New legislation allows “spare” emergency adrenaline auto-injectors in schools

New legislation was passed in Westminster this week to allow schools in the UK to keep spare adrenaline auto-injectors (AAIs) for emergency use. AAIs deliver a potentially life-saving dose of adrenaline in the event of a severe allergic reaction (anaphylaxis). The legislation comes into effect from 1 October 2017.

A working group, made up of representatives from the Anaphylaxis Campaign, Allergy UK, the British Society for Allergy & Clinical Immunology (BSACI), the British Paediatric Allergy Immunity and Infection Group (BPAIIG), and the Royal College of Paediatrics and Child Health (RCPCH), has campaigned over the last two years for the Government to amend the Human Medicines Act to allow schools to buy AAIs from a pharmaceutical supplier, without prescription, for use in emergencies. The working group and their respective organisations have welcomed the new legislation which allows school staff to administer an emergency AAI to any child who has been assessed as being at risk of anaphylaxis.

Their campaign gained a huge groundswell of support from parents and teachers: over 1600 parents/carers and 800 teachers completed a survey in 2015 to assess backing for the campaign: over 99% of parents and 96% of teachers supported the proposal. The survey formed a crucial part of the evidence presented to the Department of Health. A public consultation conducted by the Department of Health this year also found overwhelming support for a change in the law to allow schools to hold spare AAIs, without a prescription, for use in emergencies.

A joint statement from the five organisations says:

“The rise in food allergy among young people is posing a significant risk for schools who can be faced with a life-threatening situation requiring urgent action. One in five fatal food-allergic reactions in children happen at school. Schools can now purchase the first-line treatment for anaphylaxis, without a prescription. While not compulsory, we hope many schools will take advantage of this change as part of their duty of care to those children who are at risk of anaphylaxis. This is likely to increase awareness and highlight the need for staff to be trained to recognise and treat anaphylaxis in school. The working group is now developing a website which will provide online resources to support school staff.

For a parent of a child at risk from anaphylaxis, this will provide valuable reassurance that their child can receive prompt emergency treatment while on school premises.

We are delighted that our campaign has delivered the result we hoped for.”

Adrenaline Auto-Injectors in Schools

There has been a recent announcement that schools will soon be able to hold a spare adrenaline auto-injector pen for use on children. These will be available for anyone to administer in the case of anaphylactic shock. This has been something that has been campaigned for by several organisations, including the Anaphylaxis Campaign alongside Allergy UK, The British Society for Allergy & Clinical Immunology (BSACI) and British Paediatric Allergy Immunity and Infection Group (BPAIIG).

The legislation for this is likely to be in place by October this year (2017). The way this appears to be worded is that the spare adrenaline auto-injectors will be available to administer to children, it does not mention staff being able to administer to other staff.

For more details, please click here.

Paediatric First Aid Training – New Guidance

Millie's-Mark-Low-Res-RGBAs from 1st September 2016, if you are to become part of the early years environment, it is likely you will have to have a paediatric first aid certificate. This will apply to all newly qualified staff possessing a Level 2 or Level 3 childcare qualification. They will need to hold either the full paediatric first aid certificate or the emergency paediatric first aid certificate to be included in the required staff to child ratios.

Much of this change is said to be in relation to the campaigning of the parents of Millie Thompson who unfortunately passed away in 2012 at nursery from choking. As such, early years providers in England who have all of their staff trained in paediatric first aid will be able to apply for the Millie’s Mark. This is a new scheme that will show a dedication to keeping children safe in the early years setting by having all staff trained in vital lifesaving skills.

For more information about Millie’s Mark, click here.

Ablation (Catheter Ablation)

Ablation or catheter ablation as it is sometimes referred, is a treatment that is used to control or correct certain types of abnormally fast heart rhythms. This could be something like Atrial Fibrillation (AF) or Superior Ventricular Tachycardia (SVT).

A cardiac catheter (thin, hollow, flexible tube) is inserted in to the body via an artery in the wrist or in the groin, it is then fed around the body to the heart to where the abnormal signal is located. The medical professional will then use either radiofrequency waves (radiofrequency ablation) or freezing (cryoablation) to destroy the tissue.

This procedure can be repeated if it does not work the first time. It can take several weeks to see whether the procedure has worked or not.

Diabetes – testing, treatment and complications

Diabetes can be diagnosed using various tests, some of these tests are used by people who are already diagnosed with diabetes to check their blood glucose levels.

Blood glucose tests

These are often done when someone has the symptoms of diabetes so that their blood glucose levels can be checked. Sometimes this is done straight away (without fasting), sometimes it is done as a fasting test. This is where the person will be required to not eat for around 8 hours before hand. Drinking water is permitted during the fasting period.

This test is often carried out by people who are already diagnosed diabetic to check their current blood glucose levels.

Oral glucose tolerance test

This test requires fasting of 8 hours before the blood glucose level is checked. The next part of the test will require the person to drink a sugary drink. After 2 hours they will then have their blood sugars checked again to see how the body is dealing with the drink.

HbA1c test

This blood test measures the average blood glucose level for the previous 2-3 months. It is a way of checking a persons long-term diabetic control. If the person has high levels of HbA1c (glycated hameoglobin) in their red blood cells, it means that the persons blood glucose levels have been high over the last few months. No fasting is required for this test.

Diabetes treatment

Unfortunately diabetes cannot be cured at present, but it can be managed successfully with lifestyle changes and medication.

Type 1 treatment

A type 1 diabetic will require insulin injections, although new developments such as pumps are sometimes being used.

Type 2 treatment

A type 2 diabetic will be advised to adjust their lifestyle such as losing weight if they are overweight, stopping smoking, doing more physical activity and eating healthily. If this does not help, or does not help enough, then tablets will usually be prescribed. It is quite likely that eventually the type 2 diabetic will need to have insulin injections.


If diabetes is not well controlled, it can lead to complications, such as:

  • Eyes – diabetes can affect the blood vessels in the eye, leading to problems with eyesight
  • Feet – diabetes can affect the circulation in the feet, this can lead to ulcers and other problems
  • Nerves – diabetes can cause nerve damage which leads to loss of sensation, numbness, pain and pins and needles
  • Heart – diabetes increases the risk of high blood pressure, coronary heart disease and strokes

First Aid Kits – Tourniquets and Haemostatics

The recent European Resuscitation Council review of a number of first aid protocols suggests there is a need in certain circumstances for first aid kits to contain haemostatic dressings and tourniquets.  The view of HSE is that the inclusion of these items is based on your First Aid Needs Assessment.

Where your needs assessment has identified a requirement for tourniquets and/or haemostatic dressings you should make sure:

  • your haemostatic dressings are always in date;
  • workplace first aiders are trained by a competent provider in when to apply a tourniquet and the correct technique to use.  For example, competent training providers should be teaching clinical protocols as described by the Faculty of Pre Hospital Care; and,
  • workplace first aiders have training in when and how a haemostatic dressing is applied.

Examples of sectors that may benefit from additional training in the use of tourniquets based on RIDDOR data include: construction, agriculture, forestry and some aspects of manufacturing.

Training on Defibrillators to be included on the EFAW and FAW Syllabus

Changes to Resuscitation Council UK guidelines on cardiopulmonary resuscitation (CPR) in October 2015 mean that HSE will now be revising the Emergency First Aid and First Aid at Work syllabuses.  The revision will require all workplace first aiders to be trained in the use of an automated external defibrillator (AED) from the 31 December 2016, as the Resuscitation Council UK guidelines now state that the management of a casualty requiring CPR is to request an AED.

It is sensible to ensure that EFAW and FAW first aiders are trained in AED use as they are now available within many workplaces and public spaces.  There is good evidence that the early use of an AED has a far more beneficial outcome for the casualty than if that intervention is delayed.

For employers this does not mean you have to purchase a defibrillator for your workplace as the requirement for a defibrillator is still dependent on your needs assessment.  Neither do you have to retrain all your existing first aiders as they will be updated in this skill when they requalify.

For those who deliver EFAW and FAW training the change means that you should ensure that students are trained and assessed on how to use an AED from the 31 December 2016 within the existing timeframe allowed for the delivery of either EFAW or FAW training.  HSE has no objection if training providers wish to adopt this change before the 31 December.

HSE updated stance on Blended Learning

Advice to Employers on the use of Blended Learning* in First Aid Training

Blended learning is an accepted means by which workplace first aid training can be delivered.  It is important that Employers conduct the necessary additional checks (due diligence) to decide if staff should be trained in first aid using this method (a combination of electronic distance based and face to face classroom based instruction).  This means you should make sure:

  • you are satisfied that where first aid training comprises of blended learning, it is as effective as exclusively face to face learning;
  • the individual being trained knows how to use the technology that delivers the training;
  • the training provider has an adequate means of supporting the individual during their training;
  • the training provider has a robust system in place to prevent identity fraud; and,
  • sufficient time is allocated to classroom based learning and assessment of the practical elements of the syllabus.

Employers should also ensure they are complying with Regulation 13 of the Health and Safety Management Regulations 1999, which has a requirement  to ensure adequate time is set aside during the working day to undertake any first aid training employees receive.  HSE Guidance document GEIS3 will be updated to reflect this change.

* Blended learning is a combination of online learning and traditional face-to-face learning. For first aid training, this would be items such as roles and responsibilities and legislation as the online learning and then performing things like CPR and recovery position in the face-to-face time.

Lifesaving Defibrillators Often Behind Locked Doors, Study Finds

Devices that shock heart rhythm back to normal were not available 25 percent of time in emergencies

Powerheart G3 Plus

Public defibrillators can help anyone save the life of someone suffering cardiac arrest, but the devices are often kept behind locked doors, a new study finds.

At issue is the accessibility of devices called automated external defibrillators, or AEDs. They are portable, layperson-friendly versions of the devices doctors use to “shock” the heart out of cardiac arrest.

It’s now routine for paramedics to carry AEDs, and the devices are often available in large venues, such as airports and sports stadiums, as well as schools and private businesses. To live up to their full potential, though, those devices have to be readily available, said study author Timothy Chan, a researcher at the University of Toronto.

However, his team found, that’s often not the case. The researchers looked at the cases of 451 Toronto residents who went into cardiac arrest within 100 meters of an AED — about a football field’s distance. One-quarter of the time, the devices were behind locked doors. “If the AED isn’t accessible, it’s as if it’s not there at all,” Chan said.

The study found that AEDs in schools, office buildings, industrial sites and recreational facilities were most likely to be locked up, particularly at night or on weekends — which is not surprising, Chan noted, since such buildings are not open 24/7. Unfortunately, two-thirds of the cardiac arrests in this study occurred at night or over the weekend, Chan said.

He was to present the findings Sunday at the annual meeting of the American Heart Association, in Orlando, Fla. The data and conclusions should be considered preliminary until published in a peer-reviewed journal. The findings “ring true,” according to Dr. Clifton Callaway, an AHA spokesperson and a professor of emergency medicine at the University of Pittsburgh.

“One of our longstanding concerns is that AEDs are not always in locations that are clearly marked, or that people are aware of,” Callaway said. It makes sense, he added, that AEDs would also frequently be inaccessible — particularly those owned by private businesses. “A lot of businesses would buy these with their employees in mind, and not for the general public to use,” Callaway said.

He said local communities need to come up with “novel ideas” on how to make AEDs broadly available, and make sure that people know where the devices are located. There is work being done, both Callaway and Chan said. The PulsePoint Foundation, for example, has developed a smartphone app that allows users to locate local AEDs. Chan said companies are also working on ways to make AEDs available outdoors, in weatherproof, vandalism-proof containers.

But more innovation is needed, according to Chan. One possibility, he said, would be to bring banks on board and have AEDs available in ATM lobbies. In Japan, Chan noted, there are AED vending machines.

AEDs can be used to restore a normal heart rhythm in some cases of cardiac arrest. Most often, cardiac arrest occurs when the heart’s main pumping chamber stops contracting and begins to quiver chaotically — depriving the body of blood and oxygen. Without prompt treatment, it’s fatal within minutes.

Each year in the United States, about 360,000 people suffer cardiac arrest outside of a hospital, according to the AHA. Less than 10 percent of those people survive. The odds of survival do improve, however, if bystanders perform chest compressions or use an AED while waiting for paramedics to arrive.

Chan said it’s not clear how AED availability might have affected the survival of patients in his study. Callaway also pointed out that increasing AED availability is just one piece of the picture. The public also needs to know that the devices exist, and be comfortable using them.

Local CPR courses now include AED training, Chan said. But even without training, he added, anyone can use an AED: The devices automatically analyze the heart’s rhythm, then deliver a shock only if it’s appropriate.

Chan pointed to a widely reported study of “mock” cardiac arrests, where researchers found that untrained sixth-graders used AEDs almost as well as medical professionals did.

More information

The American Heart Association has more on cardiac arrest.

SOURCES: Timothy Chan, Ph.D., research chair, novel optimization and analytics in health, University of Toronto; Clifton Callaway, M.D., Ph.D., professor, emergency medicine, University of Pittsburgh Medical Center; Nov. 8, 2015, presentation, American Heart Association annual meeting, Orlando, Fla.


No driving licence without first aid training? New parliamentary bill could

New parliament bill seeks to force new drivers to obtain life-saving skills before qualifying for full license. An MP is seeking to introduce a new bill in parliament that would make first aid training a mandatory requirement before receiving a driving licence.
The Driving Licence (Mandatory First Aid Training) Bill has been presented to the House of Commons by Will Quince, Conservative MP for Colchester.

The bill, backed by the British Red Cross and St John’s Ambulance, calls for new drivers to undergo a four-hour practical first-aid course before they can be granted a licence.

So often there isn’t time for an ambulance to arrive, knowledge of first aid can be absolutely critical

Will Quince, MP

Quince says that if added to the statute book, his bill could reduce road deaths in the UK and increase knowledge among the population of important life-saving skills.

He bases this claim on a recent survey conducted on behalf of St John Ambulance, which found that 59% of respondents didn’t feel confident enough to save a life, while 24%, if they found themselves at the scene of a road traffic collision, wouldn’t take any action until an ambulance arrived.

If introduced, this legislation wouldn’t be unique: a number of countries – including Germany, Switzerland, Czech Republic and Austria – have similar laws in place. Switzerland, for example, requires new drivers to prove that they have had at least 10 hours of first-aid training in order to qualify for their driving theory test.

When presenting his bill, Quince said: “A review of road traffic in Europe cited by the World Health Organisation claims that 50% of deaths from road collisions occurred within a few minutes of the crash.

“So often there isn’t time for an ambulance to arrive, knowledge of first aid can be absolutely critical. Immediate initiation of CPR, for example, can double or even quadruple survival from cardiac arrest.

“But the sad reality is that in Britain the knowledge of first aid is patchy. Through no fault of their own, people do not feel confident enough to intervene and provide first aid in crash and accident situations.”