By Brenda Silvia-Torma

As the movement spreads to pass legislation allowing or requiring schools to stock emergency supplies of epinephrine, the challenge becomes finding ways to implement these laws.

It’s not as simple as it may seem.

School nurses and administrators tasked with developing stock epinephrine policies must address simple questions like where to store epinephrine auto-injectors, as well as more complicated ones like how to train staff to know when and how to administer epinephrine, the first-line treatment for a severe allergic reaction, or anaphylaxis.

In July 2014, the National Association of School Nurses (NASN) formed the Epinephrine Policies and Protocols Workgroup to develop resources that aid schools and school nurses with implementing stock epinephrine policies. The workgroup was comprised of members of NASN, the National Association of State School Nurse Consultants and the American Academy of Pediatrics.

Michael Pistiner, MD, MMSc, board-certified pediatric allergist at Harvard Vanguard Medical Associates in Boston and an Anaphylaxis Community Expert (ACE) with Allergy & Asthma Network, was a volunteer member of the workgroup.

Dr. Pistiner shared some of the difficult issues schools address when developing stock epinephrine policies:

  • Training teachers, cafeteria workers, bus drivers, coaches and other unlicensed assistive personnel to recognize the signs of anaphylaxis in students who do not have a prior history of allergic reactions – and to correctly administer the epinephrine auto-injectors.

“School nurses are best suited to administer epinephrine to those experiencing a first-time anaphylactic reaction at school,” Dr. Pistiner says. “When a school nurse is not immediately available, someone else will need to be trained to administer the medication. Approximately 25 percent of epinephrine treatments in schools are to students without a previously known severe allergy, so policies and protocols need to be in place to ensure schools are ready.”

  • Ensuring that stock epinephrine protocols are flexible enough – and at the same time uniform – in defining anaphylaxis and providing guidance toward appropriate management.

“The protocol should not be too broad because that could result in treating non-allergic issues with epinephrine,” Dr. Pistiner says. “It should not be too restrictive, either – this could result in life-threatening consequences by delaying the appropriate treatment.”

  • Finding room in school budgets to afford the cost of epinephrine auto-injectors and identifying a medical provider to write prescriptions.

“Stock epinephrine in schools saves lives,” Dr. Pistiner says. “The resources we developed in the NASN workgroup, which can be adapted to each district’s requirements, will support school nurses in getting policies implemented.”

The Epinephrine Policies and Protocols Workgroup was sponsored by Mylan Specialty L.P. Read the workgroup’s recommended resources as well as sample school district policies at

Want to Help?

  • Healthcare providers: Offer to provide local school districts a standing order prescription for epinephrine auto-injectors.
  • School nurses: Supplement your anaphylaxis training materials at, co-created by Michael Pistiner, MD.


Anaphylaxis Community Experts (ACE) is a national, award-winning education, advocacy and outreach program developed and hosted by Allergy & Asthma Network in partnership with the American College of Allergy, Asthma & Immunology, sponsored by Mylan Specialty L.P. 

ACE volunteer teams across the country offer free awareness and training programs about food, latex and venom allergies, signs and symptoms of anaphylaxis, and how to use an epinephrine auto-injector. Teams include allergists, school nurses, community members and parents.

Become an ACE member or request an anaphylaxis education presentation in your
neighborhood. Visit, email or call 800.878.4403.