Home » School Nurse Best Practice Manual » Emergency Care and Treatment

Emergency Care and Treatment

Emergency Care and Treatment



Anaphylaxis: An acute and potentially lethal multi-system reaction.  Unlike common allergy, anaphylaxis onset may be sudden and requires instant action to prevent fatality.  Anaphylaxis can be presented as severe symptoms in at least one body system OR it can be presented as a combination of symptoms in two or more body systems.

Treatment Guidelines

Epinephrine is the first line choice for treatment of anaphylaxis.  ALL student that receive epinephrine should be sent to the emergency department for further evaluation.  “It is now recommended that children who normally have epinephrine in the school in case of emergency have at least two doses on hand.  Twelve percent of children who needed on dose of epinephrine needed a second dose,” (Selekman2013).  A second dose is recommended if symptoms are not resolved within 5-20 minutes (consult student’s provider order).



Dosing Guidelines of Epinephrine

<66 pounds (second grade and lower)

Use junior dose: 0.15mg

>66 pounds (3rd grade and older)

Use adult dose: 0.3mg

“Antihistamines may be administered with epinephrine, but never instead of epinephrine…” (Selekman 2013).  Consult student’s physician and guardian to develop protocol for the use of antihistamines, and document in student Emergency Care Plan.

Consider anaphylaxis treatment if any of these signs and symptoms are present and severe:

OR if there are a COMBINATION of symptoms from different body areas:

Lungs:  Short of breath, wheeze, repetitive cough

Heart: Pale, blue, faint, weak pulse, dizzy, confused.

THROAT: Tightness, hoarse, trouble breathing/swallowing.

MOUTH: Obstructive swelling (tongue and/or lips)

SKIN: hives over body

SKIN: hives, itchy rashes, swelling (eyes, lips)

GUT: Vomiting, cramping pain, diarrhea

HEENT: Runny nose, sneezing, swollen eyes, phlegmy throat

OTHER: Confusion, agitation, feeling of impending doom.

Guidelines for administering Epinpehrine (taken from the sample protocol developed by the Epinephrine Policies and Procotols Workgroup of the National Association of School Nurses, 12/2014)

Planning Care for Students with Life Threatening Allergies

  • Identify students diagnosed with allergies
  • Obtain history from parents on their history of anaphylaxis. 
  • Establish Emergency Care Plan.  Consider IHP or 504 for accommodations.
  • Obtain orders for student’s medications (epinephrine autoinjector, Benadryl).  Students may self-carry emergency medication with MT Self Carry Authorization form filed. (See MT Authorization to Self-Carry)
  • Medication:  Where will medication be stored?  “It is now recommended that children who normally have epinephrine in the school in case of emergency have at least two doses on hand.  Twelve percent of children who needed on dose of epinephrine needed a second dose,” (Selekman2013)
  • Accommodations:  does this student need special diet order?  Do they need a “nut free” table?  Are their airborne issues with their allergen?  What will the child do when there is a class party?  Can they have classroom snacks?  Are their items in art class or other classrooms that may cause an allergic reaction.
  • If your school is going to have a “nut free classroom” or “nut free policy” make sure that all parents are aware.  Letters should be sent home.  Administrators may choose to have parents sign and return letters.
  • Make sure teachers and other team members are familiar with child, their allergies, and their ECP.
  • Plan appropriately for field trips and extracurricular activities.
  • Train staff in use of epinephrine autoinjector.
  • Communicate with transportation department if child rides the bus.
  • Consider sending letter home to parents. (Sample letter)

Laws and Regulations

20-5-420, MCA Self-administration or possession of asthma, severe allergy, or anaphylaxis medication
27-1-714, MCA Limits on liability for emergency care rendered at scene of accident or emergency
20 USC 1232 Family Education Rights and Privacy Act

Stock Epinephrine

According to MCA 20-5-420 Section 2 it is legal for Montana schools to possess a stock supply of epinephrine auto injectors .  “Approximately 20-25% of epinephrine administration in schools involve individuals who allergy was unknown at the time of the reaction,” (NASN SCHOOL NURSE.  “The Case for stock Epinephrine in Schools.  Vol. 27. No 4. July 2012).  Stock epinephrine is to be used in the event that an individual (student, staff, visitor, etc) is having an allergic reaction. Many of these incidents will be first time exposures.

Free epinephrine auto-injectors are currently available at www.epipens4schools.com




MT Statutes and Rules for Automatic External Defibrillators:


Sample School Board Policy

Register your school AED with the MT DPHHS at this website: 


AED Use Incident Report:


Cardiac Emergencies

Calling 911


Head Injury

Concussion and Traumatic Brain Injury

The school nurse is in a pivotal position to implement evidence-based concussion prevention and management protocols at school. The school nurse identifies students with possible concussion, makes appropriate referrals, and assists students and families through the school and activity re-entry process. The school nurse collaborates with the team of stakeholders including healthcare providers, school staff, athletic trainers, parents and students to ensure that the physical and psychosocial needs of the students are met. School nurses provide support for the prevention of concussions by advocating for safe environments and education of students, parents/guardians and staff on concussions.

NASN Position Statement
Concussions- The Role of the School Nurse


Sample Concussion Policy and Procedure

Management of Concussion in the Schools Setting 
(Wisconsin Public Health Association) 

Other Resources for School Nurses

Accommodations Guide for Students with Brain Injury

Classroom Interventions for Students with Traumatic Brain Injuries

Returning to School After a Traumatic Brain Injury
Returning to School After a Concussion: A Fact Sheet for School Professionals- Centers for Disease Control and Prevention


*​For more information on concussion rules and regulations and other resources for school personnel visit the MT DPHHS School Health Website

Neck Injury


Parent Notification