Aim To determine the policies and training in schools for the management of children at risk for anaphylaxis.

Methods A questionnaire was posted to the head teacher/SENCO of all schools in local borough. Information regarding adrenaline-injector device (AID) allocation, training of staff and its frequency was elicited. Information was also sought on the prevalence of AID in schools.

Results 23 schools responded. Every school had at least 1 child for whom an AID was kept at school. 87 of 10 135(0.85%) school children had an AID at school. All schools had a list of children with allergies although only 52% had an allergy management plan (AMP) for each of these children. In only 57% of schools were AMP updated annually. A majority of schools had two AID per child (56%). In 39% AID were kept in more than one site. The classroom (52%), school office (48%), and medical room (30%) were commonest areas. Only one school kept AID in the dining room. In only 9% schools were all staff trained to administer an AID. In 83% teachers plus other members of staff were expected to administer epinephrine. In four schools only specific staff were trained. In three schools the affected child was expected to self-administer an AID if needed, although a teacher/teaching assistant was trained too. Training occurred at least annually in 65% of schools, in 26% it was less frequently, and 9% of schools stated no repeated training occurred. In 74% of cases training was performed by the school nurse, in one case parents trained staff and in another, trained staff trained others. St. John's Ambulance had provided training in two schools. 70% of respondents wanted more training in the management of anaphylaxis.

Conclusions The number of children with AID in schools has increased and there is a wide variation in practice between schools. Improved communication between families, health care providers and schools, combined with providing improved ongoing education and training of school staff will improve safety.