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Comment by amluto | Hacker News Reader

I would love to see the way that ownership of these devices is managed. I find it rather obnoxious that every child who may need epinephrine is supposed to keep their own device at school — this means that each student needs an extra device, and most of them just sit around until expiration.

If the school could buy and store a reasonable number (funded, on a fractional basis, by the insurers of the students who need them) and use them as needed (with replacement paid for by the recipient’s insurance), the students’ lives would be simpler and a lot less money would be spent.

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Don’t those students still need the epipen when they’re at home or otherwise out of school?

Yes, but in addition to the one at home we also have to buy a separate one to sit in the nurse's office all year. Also, if the before/after school program doesn't have access to the nurse's office, we have yet another one that sits in their cabinet, too.

They all come home at the end of the year, expire, repeat.

I don’t understand what the plausible alternative policy is. Each kid needs a personal one for when they are at home. They presumably should bring it with them to school for quick action and also for if they have an episode while commuting. The school could decline to carry them to save a bit of money each year, but it seems unwise to rely on (1) kids never forgetting their medication and (2) an adult always knowing where to find the child’s medication if they are unresponsive. So shouldn’t the school have a few?

Every school should have a supply, period. Also makes sense for kids to carry.

Their complaint isn't that the school is stocking them. Their complaint is that each child that needs one available is required to provide a personal one to the school to store for use in case they have an emergency.

So instead of the school managing and restocking a reasonable number, the parents restock one each year.

Wouldn't the "reasonable number" to stock be the same? Let's say there's 8 kids that need the EpiPen. If there was a food allergy incident, it could be something like a school lunch event which means they need at least enough for every kid since they might all get the same reaction from all eating the same food. From reading these replies it looks like you need 2 for each person just in case they require a second dose, and replace them once a year.

So:

- if school stocks them for 8 kids: they need to replace 16 every year

- if the 8 kids families supply the stocks: they need to, in aggregate, replace 16 every year

Same amount. Obviously better if the school pays, but I'm not understanding the "reasonable number" part.

Where did you come up with the kids all having the same sensitivities?

A kid that regularly eats peanut butter but is very sensitive to bee stings doesn't need to plan to avoid strawberries.

And at some point, training the on site responders to inject from a vial is going to be pretty worthwhile.

I see. Yea I mean it depends on how many kids need them. If it’s just one or two kids, I don’t see how to avoid it.

I see the cost part, but on managing the devices it would either require:

- centralising all the devices in one point and have one or two trained professionals do the injections, which means a significant delay in case of emergency

- or training every professor to do injections, which isn't hard in theory, but time and cost consuming, puts more burden and restrictions on the staff (how do you deal with a 60yo math teacher who just wants to teach and not manage health emergencies ?)

And we're not going into the kids and the school staff properly communicating to get the person in charge to shoot the pen when the kid feel they need it.

Schools already have to solve exactly these problems. Kids with known anaphylactic reactions have an epinephrine autoinjector and possibly a little pack of antihistamines in a baggie, with the kid’s name on it, in the school nurse’s office. And there’s a piece of paper (generally a standard-ish form that may or may not be comprehensible) with specific instructions for that kid. This being America, the kid’s doctor absolutely does not take the time to write clear instructions for that kid.

The only thing that I’m suggesting should change is to have a pile of epinephrine auto injectors (or nose sprays) supplied by the school, so the parents would instead just supply the instructions.

We've seen these kind of settings, but some schools will refuse a kid with "special needs" and punt it to bigger/more prepared schools, while others won't go the full length.

We were in one that couldn't provide meals (kid comes with it's own lunch, and they can't touch anything else) and individual medication was on a special cabinet in the classroom, but accessed by the kids.

TBH it felt more reassuring to us, as we only had to care about our kid properly reacting, and not about a whole chain of events we have no idea how well a generic school prepares for.

> how do you deal with a 60yo math teacher who just wants to teach and not manage health emergencies

Is that an option? If you're an adult supervising kids over long enough time you will have an emergency. I remember at least 3 decent ones from primary school.

Isn't there a limitation on what teacher are allowed to do in most countries ?

I'd assume a teacher usually doesn't have the right to give medication to a kid, at least that's the rule we had when discussion with the school.

> Isn't there a limitation on what teacher are allowed to do in most countries ?

Obviously, yes.

> I'd assume a teacher usually doesn't have the right to give medication to a kid

We're talking here about emergencies and epipens. That's a bit beyond the "right to give medication" and in the good Samaritan laws territory.

The moment you put a system in place where the teacher isn't acting on its own as a human being in an unforeseen situation, but as the guardian of the cabinet where all the EpiPen are stored, you're required to codify who and under which circumstances gets access, who shoots, etc. Basically the organization gets involved as it sets the rules, and it's where the finger will be pointed when it all goes for the worse.

This is the primary reason it's the kid and the parents who are in charge, that's the discussion we had with the school staff.

> If the school could buy and store a reasonable number (funded, on a fractional basis, by the insurers of the students who need them) and use them as needed (with replacement paid for by the recipient’s insurance), the students’ lives would be simpler and a lot less money would be spent.

Except if there’s overlap in the cause of the incidents that necessitate the usage of the device. Which is very likely in the case of a food allergy driving the event.

Imagine being the principal and trying to explain, with a lot of pretty charts and statistics, why you only hand 6 devices for 12 child patients.

Liability. Not gonna happen.

Why not make the school liable for being unable to administer a simple treatment?

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