Pupils throughout Scotland will this week return to the classroom following their summer break. As lunches are prepared and school bags packed; we look at the implications for local authorities and public bodies arising from the death of 13 year old pupil Karanbir Cheema.
In June 2017 Karanbir was a pupil at William Perkin High School and was known to have severe allergies to wheat, gluten, egg, milk and tree nuts. A fellow pupil flicked cheese are Karanbir which landed on his neck causing a severe allergic reaction. There was a delay in administering an EpiPen dose which was found to be out of date. No second dose was administered and Karanbir later died in hospital.
An inquest into Karanbir’s death took place in May 2019. In her subsequent report, sent to nine different public bodies, Senior Coroner Mary Hassell set out numerous concerns arising from Karanbir’s death including:
- Pupils’ “patchy” understanding of Karanbir’s allergies;
- A failure to ensure the availability of two EpiPens in the school;
- The fact the EpiPen used was out of date;
- A failure to standardise allergy action plans across hospitals and schools;
- A lack of awareness nationally as to how EpiPens should be used, insufficient instruction provided and a failure in school staff’s first aid and EpiPen training;
- A failure by the 999 operator to suggest a second EpiPen should be administered.
Since 1 October 2017 under the Human Medicines (Amendment) Regulations 2017 schools have been allowed to obtain, without prescription, adrenaline auto-injector devices (AAIs) for use in emergencies on pupils who hold both medical authorisation and parental consent for adrenaline to be administered.
This change in the law was the result of an national campaign led by a number of leading allergy awareness charities. The Scottish government has since issued guidance in relation to the use of AAI devices in schools including proper procedures for storage and use of AAI devices, adequate risk assessment and staff training. As it stands however there remains no legal requirement for schools North or South of the border to hold AAI devices.
Karanbir’s death is being investigated by the Health and Safety Executive. However, calls are now being made by some, including leading allergy specialist Dr Adam Fox, to make it compulsory for schools to hold emergency adrenaline pens. Meantime schools have a duty of care towards all pupils in their care, and notwithstanding the lack of specific legal requirement to do so; it could be considered negligent not to hold AAI devices in schools.
Until such a time as it is compulsory for emergency AAI devices to be held in all schools, the onus is on the schools themselves to assess whether emergency AAI devices should be held. In the wake of this recent fatality it would be wise for schools to give serious consideration to whether or not this should be done. If AAI devices are to be stored it is crucial that schools ensure that proper procedure regarding the use and storage of AAI devices are put place. Practical steps which should be considered include:
- Keeping an up to date register of all children prescribed with an AAI device to ensure sufficient support is provide and consent for use of emergency devices is in place;
- Ensuring any emergency AAI devices are stored according to manufacturer’s guidelines in a safe and central location within the school and are checked on a monthly basis;
- Ensuring replacement devices are obtained when expiry dates approach;
- Ensuring up to date risk assessments are in place;
- Ensuring staff are provided with adequate training in relation to use of devices and are aware of their location.
Insurers, particularly those who regularly write business for local authorities, should have an awareness of legal developments in this area in order to assess the impact on any historic or current risks.