Resolution 20: Recognize and Treat Anaphylaxis

Introduced by:   North Carolina Allergy, Asthma, Immunology Society

Referred to:        Reference Committee No. 1 – Timothy M. Beittel, MD, Chair

WHEREAS, anaphylaxis is defined as a generalized, systemic allergic reaction which has a high incidence of  morbidity and can be fatal unless prompt and proper treatment is instituted; and

WHEREAS, the frequency of anaphylaxis in the general population, and especially in the pediatric population, is increasing; and

WHEREAS, food allergy, especially in the pediatric population, is increasing in incidence and individuals with food allergy are at an increased risk to experience an anaphylactic reaction; and

WHEREAS, data shows that up to 25% of all epinephrine administrations that occur in public and in the school setting involve students and adult staffers whose allergy was unknown prior to the time of the event; and

WHEREAS, North Carolina General Statute Section 90-21.14 provides that the person who uses an automated external defibrillator (AED) to attempt to save a life shall be immune from civil liability unless the person was grossly negligent or intentionally engaged in wrongdoing when rendering the treatment.  This  same immunity should apply to the use of epinephrine auto-injectors; and 

WHEREAS, as a result of several recent, preventable deaths, different states including Georgia, Illinois and Virginia have passed legislation requiring schools to have “non-student specific”  epinephrine auto-injectors available for use for any person suffering an anaphylactic reaction; therefore be it

RESOLVED, That the North Carolina Medical Society petition the North Carolina Legislature to require that school personnel, including but not limited to teachers, cafeteria workers and nurses, be instructed on how to recognize and then treat an individual experiencing an anaphylactic emergency and in particular the administration of an epinephrine auto-injector and require all schools to have  “non-student specific” epinephrine auto-injectors on hand to treat anaphylaxis.  Further, since persons trained to use AED devices are also trained to use epinephrine auto-injectors, all AED lockers should include epinephrine auto-injectors for emergent use in those public locations.  (action)

Fiscal Note:  Estimated additional budget impact:  $10,000.  Current resources will be allocated based on the priorities of the Society and the NCMS budget.

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  • Shawn Scott-NCMS

    Dr. Inglefield, the NCMS determines a fiscal note for all resolutions asking for legislative action. Due to limited human and other resources, all potential legislative projects must be quantified and prioritized, as we don’t have a large enough staff to address all issues that come to our attention.

  • Sandra Brown

    This might fall into the “seat belts on school buses” scenario. Careful calculations were done on how much money would be spent to install seat belts on school buses vs lives saved and it was astronomical. In this situation you are talking about training lots of people, ensuring that the epi-pens were available and in date (which means someone has to check the expirations), assuming that whatever anaphylaxis response system is already in place is ineffective, etc. I think we need more study.

  • Joseph Inglefield

    Similar data exist for rapid administration and safety of adrenaline auto injectors. If anything there is a problem with lack of administration, even in ED, for anaphylaxis. It would be considered safe to administer even if a misdiagnosis is made by lay person. Consequences of not administering are greater. Thanks for financial information but I thought this is the sort of thing staff are paid to do, what else would they be doing?

  • Jeff Wright

    There are very solid data proving that very rapid use of a defibrillator is key to survival. Do similar data exist regarding anaphylaxis? Does it truly make that much of a difference? Secondly, an automatic defibrillator makes the diagnosis and actually initiates the therapy. How do we assure that the diagnosis of anaphylaxis is being made properly?

  • Shawn Scott-NCMS

    The fiscal notes are calculated based on both human resources and hard costs required. When a resolution calls for legislative action, we estimate a number of hours required by staff and establish a rate for those hours based on salary and overhead costs. Other costs, such as web services, printing, mailings, etc. are estimated and added to the fiscal note.This fiscal note represents the projected minimum cost to the NCMS to achieve the intent of the resolution.

  • Joseph Inglefield

    Can the chair of this committee respond to the question above??

  • Joseph Inglefield

    How was the $10,000 figure attached to this resolution. Is this the cost to the NCMS or is it to the state budget? Either way what is the basis of the calculation? Is this a one-time cost or is it an ongoing? Tx