When a third-grade student who had been stung by a wasp experienced welts on his neck and difficulty breathing, school nurse Amanda Williams was prepared with the necessary dose of epinephrine to counter the allergic reaction. Thanks to a law enacted in Tennessee this year, it is now easier for schools to stock this life-saving drug. Ms. Williams shared that the emergency room doctor informed the boy’s parents that he would not have survived without the injection at Tellico Plains Elementary School since the nearest hospital is a 30-minute drive away. She described the situation as potentially tragic.

In 2013, fifteen other states joined the eleven states that already had similar laws, according to the Asthma and Allergy Foundation of America. While only four states require schools to have the medication on hand, all of these laws allow schools to stock it without an individual prescription, which can be a legal obstacle in many places. Additionally, these laws provide legal protection for staff members who administer the medication. The most common form of the medication is an auto-injector device, which is placed against the thigh and releases a spring-activated needle to inject the epinephrine.

Charlotte Collins, the senior vice president of public policy and advocacy for the allergy foundation, believes that the trend of enacting laws to encourage schools to stock epinephrine was sparked by the tragic death of a Virginia first-grader last year. The girl had an allergic reaction after eating a nut on a playground and went into cardiac arrest, ultimately passing away at a local hospital. Medical experts have stated that if her elementary school had been able to administer an epinephrine injection, she would likely still be alive. Dr. Michael Pistiner, a pediatric allergist based in Massachusetts, emphasized that epinephrine is the recommended treatment for severe allergic reactions and that delays in its administration can increase the risk of death.

Following the Virginia incident, fifteen other states have passed laws requiring schools to stock epinephrine, while additional bills are pending in Ohio and Michigan. Maryland, Nebraska, Nevada, and Virginia are currently the only states that require it. The U.S. House of Representatives also passed legislation in July that gives preference to states adopting policies to make epinephrine available in schools when applying for asthma-related federal grants. This law serves as an additional incentive for states to pass such legislation.

The bill was sponsored by Representative Phil Roe, a Republican from Tennessee and also a medical doctor, and Representative Steny Hoyer of Maryland, the House’s second-ranking Democrat. One requirement for a state to qualify for this preference is to provide adequate legal protection for personnel trained to administer epinephrine. Collins suggests that some states may not yet require epinephrine to be stocked in schools to avoid imposing financial burdens on districts that may already struggle financially. However, allowing schools to stock the medication without individual prescriptions is still an important step. Collins states that existing state laws can make it difficult for school districts to stock epinephrine without risking sanctions for dispensing prescription-only medications to institutions instead of individuals. She emphasizes that all of these laws contain some form of legal protection for those administering the drug.

In addition to school nurses, nonmedical staff who are trained by a nurse to administer epinephrine are generally covered by these laws. "A nurse can’t be everywhere," says Sally Schoessler, the director of nursing education for the National Association of School Nurses. She emphasizes the importance of quick response times when it comes to administering epinephrine for a life-threatening allergic reaction called anaphylaxis. Anaphylactic shock can be caused by various allergens, including bee stings and certain foods like peanuts, wheat, shellfish, milk, or eggs. Epinephrine is particularly effective in preventing fatal swelling in the throat or tongue and respiratory or cardiac failure.

According to Ms. Hardin, ensuring that medication is accessible in schools situated in remote rural regions like Tellico Plains Elementary holds immense significance due to the value of time. Recounting the incident involving a 3rd grader, she stated that it took approximately 15 minutes for the ambulance to arrive after their 911 call. Grateful for the availability of epinephrine and their ability to utilize it, she expressed her gratitude.