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ASTHMA
Letter to Parents – Asthma .........................................................................................................1
Asthma Action Plan ...................................................................................................................2
Self-Medication for Asthma Inhalers Authorization Form ........................................................3
Fact Sheet – Asthma ..................................................................................................................5
Early Signs of an Asthma Episode.............................................................................................7
Common Medicines Used for Asthma .......................................................................................8
Respiratory Assistance: Inhaler .................................................................................................9
Respiratory Assistance: Mechanical Nebulizer .......................................................................11
Cleaning and Care of the Nebulizer .........................................................................................13
How to Use a Spacer ................................................................................................................14
Asthma Inhaler Law .................................................................................................................15
Am. Sub. HB 121 Act Summary .............................................................................................16
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TO:
FROM:
DATE:
Parents
LETTER TO PARENTS
ASTHMA
School Health Clinic
SUBJECT: Asthma
You have told us that your child has asthma
Please fill out the attached Asthma Action Plan and return it. I will share the information with the appropriate personnel such as your child's classroom teacher(s) and physical education teacher. This information will help them work with your child to minimize unnecessary restrictions, feelings of being treated differently, and possible absenteeism.
To help your child, please let us know of changes in your child's asthma or medication schedule.
Enclosure
Asthma Page ]-10/112006
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ASTHMA ACTION PLAN
Student Information:
Student: _______________________________________________________________________ Birthdate: _____________________
School: Grade/Rm. _____________________________
Emergency Information:
Parent(s) or Guardian(s) ___________________________________________________________________________________________
Mother: Tel (W) ____________________________________________ Tel (H) _______________________________________
Father: Tel (W) ____________________________________________ Tel (H) _______________________________________
Healthcare Provider ______________________________________________ Tel _______________________________________ In case of emergency, contact:
1. Name ____________________________________________________________ Tel _______________________________________
2. Name ____________________________________________________________ Tel _______________________________________
Asthma Emergency Action:
The following are possible signs of an asthma emergency: • Difficulty breathing, walking, or talking • Blue or gray discoloration of the lips or fingernails • Failure of medication to reduce worsening symptoms.
These signs indicate the need for emergency medical care. The steps that should be taken: • Activate the emergency medical system in your area. Call 911. • Call Parent/Guardian and/or Healthcare Provider
Triggers: ________________________________________________________________________________________________________________
Name of Medication
Dosage
Time
Start Date End Date Steps for an Acute Asthma Episode (to be completed by physician)
1. _________________________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________________________ 4. _________________________________________________________________________________________________________________________
Signature of Parent/Guardian____________________________________ Date________________
Signature of Prescriber _________________________________________ Date________________ PLEASE COMPLETE NEXT PAGE FOR PERMISSION TO CARRY INHALER Revised 3/2015 Proprietary information of PSI Affiliates, Inc. Asthma Page 2
************SELF-MEDICATION FOR ASTHMA INHALERS*************
Authorization
(In accordance with ORC 3313.716/3313.14)
Please check if STUDENT is permitted by healthcare provider to CARRY an inhaler and SELF- MEDICATE at school. Complete the following and parent/guardian and healthcare provider must SIGN below: Medication __________________________________________________________________________________________________ Dosage/Time(frequency) _______________________________________________________________________________________ Date to Begin Date to End Administration ____________________________________________ Administration ___________________________________
Adverse reactions that should be reported to physician: Adverse reactions for unauthorized user: Procedure to follow in the event that medication does not produce the expected relief from student’s asthma attack: Other special instructions:
Prescriber and Parent/Guardian Names and Signatures REQUIRED for Self Medication
of Asthma Inhalers:
Prescriber Name_____________________________________________________ Tel _______________________________________ Signature of Prescriber _____________________________________________ Date _____________________________________
Parent/Guardian Name(s) __________________________________________ Tel _______________________________________ Signature of Parent/Guardian _____________________________________ Date _____________________________________
Copies must be provided to the principal and to the nurse.
Revised 3/2015 Proprietary information of PSI Affiliates, Inc. Asthma Page 3
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FACT SHEET ASTHMA
Asthma - the number I chronic disease of childhood. Out of control, asthma can distort a child's life and rule the entire fumily.
But it doesn't have to be that way - and for most, it isn't.
With understanding parents, eJrective medications and self.;:are techniques such as breathing and relaxation exercises, most children with asthma lead normal lives.
Facts about Asthma
One in 15 children will have at least one asthma episode, and for one in 40, the condition is chronic. An estimated 2.1 million children under age 17 have it. It does seem to run in families. It's the No. I cause of school absenteeism. It's not contagious, seldom fatal and can be expensive, for medications and medical care. Though rarely futal, asthma can be debilitating and frightening.
Attacks often occur with little notice, and may last from minutes to days. Nighttime asthma is common: a child's airway may narrow at night due to fatigue, and during sleep, mucus collects in the airway and lungs.
You can barely tell some children have asthma, but others are so severely aJrected that they are bedridden or hospitalized for months.
What causes asthma? Medical researchers aren't sure. It's known that allergies can trigger asthma, but they're not the only cause.
During an asthma attack, the muscles that control the air passages constrict and go into spasm. That narrows the airway. It becomes hard for the child to get air in or out ofthe lungs. The air passages may swell and secrete excess mucus, which interferes with breathing.
Warning Signals
Look for these as clues that an asthma attack is coming on: anxious or scared look, unusual paleness or sweating, tiny pupils of eyes, flared nostrils, breathing through pursed-lips, fast or irregular breathing, vomiting, hunched-over body
Asthma
posture, fidgeting, restless sleep, futigue, coughing when the child has no cold, clearing of the throat, noisy and difficult breathing, and above all, wheezing.
What to do: Stay calm, constantly reassure the child, give prescribed medication and liquids and get the child to rest. !fyou know what triggered the attack, remove it. The child might try breathing and relaxation exercises.
Triggers of Asthma
1. Allergy-producing substances like pollen, animal dander, molds, dust;food and drugs.
2. Respiratory infections such as colds and flu. 3. Emotional stress, including sadness, worry,
anger and laughing too hard. 4. Strenuous exercise, such as running too fust or
walking up stairs too fust. 5. Irritants such as chlorine, perfume, cigarette
smoke, paint fumes, aerosols and air pollution. 6. Sudden changes in temperature and/or
humidity. Windy weather may be a trigger, and the humid dog days of summer can be a bummer.
How to Prevent Asthma Attacks
1. Avoid all six triggers. Some fumilies get rid of their pets, eliminate certain foods from the fumily diet (wheat, eggs, chocolate and peanut butter are among the most common), and even move.
2. Quit smoking immediately, and don't let guests smoke.
3. Keep the child home when it's extremely hot or cold, if possible.
4. Plan regular exercise, especially the kind that develops lung capacity. Swimming is terrific.
5. Make sure the child takes all prescribed medications exactly as the doctor says.
6. Don't give a child sleeping pills or sedatives. 7. Make sure the child won't come near fumes
from insecticides, cleaning fluids, chlorine, flesh paint, etc.
8. Keep a record of the incidence and severity of asthma symptoms - loss of sleep, wheezing, coughing, etc. - and look for patterns in where and when attacks occur. Discuss it with your child's physician to draft a prevention strategy.
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Asthma Medications
Medicines come in liquids, pills, powders, vapors and injections, because each case of asthma is dilfurent. Some children take regular daily doses; others take medicine only when they expect to encounter a trigger or when they teel an attack coming on.
One of the commonly used medicines is theophylline, which helps relax and open airways, lasting for several hours. Also common is adrenaline, but it only lasts for 15 to 20 minutes and is used for acute attacks.
A relatively new drug is cromolyn sodium. The child can inhale it via an inhaler device, or nebulizer, to prevent asthma attacks. The inhaler is handy at school or before taking part in sports.
Children with severe asthma may take corticosteroids, a hormone in carefully controlled doses.
Never give your child an over-the-counter drug, such as an antihistamine, without fll'St discussing with the child's doctor.
Effect on the Child
Emotional factors definitely alrect asthma. A child who feels diffi,rent or left out is subject to sadness and depression. So help your child toward normalcy. Encourage your child to increase his Or her self-awareness. Channel energies into swimming and other pursuits.
Don't teach your child that it pays to be sick. Don't let your child actually look forward to asthma because it gets him out of school or chores. Don't hassle the child with unnecessary restrictions; let the child test his or her own limits. That builds self-esteem.
Think ahead. Anticipate difficult situations and make them easier for your child.
What Else Can Parents Do?
Above all, educate yourself about asthma. Talk to doctors, nurses, other parents. Never be ashamed to ask questions, and never trust your memory; write instructions down.
Meet in person with your child's teacher and school nurse. Ask them to team up with your child to help recognize warning signals and act accordingly.
The more you know about managing asthma, the more confidence you will have. That will help your child. Learn to show concern, but not panic. Don't overcompensate and spoil your child. Asthma is a special challenge fur a child. But it's one that millions of people live with every day.
It takes patience and practice. But all an asthmatic child needs is what any child needs: reassurance, attention and love.
Your child's physician is an excellent source offurther information about illness.
Source: CHILDREN'S MEDICAL CENTER, 281 Locust Street Akron, Ohio 44308. This infonnation is ofagenoral nature and is not intended to serve as a substitute for the advice ofa physician.
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EARLY SIGNS OF AN ASTHMA EPISODE
Students who have asthma often learn to identifY their early warning signs - the physical changes that occur in the early stage of airway obstruction. These early warning signs usuaUy happen long befure more serious symptoms occur. Being aware of these early warning signs allows the student to IRke medication at a time when asthma is easiest to control. Teachers should encourage students to be aware of these early symptoms, and to take the proper action immediately.
Knowing the signs of a beginning episode will help you and other stalftRke appropriate measures to avoid a more serious medical emergency. There should be no delay once a student has notified the teacher ofa possible problem.
A student may exhibit one or more of these signs during the initial phase of an asthma episode:
1. Cbanges in breathing may include: coughing; wheezing;
• breathing through the mouth; • shortness of breath andlor rapid breathing.
2. Verbal complaints. Often a student who is familiar with asthma will know that an episode is about to happen. The student might teU the teacher that:
the chest is tight; the chest hurts;
• helshe cannot catch a breath; • the mouth is dry;
the neck feels funny; andlor a more general "I don't fuel well."
3. Otber signs may be: an itchy chin or neck - some people may rub their chin or neck in response to th is feeling, or
• "clipped" speech - the student may speak in choppy sentences.
_ Managing Asthma, A Guide for Schools. National Heart, Lung, and Blood Institute (NHLBI). Nationallnstitures of Health, U.S. Department of Health and Human Serv ices, and the Fund fur the hnprovement and Reform of Schools and Teaching, Office of Educational Research and hnprovement (OERl), U.s. Department of Education, September 1991. NIH Publication No. 91·2650.
Asthma Page 7 - 101112006
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COMMON MEDICINES USED FOR ASTHMA VENTOLIN AND PROVENTIL (ALBUTEROL)
Side Effects
• nervousness • restlessness
• insomnia • tremor • headache • hypertension • nausea/vomiting
Teaching
• take medicine only as prescribed • do not double dose • do not exceed recommended dose • contact physician inuncdiately if shortness of breath is not relieved by medicine or is
accompanied by diaphoresis, dizziness or chest pain • consult with pharmacist before taking any over the counter medications • instruct in the proper use of the metered-dose inhaler or rotohaler • use this medicine fITst if using other inhalation medications unless otherwise directed.
Instructions on How to Use This Medicine
1. Shake the inhaler weU inunediately before each use. Then remove the cap from the mouthpiece. The inhaler mouthpiece should be inspected for the presence of foreign objects before each use. Make sure the canister is fully and fumly inserted into the actuator.
2. Breathe out fully through the mouth, expelling as much air from your lungs as possible. Place the mouthpiece fully into the mouth, holding the inhaler in its upright position and closing the lips around it
3. While breathing in deeply and slowly through the mouth, fuUy depress the top of the metal canister with your index fInger.
4. Hold your breath as long an possible. Before breathing out, remove the inhaler from your mouth and release your fInger from the canister.
5. Wait one minute and shake the inhaler again. Repeat steps 2 through 4 for each inhalation prescribed by your doctor.
6. Cleanse the inhaler thoroughly and frequently. Remove the metal canister and cleanse the plastic case and cap by rinsing thoroughly in warm, running water at least once a
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day. After thoroughly drying the plastic case and cap, gently replace the caniSter into • the case vvith a twisting motion and put the cap back onto the mouthpiece.
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RESPIRATORY ASSISTANCE:
INHALER AN INHALER DELIVERS MEDICATION DIRECTLY TO THE LUNGS.
I.
IL
1II.
Personnel Involved A. Clinic staff B. Designated school personnel under indirect supervision
·C. School nurse as an indirect procedural supervisor
General Information A. The inhaler is used when medication to open or dilate the bronchial tubes must be delivered
directly to the lungs. B. The use of medication and the inhaler requires a physician's written authorization. This
service must be reauthorized yearly by the prescribing physician and parent or guardian.
Guidelines A. Purpose: To improve breathing by administering medication directly into the lungs (To
prevent an attack or to control an attack that has begun, asthmatics can use an inhaler before exercising.)
B. Equipment 1. Inhaler with tube (Various brands are available.) 2. Prescribed medication 3. Aerosol chamber or bubble reservoir ifprescribed
Inhaler - Procedure
Essential S te s Key Points and Precautions
I.· Determine the need fur pupil to use an inhaler at school by reviewing the physician's order.
To get the medication directly to the lungs, the technique with the inhaler must be correct. If the inhaler cannot be used correctly, an aerosol chamber or bubble reservoir may be attached to the inhaler. This method allows the medication to be held until the pupil is ready to breathe in.
2. Wash hands.
3. Attach the inhaJer to the tube if necessary.
4. Shake the inhaler well.
5. Have the pupil: a. Hold the inhaler in one hand in an
upright position. In the other hand hold the tube attached to the inhaler.
b. Breathe out to the end of a normal breath.
c. PI= the tube in the mouth. d. Tilt the head slightly back and start
to breathe in slowly.
The right amount of medication may not spray out if the inhaler is not shaken well.
The inhaler will stop spraying if it is held upside down. See the manufucturer's directions fur the correct position.
Breathing in too fust makes most of the medicine stick in the mouth and throat rather than being delivered to the lungs.
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Essential S te s
6. Spray the inhaler at the start ofanormal breath.
7. Breathe in as deeply as possible over 2 to 3 seconds.
8. Take the inhaler out of the mouth and hold the breath 8 to 10 seconds. a. Repeat the procedure if another puff
is required. b. Record the use of the inhaler and
medication on the pupil's medication record.
9. Determine the condition of the pupil based on the posttreatment status.
Ke Points and Precautions
If sprayed at the end of a breath, the medication will not work as well.
Wait 5 to 10 minutes between puffS. Do not let the pupil take more puffs than directed by the physician.
Contact the parent and consult with the physician as needed.
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RESPIRATORY ASSISTANCE: MECHANICAL NEBULIZER
A MECHANICAL NEBULIZER CONVERTS A LIQUID TO A FINE SPRAY.
I. Personnel Involved A. Clinic staff B. Designated school personnel under indirect supervision C. School nurse as an indirect proceduml supervisor
II. General Information
III.
A. A mechanical nebulizer is powerod by either oxygen or compressod air that produces a stable aerosol of fluid particles.
B. An ultrasonic nebulizer contains fluid in a chamber that is vibrated rapidly, causing the fluid to break into small particles that are then cattiod by a flow of compressed air or oxygen to the pupil.
C. This procedure requires a physician's written authorizmion. This service must be reauthorized yearly by the prescribing physician and the parent.
Guidelines A. Purpose: To improve breathing by the administration ofbronchodilators, mucolytics, or other
modications directly into the lungs by means of aerosol instillation; and t provide an atmosphere of high humidity to assist the breakup of pulmonary am bronchial secretions and aid the pupil in coughing them up
B. Equipment {Parents are responsible for providing and maintaining equipment. I. Air compressor or oxygen 2. Oxygen nipple adapter 3. Connection tnbing 4. Mechanical nebulizer manifold or ultrasonic nebulizer with cup and mask 5. Medication or saline solution
Mechanical Nebulizer - Procedure
Essential Steps Key Points and Precautions
I. Determine the need for the pupil to use the nebulizer at school by reviewing the physician's orders.
2. Assess the pupil's respirations.
3. Monitor the heart rate before and ~r treatment by taking a pulse when bronchodilators are administered.
4. Assemble equipment and modication, as ordered, near the pupil.
Establish a baseline for rate, depth, efihrt, noise, color, restlessness, and level of consciousness.
Bronchodilators may produce tachycardia, rapid heartbeat, palpitation, dizziness, nausea, and excessive perspiration.
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Essential Ste s
5. Explain the procedure to the pupil.
6. Wash hands.
7. Place the appropriate amount of medication and saline solution or water in the nebulizer.
8. Place the pupil in a comfortable sitting . position.
9. Have the pupil demonstrate mouth breathing. Have him or her practice if necessary.
10. Attach the nebulizer hose to the air compressor or to oxygen and tum it on. A fme mist should be visible.
11. Follow the instructions from the manufucturer when an ultrasonic nebulizer is used.
12. Have the pupil place the mouthpiece in his or her mouth if possible.
13. Tell the pupil to breathe in and out through his or her mouth.
14. Every 2 minutes, or as ordered, have the pupil take an extra deep breath or two, hold his or her breath briefly; then exhale as slowly as possible. Resume nonnal breathing until time for the next deep breaths.
15. Observe the expansion of the pupil's chest.
16. Remove lbe mouthpiece or mask if a cough occurs during the treatment, and allow the pupil to clear !be secretions completely and then continue the treatment.
17. Give the pupil time to rest during lbe procedure if nceded.
1(, Poini;:(Jnd Precautions
Use language and demonstration melbods that are appropriate !iJr the pupil's level of development because the effectiveness of this therapy depends on the pupil's efforts.
Do not exceed the ordered amount.
Expansion of the lungs and movement of lbe diaphragm are greatest in this position, allowing for maximum treatment of the basilar areas of the lungs. Instruct and demonstrate the technique as needed.
A flow rate ftom 5 to 6 to 8 to 10 liters per minute will provide a treatment time of about 8 to 10 minutes.
Instructions vary. See the physician's orders.
Use a mask if the pupil cannot use the mouthpiece.
When output ftom the nebulizer appears to have decreased, unplug the device and check the tiny opening for clogging. If the opening is clogged, carefully run a pin through it and rinse it w.ell.
Noseclips are sometimes used if the pupil has difficulty breathing only through his or her mouth. (This step is perfonned under a physician's directions.)
This technique allows the medication to remain in the lungs longer and fll.cilitates dispersion of the particles.
Deep breaths ensure that the medication is deposited below the oropharynx.
Tum off the machine when it is not being used.
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Essential Ste s
18. Observe the pupil for any adverse reactions such as wheezing (bronchospasm) and excessive fluid deposition causing suffi:Jcation.
J(, Points and Precautions
Wheezing indicates air turbulence and may result from the irritating efrect of the medication on the airway or from inability to expectorate the loosened secretions. Wheezing may also indicate improvement of the rur exchange if little air movement occurred previously.
19. Continue the procedure until all the Note the length oftime fur this process, medication or fluid has been nebulized.
20, Have the pupil take several deep breaths, Demonstrate the procedure ifneeded, cough, and spit out the secretion after the treatment.
21. Wash your hands; have the pupil wash his their hands.
22, On the medication administration log, document the use of the nebulizer, with or without the pupil's having been given medication.
, Record the date and time, the name of the medication used, the duration of the treatment, the respiratory rate and uJfurt, the heart rate before and after the student has been treated with bronchodilators. and a description of the secretions expectorated .
CLEANING AND CARE OF THE NEBULIZER
Thorough cleaning should be done at home.
AFTER EACH TREA TMENT:
1. Rinse the nebulizer, mouthpiece. andlor mask under hot running water.
2. Shake off the excess water.
3. Lay these parts on a clean cloth or towel to dry.
4, Cover the nebulizer parts with a cloth or towel.
5. When the parts are dry, store them in a clean plastic bag, the top of which can be sealed. The tubing does not have to be cleaned. but it should be stored in the same bag with the other equipment.
Asthma Page 13 -10/112006 AffiHa~s, Inc. May not be copied without consent.
HOW TO USE A SPACER
A SPACER IS A CHAMBER THAT HOLDS THE MEDICINE DELIVERED BY AN INHALER UNTIL YOU ARE READY TO BREATH IT IN.
--Inhaler
Inhaler adaptor.
Flow signal whi[!:tIi~· (on some models~
Mouthpiece
Cap
Steps 1. 2. 3. 4. 5.
6.
7.
Remove the cap from the inhaler and shake the inhaler. Insert the inhaler into the spacer. Breathe out as much as you can fully and gently. Also keep your chin up. Place the opening of the spacer in your mouth with your lips closed tightly around it. Press the canister top finnly, discharging the medication into the chamber of the spacer. Then breathe in slowly (over 3 - 5 seconds). Remove inhaler from your mouth and hold your breath for 10 seconds. Then breathe out slowly through your nose. If your doctor instructed you to take more than one puff, wait at least one minute. Shake the inhaler and repeat the above process.
All types of metered dose inhalers can be used with a spacer.
Spacers can be particularly helpful in getting the medication to your lungs and in preventing throat irritation or the development of a yeast infection related to taking inhaled corticosteroids.
Different brands of spacers are available in the market place. One of the most effective is the OptiChamber. Others include the AeroChamber and the InspirEase Holding Chamber.
-University Allergy and Asthma Center
Astluna Page 14 -101112006
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ASTHMA INHALER LAW ENACTED AUGUST 1999
An asthma inhaler bill was passed in Ohio in August 1999. This bill allows students to self-administer inhalers in schools.
The amendment included the addition of instructions "that outline procedures school personnel should follow in the event the asthma medication does not produce relieffiom a student's asthma attack," and the addition of emergency phone numbers for the parent/guardian and physician. This language was proposed to protect the health of the student. Other than school nurses, few school personnel are trained to manage the treatruent of an asthma attack or to recognize a serious tum of events should the asthma medication not produce relief. Written instructions that outline proper procedures for school personnel to follow will help safeguard the child's well being and could save a life. Children with severe asthma have been known to have an attack, treat it properly with the medication prescribed and still have breathing deteriorate so rapidly that they are unable to speak. The written instructions would speak for them. Since there is not a sehool nurse in every school bUilding, it is imperative that written instructions be provided so that teachers, coaches, substitute teachers, secretaries, principals, bus drivers and parent volunteers on field trips, will be able to act swiftly and appropriately should the student not receive relief from an asthma attack.
SUMMARY OF LAW
This law permits students of school districts, community schools and chartered nonpublic schools to carry asthma inhalers with the consent of the students' physician and parents. In addition, the bill would grant immunity to school districts, community schools, and chartered nonpublic schools and their employees for good faith actions in connection with this permission .
The written approval form shall include at least all of the following:
1. Physician and parent/guardian written authorization; 2. The student's name and address; 3. Name and dose of tile medication contained in the inhaler; 4. Date administration is to begin and cease; 5. Written instructions that outline procedures school personnel should follow in the event the
medication does not produce the expected relieffrom the srudent's asthma attack; 6. Side eff"ects or severe reactions that may occur to the child for whom the medication was prescribed or
to any other child using the inhaler; 7. Emergency phone numbers for physician, parent andlor guardian; 8. Other special instructions.
The school principal and school nurse should receive a copy of the written approval.
School nurseS are now challenged to promote the health oftheir students with asthma by:
Interpreting this new law to parents, physicians, teachers, administrators staff and srudents. • Work with school personnel to review and update school districts' medication policies including issues
regarding self-administration (A school district may choose to make more restrictive procedures to follow when a child uses an inhaler. For example, a student may be asked to report to an adult when the inhaler is used or be sent to the health office to be assessed by the nurse.)
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AM. SUB. HB 121 ACT SUMMARY
Permits public Or chartered nonpublic school students to use an.inhaler to self-administer asthma medication with the written approval of the parent and physician.
Removes any cause of action against a school district and its board of education or employees, or against any chartered nonpublic school or community school and its directors, officers, governing authority, or employees, for the fullowing:
(I) A school employee permits a student to use an inhaler because of a good faith belief that the required written approvals had been received;
(2) A school employee prohibits the student from using an inhaler because ofa good fuith belief that the required written approvals had not been received; or
(3) A student for whom the inhaler was not prescribed uses it.
Content and Operation
Self-administration of asthma medication (Sees. 3313.716(A) and 3314.03; Section 50.52.5 ofRB. 215 of the 122nd G.A.)
Continuing law (Sec. 3313.713, not in the act) contains extensive provisions for school districts to pennit or prohibit school employees from administering medications to students, but does not expressly cover the situation where a student would self-administer medications. However, under their general authority to operate schools and establish policy for the behavior of students on school premises (Sees. 3313.20, 3313.47. and 3313.661, not in the act), many school districts have adopted policies concerning possession and use of medications by students. Presumably, some of these policies could limit the ability· of a student to self-administer asthma medication.
The act expressly establishes the right of a student in a public school, community school, or chartered nonpublic school to possess and use a metered dose inhaler or a dry powder inhaler either before exercise to prevent the onset of asthmatic symptoms or to treat the symptoms once they occur. The right extends to any activity, event, or program sponsored by the student's school or in
Asthma
which the school participates.
In order to acquire the right to self..administer an inhalant under the act, the student must have the written approval of both the student's physician and (if the student is a minor) the student's parent or other caretaker. In addition, the school principal and the school nurse (if a nurse is assigned to the student's school) must have received copies of these required written approvals. The physician'S written approval must specny at least the following infonnation:
(1) The student's name and address; (2) The name and dose of the medication
contained in the inhaler; (3) The date the administration of the
medication is to begin; (4) The date, lfknown, that the
administration of the medication is to cease;
(5) Written instructions that outline procedures school personnel should follow in the event that the asthma medication does not produce the expected relief from the student's asthma attack;
(6) Any severe adverse reactions that may oecur to the child using the inhaler and that should be reported to the physician;
(7) Any severe adverse reactions that may occur to another child for whom the inhaler is not prescribed, should he or she receive a dose ofthe medication;
(8) At least one emergency telephone number for contacting the physiCian;
(9) At least one emergency telephone number for contacting the parent, guardian, or other person having care or charge of the student in an emergency; and
(10) Any other special instructions from the physician.
Immunity from tort liability (Sees. 3313.716(B) and 3314.14; Section 50.526 ofH.B. 215 of the 122ndGA.)
School districts, community schools, and their employees acting within the scope of employment generally have immunity from tort liability in the perfurmance of governmental ftmctiom through the sovereign immunity law (Chapter 2744. of the Revised Code). Under that law, unchanged by the act, the provision ofa system ofpubJic education is explicitly included as a governmental function and,
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accordingly, school districts have immunity from tort liability while providing "public education." In addition, courts have consistently held extracurricular activities to be part of the public education function.
Nonetheless, the act specifically states that under any circumstances, neither a school district nor any member of the board of education nor any employee is liable for injury, death, or loss to person or property when a district employee prohihits a student from using an inhaler because the emp loyee believes in good fuith that the required written approvals had not been received by the principal. Similarly, liabUity cannot accrue because the employee permits the use of an inhaler when the employee believes in good fuith that the written approvals have been received as required by the act. lt further asserts that school districts and their board members and employees are not liable for injury, death, or loss to person or property allegedly arising from the use by another student, fur whom the inhaler was not prescribed, of an inhaler that the act entitles a student to possess and use.
Identical immunities are granted to community schools and their governing boards and employees.
Asthma
The act also explicitly states that all immunities gtanted to school districts and community schools under the sovereign immunity law still apply.
Chartared nonpublic schools, as nongovernmental entities, do not acquire immunity under the sovereign immunity law. However, the act grants them and their employees, officers, and directors the same immunities from liability with respect to . student use of inhalers that it specifies for public schools and community schools.
Grandparent may sign in lieu of parent (Sec. 3313.64)
Under some circumstances, continuing law permits a student to attend school in a district where the student lives with a grandparent, instead of in the district where the parents reside. In this case, the act specifIeS that the grandparent may be asked by the district to complete the written "parental" approval required by the act for use of an inhaler. The school district would incur no liability fur accepting a written approval from the grandparent instead offtom the parent
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