New York State’s Day Care Centers Implement EATA
It was wonderful that the Emergency Allergy Treatment Act (EATA) was passed last September, enabling New York State’s public facilities to stock and administer epinephrine. This will be especially important to day care centers, where young children can have undiagnosed allergies to food or insect stings. While many centers are taking advantage of training provided by the Child Care Council of Rochester, they will have to come up with their own funding in order to purchase EpiPens. If you know of a business or foundation that might be willing to make a charitable donation for this important purpose, please let us know. You can read the full article here.
Emergency Allergy Treatment Act Becomes a Reality
By Janet Goldman
August 22, 2017
There is an old saying that goes something like this: “Children are the most precious of all” (author unknown). Due to our economy’s demands, countless children spend many hours in day care centers. With trust, parents choose these centers, expecting quality attention. To better ensure safety for those with life-threatening allergies, parents provide epinephrine auto-injectors. But what about protecting those that don’t know they are at risk?
38.7% of children with food allergies have had severe reactions(statistic from AAAAI). According to one survey (Snack Safely, 10/26/15, Dave Bloom) in the 2013/2014 school year, 22% of the anaphylactic cases were experienced by students who didn’t have an allergy history. Consequently, public facilities need to consider stocking epinephrine for their communities’ safety.
Last September, Governor Andrew Cuomo signed the Emergency Allergy Treatment Act (EATA), enabling New York State’s public facilities to take such safety measures. This past March, New York’s Health Department designed a policy supporting the new legislation. Also in March, New York’s Office of Children and Family Services (OCFS) arranged a health care plan, providing guidance to day care centers for implementing EATA.
According to OCFS’s health care plan, day care centers must complete a formal process to become eligible for stocking and administering epinephrine. OCFS has provided specific training requirements, clarifying factors such as the instruction topics and the trainer’s qualifications. Similarly, the health care plan requires each day care center to arrange a non-patient specific prescription from a health care practitioner or pharmacist. Additionally, the day care center needs to arrange funding for purchasing the epinephrine auto-injectors.
Supporting OCFS’s revised health care plan, the Child Care Council of Rochester, New York has alerted local day care centers of the new state policy. Additionally, the Council has provided day care centers with training options. The council’s health services coordinator, Joanne Buell, explained, “Programs interested in stocking epinephrine devices are referred to the Child Care Council Training Calendar and can enroll into one of our scheduled Emergency Medication with Stock Epinephrine training dates. The enrollment process is usually emailed to them if they have questions regarding enrollment.” Joanne feels “very supportive of the education piece in the law. In such a crisis situation, providers need to stay calm and administer the medication correctly; otherwise it is not going to help the situation. Having an epinephrine device in the program without the training to use it correctly only gives a false sense of security.”
For prescriptions, the Council has advised the day care centers to utilize their respective families’ networks with local physicians. Already, the Council is working through one challenge related to the newness of the health care plan’s revisions. Upon being approached for prescriptions, local doctors are expressing their unawareness of the authorization. Joanne Buell stated “We suggest they speak with a MD, NP (Nurse Practitioner) or PA (Physician Assistant) whom they trust and know and ask for a prescription. If they have trouble, we refer them to the Allergy Advocacy Association for suggestions on allergists or other health professionals willing to write the prescription.”
For funding, the Council has suggested approaching the manufacturer. Their reasoning is the example set by Mylan which provided free auto-injectors to school programs. However, day care center directors have shared concerns with funding. They question whether they can afford to stock epinephrine.
Regarding the benefits of public entity stocking, day care center directors have shared experiences. One day care center director, Jill Bellucco, shared an example of the need for stocking epinephrine: She recently had a 16 month old develop hives. The child’s breathing was starting to become labored and she was coughing a little. Jill wasn’t sure what triggered the reaction. After calling 911, she sent the child to the hospital. Thankfully, the child recovered.
In Wisconsin, Angel and George Mueller have assisted a variety of public entities, including day care centers, with stocking epinephrine. In memory of their son, Dillon, who died in 2014 from anaphylaxis caused by an undiagnosed bee sting allergy, they set up a memorial fund for improving access to epinephrine (epifordilly.com). Through free training sessions, they have taught businesses how to recognize anaphylaxis symptoms and how to administer an epinephrine auto-injector. Angel explained at the end of their training sessions, “the businesses and/or agents representing the businesses complete the forms which are then endorsed by the certified instructor. The forms are then put on file at their local Clinic after the Nurse Practitioner phones in the prescription and tells the pharmacist to use the Good RX Savings Plan. Businesses cannot use the “zero copay” coupon Mylan offers as they do not have health insurance.”
With their memorial fund, the Muellers have provided additional financial assistance to some of these businesses. Their fund depends upon local donations together with various fund raisers such as t-shirt sales and an annual memorial race. Since businesses lack health insurance, Angel recommended the concept of shopping around for the lowest prices.
Angel and her family are supporting "Dillon’s Law,” new legislation in Wisconsin. Related to EATA, it extends Good Samaritan protections to "trained individuals" as well. Dillon's Law has passed unanimously in the Wisconsin assembly and is on its way to the state senate. Once enacted ANY TRAINED INDIVIDUAL can administer an epinephrine auto-injector. In this case the Mylan "zero copay" coupon will work because these individuals have health insurance.
In Canada, some day care centers already stock epinephrine. Kelly Dunfield, Nurse Practitioner and owner of Be Ready Healthcare, has assisted some of Canada’s day care centers with training sessions. Prescriptions have not been an issue as they’re not required in Canada. Similarly, price is not as big of an issue as in the US. In Canada, epinephrine auto-injectors cost approximately $110 to $125 each. Consequently, Kelly said day care centers pay for them with their own budgets. As explained in one of our earlier newsletter articles, Kelly has also provided some of these centers with her alarmed cabinets to safely store the epinephrine. (June 2017) From Kelly’s perspective, she believes “day care centers and any public areas/venues where there is food, insects, medications or exercise need to have publicly available epinephrine.” The Allergy Advocacy Association fully supports improved access to life-saving epinephrine in New York state and across North America.
© Copyright Allergy Advocacy Association 2017.