San Francisco Schools Now Required to Stock, Train Staff on Lifesaving EpiPens

Jan. 03--When the student arrived in the wellness center at San Francisco's Mission High School, she said her eyes felt funny, then almost immediately told school nurse Mary-Michael Watts she couldn't see.

A minute later, the teen said she couldn't breathe and her throat was tightening up.

"I was losing her," Watts said of the October incident.

Watts called 911 and grabbed an epinephrine auto-injector to counteract a severe allergic reaction and jammed it into the girl's thigh.

And when that didn't seem to help, she put another one in the girl's other leg.

At many other schools across California, a child with a similar funny feeling in her eyes might have gone to the school nurse or the front office, where the only recourse would have been a call to 911 and an excruciating wait, but no epinephrine.

That's because epinephrine auto-injectors, a lifesaving device for a person with a severe allergic reaction or in anaphylactic shock, were optional in schools -- until Thursday.

Foods such as peanuts, dairy, eggs or shellfish can cause severe reactions, as can insect stings or an adverse reaction to medication or latex.

When the San Francisco girl stumbled into Watts' office, as few as 13 percent of state schools stocked the epinephrine device, according to the most recent survey in 2011 by the Journal of School Health.

A new state law that kicked in Jan. 1 requires schools to stock them and instruct school nurses or staff who volunteer to participate in the training how to use them.

Preventing injury, death

Before the October incident, Watts had never needed an epinephrine auto-injector -- often referred to by the brand name EpiPen -- in the eight years she'd been a school nurse. The devices sat in a drawer, but she's glad they were there.

"You might not need it for five or 10 years, but when you need it, you need it," she said. "I'm really relieved I had it."

Anaphylaxis can cause severe injury or death in five to 10 minutes, according to the California Advocates for Food Allergies, which supported the new requirement.

"This law will protect students and teachers who suddenly develop severe allergies for the first time while at school," according to the organization's statement on the passage of the law. "Startlingly, 25 percent of the emergency first-aid epinephrine used at school is used on people who have never been diagnosed with an allergy."

The girl struggling to breathe in Watts' Mission High office didn't know what was causing the severe reaction. She had no known allergies.

As Watts waited for the emergency responders, fear and nausea rushed over her as she watched the girl become unresponsive, her head flopping back. But she kept breathing.

Potential lifesaver

Paramedics soon arrived and administered more epinephrine and hooked her up to an IV and an albuterol nebulizer to administer a medicated mist to help her breathe.

She regained consciousness briefly, was taken to the hospital and survived. It's still unclear what caused the response, but Watts believes the two doses of the EpiPens saved her life.

"I'm really relieved I had them," she said. "I think they kept her breathing."

California becomes the ninth state to require that epinephrine is stocked in schools, according to the California School Nurses Association. The new law requires schools to stock at least one auto-injector and train those volunteering in how to identify anaphylaxis as well as the use, storage and restocking of the devices.

The law, Senate Bill 1266, also protects those trained from civil liability related to the use of of the auto-injectors. Schools would be responsible for getting a doctor's prescription for the regulated devices, which can cost more than $100 each and must be replaced when they expire or are used.

Currently, Mylan pharmaceuticals, which markets the EpiPen, has offered to supply four free EpiPens to each school, provided they have a prescription, under the EpiPen4Schools program.

'Such a brilliant idea'

Free or not, Watts wants them in her school.

A month after injecting the girl in anaphylactic shock in her office, another student came in at lunch complaining of throat irritation and stomach pains. The student, Robyn Stotomas, had taken a bite of a burrito he had thought didn't contain cheese, to which he's highly allergic.

He doesn't always carry his own EpiPen. Watts pulled out hers and jabbed him in the thigh to prevent the onset of more symptoms while they waited for his mother to arrive and take him to the hospital.

"When I was a kid I thought I would die of my allergies," said Stotomas, 18, a senior. "It's such a brilliant idea to employ this law."

Jill Tucker is a San Francisco Chronicle staff writer. E-mail: jtucker@sfchronicle.com Twitter: @jilltucker

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