphylaxis is 100 times more common than heart attacks in school aged children

Food allergies have dramatically increased unfortunately over the last decade. There are currently about two children in each classroom with a recognized food allergy. This proposal is to protect the 25% of children who have anaphalaxis while at school with NO prior diagnosis of severe food allergy (so they do not already have prescribed their own Epipen). Their parents and physicians are unaware they might need an EpiPen.

It should not take a child'd death (such as what happened in VA) for Palo Alto school district to act. In VA (and 4 other states) it is now mandatory for schools to stock available EpiPens.

[Post removed]

Parents-Are-Responsible,

There is a process and documentation in place where you are required to be responsible for your medicines in school, and that includes a prescription and signature from your pediatrician.

This should not change, but I completely support the initiative to stock up schools with Epipens. I would add bronchodialators and benadryl.

These are extremely COMMON life saving defense medicines, and should be as necessary to have on hand as bandaids.

Children and minors require adult advocates to look out for them, not any different than getting a crossing guard for school neighborhoods.

Failure to understand these medicines and the standard that should be expected from adults looking out for kids is more problematic and less expensive than fighting common sense.

Epipens can sometimes fail, and have a glitch, like a bandaid, and having extras on hand is LIFE SAVING. Much bigger stakes than bandaids.

I meant to say that fighting commons sense is more expensive, and I would add risky!

I just want to interject here that the cost for a single Epi-Pen is >$100. This is amazing as the cost of the epinephrine is less than $0.15! I know because we have to keep several epinephrine auto-injectors around the house and cars for my husband's bee anaphylaxis.

Fortunately, Kaiser just switched to a generic one. One can hope that it will be priced more reasonably.

Our kids attended a private elementary school and there was very little medical drama except there was a highly seriously allergic child and we became aware school-wide each year of required practices to protect this child. The mother was nice and informative in her approach. She was visible often but not totally hovering over the child. So she did not totally hand over all responsibility to others but made us all more informed and part of helping to avoid an allergy attack. I recall she told us the story of always checking at restaurants before ordering food (for the table) and yet, still, her child DID experience shock a couple of times.
I understand there is a much higher incidence of serious allergies nowadays. I suggest that all parents sign a release indicating they will not sue if an Epi-pen is used on their child (is it correct that there is no chance of adverse reaction to an application of an Epi-pen?) That way, regular old parents/yard duty and school personnel should be much more comfortable in making the big decision to use an Epi-pen on a child. It seems time is of the essence in these situations. Many of us are not medically trained.
When I hear of initial symptoms like "Scratchy throat" it makes me wonder how non-medical personnel can immediately decide that is heading into an allergic shock and time is of the essence. If one sees a kid in obvious trouble breathing and others state that the child is highly allergic, then the balance of evidence would lead an adult to take immediate action, but still - where will the Epi-pens be stored (school supply, as opposed to some individual children who have them stored away at school and not immediately available at lunchtime, perhaps)? A kid could also have trouble breathing and it could be a choking situation, etc....

As the father of an asthmatic child, who always kept an EpiPen ready to go in my house, I am not sure that such devices should be readily available in schools. Why? Because the school district can be sued for $Ms of dollars if it is not done perfectly.

Tort reform (loser pays in court) would greatly relax such concerns for school districts. The perfect should not get in the way of the good.

Anonymous,

"When I hear of initial symptoms like "Scratchy throat" it makes me wonder how non-medical personnel can immediately decide that is heading into an allergic shock and time is of the essence. If one sees a kid in obvious trouble breathing and others state that the child is highly allergic, then the balance of evidence would lead an adult to take immediate action, but still - where will the Epi-pens be stored (school supply, as opposed to some individual children who have them stored away at school and not immediately available at lunchtime, perhaps)? A kid could also have trouble breathing and it could be a choking situation, etc...."

Really good questions! There are answers, and the doctors should have recommendations on how schools can handle different situations.

Perhaps the best way to think about this proposal is to imagine that it was your own child that suddenly and unexpectedly needed the life-saving eli-pen.

Is your child's life worth it?

As a lawyer I feel compelled to respond to the concerns of a couple of posters regarding the liability issues. California law imposes a duty upon school districts to take all reasonable steps to carefully supervise the safety of their students while on campus and a school district is liable for injuries caused by the failure to exercise such care. When, as here, you have overwhelming testimony from the medical community establishing that it is reasonable and necessary to maintain an epi pen on campus, it is a no-brainer from a legal/risk perspective. If the school were to fail to adopt the proposed plan to maintain an epi pen and a child were to die as a result, the liability of the school district would be substantial (and rightly so). In contrast, the risk or legal exposure for an unneeded use of epi pen is minimal at best. First, California has a good samaritan law that protects individuals from liability who provide emergency assistance in good faith. Second, under the California Education Code a district is protected from the administration of emergency care so long as the parents did not provide a written request that no such care be given in advance. Third, there would be no damages and nothing for a parent to sue for if an epi pen was erroneously administered to their child.

All of the concerns have been answered in places where these life saving measures are available. It's now about the will to act, rather than the lack of answers. It's just bureaucratic shuffling for the district to say this should get punted to the county, guidelines are available now.

Asthma kills around 10 people every day in this country. Although adults are actually more likely to die of an attack than kids, kids are still seriously affected and it's getting worse. Asthma is now the leading cause of illness-related absenteeism in schools. Anaphylaxis from foods AND serious asthma attacks can require such measures.

Craig, the concerns about liability are important to take into account, you're right, but at the same time, it's important not to allow people to use liability as an excuse for inaction. We all know that insurance companies have distorted the risk for their own benefit: the specter of malpractice is huge to get doctors to keep paying giant premiums; suits and awards have been dropping while premiums have remained the same or increased. The major studies Harvard did to investigate the phenomenon of malpractice found that when malpractice for sure happens (and kills or injures), only in 1/5 of 1 percent of cases does a lawsuit result. And when it does, proper measures to apologize and take responsibility to cover costs etc, end up saving money overall (other studies show this averts lawsuits and saves money even if there is a suit).

So, doing the right thing actually ends up saving money. And lives. These are our kids, we should first be thinking about doing the right thing.

Parents-Are-Responsible-For-Their-Children
Is way off base. When you are in a restaurant and choking and in need of a Heimlich should I just do do it? Or would you rather I wait for someone trained to come and assist you so I won't be sued. When death is the outcome, The question how common the problem is should go out the window. I know of a colleague who attended a scientific meeting out of town. He sat down at a table and pushed an empty bowl aside, not realizing it had contained salted peanuts. The residue was enough to cause severe anaphylaxis and within minutes he was dead. These can be very serious often fatal situations. I repeat the comment of the another poster:
if it was your child, wouldn't you want them saved? As an MD, I echo the lawyer's comment. There is essentially no risk to use Epinephrine when it is used in error. If there is another diagnosis, the protocol should already be to administer the med while simultaneously calling for 911 help.

@parent of asthmatic...I'm glad you agree these are valid questions...actually, I am past being a parent of school-aged kids, but as a community member I continue to be interested in local school issues (so it's not like I would be the one volunteering during lunchtime).

@doctor, what about the situation wherein a diver comes up and appears to have the bends, those one the boat cannot administer oxygen w/o risk of severe liability w/o stating a phrase that indicated the bent diver overtly asks for and agrees with the oxygen administration. Also only trained persons in CPR with current cards can do CPR even in situations where the diver's life is definitely in the balance. Liability issues. Correct me if I'm wrong, this comes from reading a lot about technical diving. I am interested that in sue-happy California you feel there are no risks to good Samaritans/bystanders/yard duty parents or teachers -- then why are teachers opposing this new plan (if I got that part correct)? Why not have everything in writing in advance (release of liability of parent volunteers and parents) w/regards to use of an Epi-pen.

Folks, in case you don't know, an EpiPen is a syringe full of epinephrine, which is adrenaline, a heart stimulant. Adrenaline relaxes lung smooth muscle, thus helping the asthmatic attack, at the same time stimulating the heart. If a school district administers the EpiPen, it will need to consider the liability of relieving the asthmatic attack or causing a heart attack.

How many of you, who support the schools administering the EpiPen, want to stand up and accept causing a heart attack in a young child?

Until tort reform is accomplished (loser pays), I would not support such a construct for our school districts. Way too much liability, no matter what the defense lawyers say.

Let's look at what the district has paid hundreds of thousands in legal fees for in the last few years : not doing the right thing, not doing their jobs, not errng on the side of protecting kids. Schools should have policies, but they should be prepared to care for the kids.

The last major suit I recall when I child died because the school didnt let him carry an inhaler, the district lost bigtime. School people need to be properly trained, But these should be available. Maybe it's time we brought back real school nurses.

Mr. Laughton
The Good Samaritan Law protects someone trying to save a life. It acknowledges that Good Samaritans are not doctors and must use their best judgement in a critical situation. Teachers receive training about assessing and responding to medical situations. They are responsible for the students they supervise.

You ask: "How many of you, who support the schools administering the EpiPen, want to stand up and accept causing a heart attack in a young child?"

You should ask: How many would support standing there and not trying to do anything and watching a child die?
Anaphylactic shock happens very quickly. A judgement must be made -- no time to call anyone.

Mr. Laughton: Would you save a choking person or would you really stand there worrying about a potential lawsuit and watch them die? That could generate a different type of lawsuit.

If you were the victim of a asthma attack/choking/or similar situation -- my guess is that your heirs would sue the folks who refused to help because it "was not their job?"

I witnessed the death of a Stanford Frosh due to an allergic reaction. She would have graduated by now if an epi-pen had been available and had been used. What percentage of my tax dollars would I use to support a device that could have saved her life? What would her parents give? Her roommate and dorm-mates who witnessed this tragedy? Her classmates and family? I would have done ANYTHING to have saved that life. There was no pen available and nothing I could do. She was transported to the emergency room too late.

Craig
It is unfortunate that you are apresding fear about the amount of adrenaline in an epi pen. You are confusing this with the amount a paramedic might give a heart attack victim.
The amount in an epi pen is safe to even use on a baby.
The chance of giving someone a heart attack with the small amount that is in an epi pen is so low they over 200 doctors from Stanford and PAMF are in favor of this.

Please do not spread fear. You are misinformed. Speak to your personal doctor and you can verify how safe it is.

Why is a prescription required (in the US) for an EpiPen?

>Please do not spread fear. You are misinformed. Speak to your personal doctor and you can verify how safe it is.

Uh well, I spent over 20 years in the pharmaceutical industry, primarily involved with beta-agonists (adrenaline and related molecules), especially on vascular wall cells. The levels of adrenaline that relax smooth muscle cells in the lung are about the same as those which stimulate heart muscle cells. If you would like your 200 doctors from Stanford or PAMF to enter the fray, I invite them to do so, here. I used to publish papers with with some of them, so I comfortable discussing the subject.

If an EpiPen is administered to a child, for an asthma attack (something I would do for my own asthmatic child, in an emergency) by a school district, and the child has a heart issue, then the school district will get sued. I think the school district should be able to do this (EpiPen), but not until tort reformed (loser pays) is embedded into our legal system.

Lawyers should not be running this show. Tort reform will cut them off at the knees, then we can take a rationale approach. Please let me hear from the lawyers who support 'loser pays'. I won't hold my breath, but if they want to reply (or oppose this concept), I request that they use their real names and their law firm's name.

My name is Craig Laughton.

If you want to suggest "doctors" support this then you might want to provide a little more background information - like are they specialists in the field of allergies. Frankly, I have lost all trust in the Palo Alto Medical Foundation so the fact that one of their doctors supports this is nothing more than unreliable information and adds no value to the proponents case. I would think the only way to approach this would be to identify 2-3 people at each school - give them training and provide indemnification.

The law addresses liability. It protects our pausd employees and allows them to help save lives. :

California law imposes a duty upon school districts to carefully supervise
the safety of their students while on school premises and districts may be
held liable for injuries caused by the failure to exercise such care. See
Hoyem v. Manhattan Beach City Sch. Dist., 22 Cal.3d 508, 513 (1978). In
fact, due to the special relationship between a school and its students
and the compulsory nature of education in this state, a school district
has an affirmative duty to take all reasonable steps to protect its
students. See Rodriguez v. Inglewood Sch. Dist., 186 Cal.App.3d 707,
714-15 (1986). Teachers also have a statutory duty supervise their
students, both inside and outside of the classroom, to ensure the health
and safety of students. Ed. Code § 44807.

The California Legislature has specifically provided that a school
district “may provide emergency epinephrine auto-injectors to trained
personnel who may utilize those epinephrine auto-injectors to provide
emergency medical aid to persons suffering from an anaphylactic reaction.”
Ed. Code § 49414(a). In addition, “[e]ach public and private elementary
and secondary school in the state may voluntarily determine whether or not
to make emergency epinephrine auto-injectors and trained personnel
available at its school. In making this determination, a school shall
evaluate the emergency medical response time to the school and determine
whether initiating emergency medical services is an acceptable alternative
to epinephrine auto-injectors and trained personnel.” Ed. Code §
49414(c).

Whenever a child enrolled in any school district is ill or injured
during regular school hours and requires reasonable medical treatment,
if the parent or guardian of the child cannot be reached, the district,
its officers, the school principal, and the physician and hospital
treating the child are not liable for the reasonable medical treatment
unless the parent or guardian previously filed with the school district
a written objection to any medical treatment other than first aid. See
Ed. Code § 49407.

Craig -- a position in pharmaceutical sales and your other work experience notwithstanding, you are still not physician. Physicians have refuted your arguments. In fact, TWO HUNDRED local physicians support this simple measure.

NOTE
--- The odds of complications are way less than the odds of death from the asthma attack.

--- In any case, parents of children with heart issues should notify the school of those dangers and perhaps should have their child wear a medical id bracelet.

AND...maybe you should wear one as well, since you seem so apprehensive about this intervention. After all, the odds of a middle aged man having heart problems is significantly higher than the odds for a child having such a condition.

And, again please note that a person who can't breathe -- adult or child -- will be a dead person very soon without an intervention.

>Craig -- a position in pharmaceutical sales and your other work experience notwithstanding, you are still not physician. Physicians have refuted your arguments. In fact, TWO HUNDRED local physicians support this simple measure.

Hate to bust your bubble, but that's a chuckle to me. I was never involved in sales, just bench level research, and I was involved with many medical doctors/PhDs involved in medical research, especially vascular research. You can do a search on papers I have published, if you care to make the effort. Hundreds of local doctors don't impress me, unless they have something they can defend. I can defend what I say.

The main issue is tort reform, not the basic facts about adrenaline issues. Do you support tort reform?

No, Craig, the main issue in this thread is pipers. Did a quick pubmed search and your publications, few that there are, are from over a decade ago. Plus you are middle author, indicating that you made some small contribution and was not the lead person in the study.
I guess the usual issues of car camping, BMR housing or secret ballots are not featured on this forum recently, so you have decided to stir the pot with your comments here.

Whoops, should be epipens and not pipers

(FYI, I'm one of the parents who commented at the meeting.) To share more detail on the signatures, the doctors at the meeting presented 134 signatures from doctors at PAMF, 75 from doctors at LPCH, and another 73 from Stanford Med School faculty, including allergists and pediatric specialists. I have heard two types of reactions about this from doctors: either "that's a great idea" or "what? they don't have epipens at schools?" If you're not convinced that the medical community overwhelmingly supports this, you should ask your own pediatrician or family doctor.

>Whoops, should be epipens and not pipers

You mean EpiPens, right? Pretty funny for someone who calls his/her self "Real researcher".

I support the schools being able to administer EpiPens, but only after tort reform protects them from potentially huge lawsuits.

I am still waiting to hear from those on this thread who support tort reform (loser pays).

BTW, and FWIW, I am the lead author on several papers...maybe you should do a more thorough search. Doesn't really matter to me, but it seems to concern you. If you want to call yourself a researcher, then you have to do your homework and hard work. The main point is that I can defend what I say, and I am willing to consider the serious arguments that challenge my views. If they are not serious, then they are frivolous, and not worth the expenditure of time and energy on anybody's part.

Perhaps there should be a public debate between Craig and the 282 physicians who support this proposal -- and we can add a few attorneys in the mix as well because Craig rejects the legal opinion from "Lawman" posted earlier in the thread.

neighbor, I am here, so let at least one of the 282 physicians make their case on this blog. Just make sure that they use their own real name, and what institution they represent. I'm ready.

Perhaps the main attorney I am concerned about is the one that represents our school board. Where does he/she stand on this issue? Would he/she feel much more comfortable with tort reform? I would think so.

"You mean EpiPens, right? Pretty funny for someone who calls his/her self "Real researcher"."
Not really, Craig. Considering I corrected it right after or did you not notice?

"BTW, and FWIW, I am the lead author on several papers...maybe you should do a more thorough search. "
I did. Did not find anything.

"Doesn't really matter to me, but it seems to concern you. "
Well, if you are going to present yourself as an expert in the field, then proof matters. And it should be modern work, not 3rd author papers from 10-20 years ago from a company that no longer exists.

"neighbor, I am here, so let at least one of the 282 physicians make their case on this blog. Just make sure that they use their own real name, and"
Why do they have to make their case on this blog-- to feed your ego? They made their case where it counts. You do not have any decision making power on this issue, so why bother arguing with you?

"California legislation that would require schools to stock EpiPens, sponsored by State Senate Republican Leader Bob Huff of Diamond Bar, was met with resistance from unions representing teachers and other school employees in hearings earlier this month." - from the article
- anyone know why?

I had no trouble finding Craig as first author on several journal articles. And if we dismiss everything from 10-20 years ago, I guess we'll never get back to the moon. Plenty of opinions are expressed in these comment boards, and sometimes some of it sticks when voting time comes around. Just another venue for public discourse.

Do you want to have your medical conditions -- or your child's -- evaluated by someone who not only relies on information from 10-20 years ago, but who is not a trained and practicing medical doctor?

Get real and stop trying to politicize this (and every) issue.

> California law imposes a duty upon school districts to take all
> reasonable steps to carefully supervise the safety of their students
> while on campus and a school district is liable for injuries caused
> by the failure to exercise such care

Thanks for the input. However, such vague laws are not really helpful—since we all know that the Legislature routinely words its laws so vaguely that only the lawyers win—and then only 50% of them prevail in court.

Let’s start with a couple of premises:

1) The District has an obligation to insure than anyone who has a “pre-existing condition” must have sufficient preventative medicines available so that no student will suffer any significant medical injury while on a school site, or during a school-monitor activity off a school site.
2) The District shall be financially responsible for all situations where a child’s medical emergencies are concerned.

OK .. the law segment offered by our lawyer friend doesn’t exactly say this—but given that lawyers make billions by going into courts, and saying the magic words: “the accused either knew, or should have known” ..

Clearly no school district can possibly know the medical conditions of children—many here in the country illegally—and be prepared for every conceivable emergency. Yet, our lawyer friend wants us to believe that they should be—and that he is prepared to step in an “clean up” any time he finds a situation where a school district isn’t as prepared as he is when he goes into court.

Let’s try to answer a few questions here:

1) Since the schools were opened in the 1890s—how many children have died on campus, during a school day?
2) How many children have suffered any kind of medical emergency that has required a 911 call, and hospitalization, in the past twenty years, or so?
3) What is the longest response time for an EMS call to each of the schools?
4) How many children die on school campuses yearly, that would have been saved if an EPIPen were handy?

It’s fair to say that ZERO is an answer for most of these questions. Children are killed on school campuses because of deranged students bringing firearms on campus, or by criminals shooting at each other in the vicinity of school grounds—but virtually no students die because of a Anaphalaxis.

Now—there are about 12,000 PAUSD students (and about 65M public school students in the US). How many of these EPIPens should be purchased, and where should they be placed to guarantee that no student will go without this emergency medication for say—more than 60 seconds? Any one even consider that fact that kids are all over the school grounds, that most have cell phones, and that it would be easier for them to call 911 than to call the person who is supposed to have the nearest EPIPen?

And what about cost? A quick look on Google suggests that the Walmart cost is about $125/pen. Shelf life seems to be about 12 months, but maybe that information needs more clarification. And then there is the matter of theft of these medications for resale on some secondary market. Should students be held accountable for stealing these medications, or should they be given a pass—because it’s really OPM (Other People’s Money) and we wouldn’t want our students to be charged with grand theft if we can somehow manipulate the situation to avoid their being responsible for their acts.

So—back to cost: Assuming that we should be purchasing these things in the hundreds, that comes to about $10,000/hundred. Anyone got any idea how many hundreds the PAUSD should purchase—in order to be fully protected from any possible litigation? And please remember that this $10K will likely be stolen, or thrown away—by the end of each school year.

Soo—just how much money should we be spending to possibly NEVER save anyone’s life? Money that should have been spent by the parents of the students with these conditions? (And please keep in mind that these sorts of attacks can happen anywhere.)

SOOOOOOOO tired of every issue becoming politicized by the anti-government folks.

To the previous writer: I assume you and your family members all carry "Do Not Resuscitate" tags at all times because you don't want any government health interventions?

PiE should get out of the hallways of 25 Churchill and purchase EpiPens for everyone--and take the liability for their misuse and neglect (only good for 12 months, someone has to be accountable for that). Maybe we should ask the many realtors who advertise on PiE's website. Don't expect the unions to welcome these devices. They certainly don't want any accountability. And Kevin Skelly's response Tuesday night was classic and defined his leadership over the past seven years: We hear the concern and we are going to wait until all the other districts do first, then we will bring it back to a vote--just like the bullying policy that the board had trouble agreeing on Tuesday. Things dont seem to be getting better.

I am sure the teachers would be willing to do anything to insure the well being of the kids but they equally certain that they will be crucified if anything (ever so slight) goes wrong by the vocal/annoying minority of parents (along with this “paper”) who are more concerned about their own selfish interests than the community as a whole. It is no wonder the “union” would prefer to have the district hire school nurses to avoid the inevitable conflict that will result from this program. Things will get better when more parents are forced to understand Rights and Responsibilities go hand in hand.

Mr. Laughton, you are the reason why people post anonymously -- for fear of being harassed by you and those like you. FYI, for those interested, this is not Mr. Laughton's only attempt to obtain personal information regarding contributors. See also Web Link

Speaking of disclosures, I am a shareholder of Pfizer. Anybody else here admit it?

I once chaperoned middle school outdoor education and, on the first day, one group hiked directly into a hornet nest. Most of that group were stung including one with a bee sting allergy. We were far from any first responders. Luckily this student had an pen. This allergic emergencies are more common than you might think.