Epi-Pen Policy

August 26, 2026 | by dsmallwood

NOC Science and Math High School Epinephrine Protocol

This Standing Protocol (SOP) is attached to and accompanies the “Recognition of Epinephrine as a Life-Saving Medication, Standing Order for the Distribution or Dispensing of Epinephrine, and Standing Protocol for the Administration of Epinephrine” issued by the Louisiana Department of Health, Office of the Secretary on April 1, 2026.

Purpose of Epinephrine: Epinephrine is a medication used for the purpose of being administered to any child or adult who is experiencing an acute allergic reaction (anaphylaxis).

Training Requirements:

Training must include the following:

• How to prevent, recognize, and manage anaphylaxis
• Indications, contraindications, and precautions related to epinephrine • Epinephrine administration techniques including intramuscular (IM) injection, such as EpiPen® and Auvi-Q®, and intranasal administration, such as Neffy® • Necessity of promptly calling 911 for further care of effected

individual(s)

Indications: Intramuscular (IM) epinephrine (1:1,000) (EpiPen or EpiPen Jr®, Auvi-Q®, and authorized generics) and intranasal (IN) epinephrine (Neffy®) are indicated for the treatment of severe allergic reactions including anaphylaxis to insects, foods, drugs, or other substances.

Anaphylaxis is a potentially life-threatening reaction that occurs promptly (typically within a few minutes to a couple of hours) after exposure to a known allergen and when any one of the following three sets of criteria is met (see Figure 1):

• Criteria Set 1: Skin symptoms, PLUS respiratory symptoms or blood pressure drop in blood pressure
• Criteria Set 2: Symptoms from TWO of the following systems: skin, respiratory, gastrointestinal, cardiovascular
• Criteria Set 3: Sudden drop in blood pressure.

Left untreated, anaphylaxis can ultimately lead to death via respiratory and circulatory collapse. Calling 911 as soon as possible is always the correct action. Call nursing staff in the SBHC when on campus 504-613-5648.Nursing Staff stocks Epinephrine for emergency use.

Figure 1. Anaphylaxis can present differently in different people but is present when the described sets of signs/symptoms are present. Image used with permission from Code Ana.

Dosing:

IM epinephrine is available in three doses:

- 0.1 mg for children weighing 7.5-15 kg (16.5-33 lbs.)

- 0.15 mg for children weighing 15-30 kg (33-66 lbs.)

- 0.3 mg for adults and children weighing 30 kg (66 lbs.) or more IN epinephrine (Neffy® 2 mg) is available in one dose:

- 2 mg for adults and children weighing 30 kg (66 lbs.) or more

- 1 mg for children 4 years and older weighing 15-30kg (33-66 lbs.)

Note: Upon FDA approval in 2025, intranasal epinephrine (Neffy®) is safe for use in children aged 4 years and older, weighing 15-30 kg, at a dose of 1 mg per spray in a single nostril.

Figure 2. Types of epinephrine devices FDA-approved to treat anaphylaxis.

Storage and Availability

IM and IN epinephrine should be stored according to the manufacturer’s instructions, which include being stored at room temperature and away from light, moisture and heat. It should not be refrigerated or frozen.

IM and IN epinephrine should be placed in an easily accessible and well-known location that is not accessible by children.

Recognition of an acute allergic reaction (anaphylaxis) may include the following symptoms:

• Swelling to the face, lips, tongue or throat
• Hives (raised red rash) or extreme pallor (whitening of skin)
• Difficulty breathing (coughing, stridor, or other respiratory symptoms) • Sudden-onset nausea and vomiting
• Weak or absent pulse (indicating low blood pressure)
• Sudden change in mental status

There is NO ABSOLUTE CONTRAINDICATION to administering IM or IN epinephrine to a child or adult experiencing a severe allergic reaction (anaphylaxis).

Protocol for Administering Intramuscular Epinephrine

Step 1: Confirm signs and symptoms of acute allergic reaction (anaphylaxis)

Step 2: Call 9-1-1 and administer IM epinephrine per manufacturer’s instructions, which may include:

1. In a safe location, have subject lay flat.

2. Remove device from its carrying case.

3. Remove safety guard.

4. Place needle-end to the outer thigh, then apply firm pressure to inject the medication. Hold in place for 2-10 seconds, depending on the device. 5. Have patient continue to flat until EMS arrives.

For specifics on using the device, refer to manufacturer’s instructions and to your entity’s selected epinephrine training program.

Protocol for Administering Intranasal Epinephrine

Step 1: Confirm signs and symptoms of acute allergic reaction (anaphylaxis)

Step 2: Call 9-1-1 and administer epinephrine per manufacturer’s instructions, which may include:

1. In a safe location, have subject lay flat.

2. Remove device from its packaging.

3. Hold device with thumb on plunger and pointer and middle fingers on either side of the nozzle.

4. Insert the nozzle into the nose until the pointer and middle fingers are touching the nose. Point the nozzle toward the middle of the person’s forehead, NOT toward the middle of the nose.

5. Press the plunger to spray the medication into the nose. The subject should not sniff during or after the dose.

6. Have patient continue to flat until EMS arrives.

For specifics on using the device, refer to manufacturer’s instructions and to your entity’s selected epinephrine training program.

Policy is adopted from the State of Louisiana Standing Protocol for the administration of Epinephrine issued by the Department of Health, Office of the Secretary.

Adopted August 2026.