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Oregon Bulletin

November 1, 2012

Oregon Health Authority, Public Health Division, Chapter 333

Rule Caption: Treatment of Allergic Response.

Adm. Order No.: PH 14-2012

Filed with Sec. of State: 9-19-2012

Certified to be Effective: 9-19-12

Notice Publication Date: 8-1-2012

Rules Adopted: 333-055-0006, 333-055-0021

Rules Amended: 333-055-0000, 333-055-0015, 333-055-0030, 333-055-0035

Subject: The Oregon Health Authority, Public Health Division is permanently adopting and amending Oregon Administrative Rules relating to the treatment of allergic response in response to legislation passed in 2011 (SB 104, sections 8 & 9) along with making updates to outdated language and processes. The legislation that passed allows the training to be taught by an emergency medical service provider meeting requirements established by the Authority, specifies the proper administration of epinephrine, and lowers the eligibility training age from 21 to 18 years.

 The Public Health Division is responsible for the development of an educational training protocol on the treatment of allergic response to be used by providers to train individuals who have, or reasonably expect to have, responsibility for or contact with persons as a result of the individual’s occupation or volunteer status.

 These rules were last updated in 2004 and the changes address the following:

 Create definitions;

 Clarifies who may conduct the training;

 Creates a section on who is eligible to receive training; and

 Updates terminology and process for the training and statements of training completion.

Rules Coordinator: Brittany Sande—(971) 673-1291

333-055-0000

Purpose

(1) The purpose of OAR 333-055-0000 through 333-055-0035 is to define the procedures for authorizing certain individuals, when a licensed health care professional is not immediately available, to administer epinephrine to a person who has a severe allergic response to an allergen, and glucagon to a person who is experiencing severe hypoglycemia when other treatment has failed or cannot be initiated, and to define the circumstances under which these rules shall apply.

(2) Severe allergic reactions requiring epinephrine will occur in a wide variety of circumstances. Severe hypoglycemia requiring glucagon, in settings where children prone to severe hypoglycemia are known to lay providers and arrangements for the availability of glucagon have been made, will occur primarily in, but not limited to, school settings, sports activities, and camps.

Stat. Auth.: ORS 433.800 & 433.830
Stats. Implemented: ORS 433.800 - 433.830
Hist.: HD 10-1982, f. & ef. 5-25-82; HD 23-1990(Temp), f. & cert. ef. 8-15-90; OHD 7-1998, f. & cert. ef. 7-28-98; PH 14-2012, f. & cert. ef. 9-19-12

333-055-0006

Definitions

(1) “Allergen” means a substance, usually a protein, which evokes a particular adverse response in a sensitive individual.

(2) “Allergic response” means a medical condition caused by exposure to an allergen, with physical symptoms that may be life threatening, ranging from localized itching to severe anaphylactic shock and death.

(3) “Emergency Medical Services Provider (EMS Provider)” means a person who has received formal training in pre-hospital and emergency care and is state-licensed to attend to any ill, injured or disabled person. Police officers, fire fighters, funeral home employees and other personnel serving in a dual capacity, one of which meets the definition of “emergency medical services provider” are “emergency medical services providers” within the meaning of ORS chapter 682.

(4) “Hypoglycemia” means a condition in which a person experiences low blood sugar, producing symptoms that may range from drowsiness to loss of muscle control so that chewing or swallowing is impaired, to irrational behavior in which food intake is resisted, or to convulsions, fainting or coma.

(5) “Other treatment” means oral administration of food containing glucose or other forms of carbohydrate, such as jelly or candy.

(6) “Other treatment has failed” means the hypoglycemic student’s symptoms have worsened or the student has become incoherent, unconscious or unresponsive.

(7) “Paramedic” means a person who is licensed by the Oregon Health Authority as a Paramedic.

(8) “Supervising professional” means a physician licensed under ORS chapter 677, or a nurse practitioner licensed under ORS chapter 678 to practice in this state and who has prescription writing authority.

Stat. Auth.: ORS 433.810
Stats. Implemented: ORS 433.800 & ORS 433.810

Hist: PH 14-2012, f. & cert. ef. 9-19-12

333-055-0015

Educational Training

(1) Individuals to be trained to administer glucagon shall be trained under the supervision of a physician licensed under ORS chapter 677, or a nurse practitioner licensed under ORS chapter 678 to practice in this state. The training may be conducted by a registered nurse licensed under ORS chapter 678 as delegated by a supervising professional.

(2) Individuals to be trained to administer epinephrine shall be trained under the supervision of a physician licensed under ORS chapter 677, or a nurse practitioner licensed under ORS chapter 678 to practice in this state. The training may be conducted by a registered nurse licensed under ORS chapter 678 as delegated by a supervising professional, or a paramedic as delegated by an EMS medical director defined in OAR chapter 333, division 265.

(3) The training shall be conducted following an Oregon Health Authority, Public Health Division training protocol (or approved equivalent). The Public Health Division approved training protocol for emergency glucagon providers is available on the Internet at http://healthoregon.org/diabetes. The training protocol for the treatment of severe allergic reaction is available on the Internet at http://healthoregon.org/ems.

Stat. Auth.: ORS 433.810
Stats. Implemented: ORS 433.800 - 433.830
Hist.: HD 10-1982, f. & ef. 5-25-82; HD 23-1990(Temp), f. & cert. ef. 8-15-90; OHD 7-1998, f. & cert. ef. 7-28-98; PH 10-2004, f. & cert. ef. 3-23-04; PH 14-2012, f. & cert. ef. 9-19-12

333-055-0021

Eligibility for Training

In order to be eligible for training, a person must:

(1) Be 18 years of age or older; and

(2) Have, or reasonably expect to have, responsibility for or contact with at least one other person as a result of the eligible person’s occupational or volunteer status, such as, but not limited to, a camp counselor, scout leader, forest ranger, school employee, tour guide or chaperone.

Stat. Auth.: ORS 433.810
Stats. Implemented: ORS 433.820
Hist.: PH 14-2012, f. & cert. ef. 9-19-12

333-055-0030

Statement of Completion of Training

(1) Persons who successfully complete educational training under OAR 333-055-0000 through 333-055-0035 shall be given a Public Health Division statement of completion signed by the individual conducting the training. The statement of completion for the treatment of allergic response training may also be used as an authorization to obtain epinephrine if fully completed and personally signed by a nurse practitioner or a physician responsible for the training program. Statements of completion for the treatment of allergic response training may be obtained from the Oregon Health Authority, Public Health Division, 800 NE Oregon Street, Suite 290, Portland, Oregon 97232, Phone: (971) 673-1230. A statement of completion for emergency glucagon providers is included in the training protocol available at http://healthoregon.org/diabetes.

(2) The statement of completion and authorization to obtain epinephrine form allows a pharmacist to generate a prescription and dispense an emergency supply of epinephrine for not more than one child and one adult in an automatic injection device if signed by a nurse practitioner or physician. Whenever such a statement of completion form for an emergency supply of epinephrine is presented, the pharmacist shall write upon the back of the statement of completion form in non-erasable ink the date that the prescription was filled, returning the statement of completion to the holder. The prescription may be filled up to 4 times. The pharmacist who dispenses an emergency supply of epinephrine under this rule shall also reduce the prescription to writing for his files, as in the case of an oral prescription for a non-controlled substance, and file the same in the pharmacy.

(3) A person who has successfully competed educational training in the administration of glucagon may receive, from the parent or guardian of a student, doses of glucagon prescribed by a health care professional with appropriate prescriptive privileges licensed under ORS chapters 677 or 678, and the necessary paraphernalia for administration.

(4) Completion of a training program and receipt of a statement of completion does not guarantee the competency of the individual trained.

(5) A statement of completion and authorization to obtain epinephrine shall expire three years after the date of training identified on the statement of completion. Individuals trained to administer epinephrine or glucagon must be trained every three years in accordance with OAR 333-055-0015 in order to obtain a new statement of completion.

(6) Individuals trained to administer epinephrine or glucagon may be asked to provide copies of a current statement of completion to their employers or to organizations or entities to which they volunteer.

[ED. NOTE: Figures referenced are available from the agency.]

Stat. Auth.: ORS 433.810
Stats. Implemented: ORS 433.800 & 433.830
Hist.: HD 10-1982, f. & ef. 5-25-82; HD 23-1990(Temp), f. & cert. ef. 8-15-90; OHD 7-1998, f. & cert. ef. 7-28-98; PH 10-2004, f. & cert. ef. 3-23-04; PH 14-2012, f. & cert. ef. 9-19-12

333-055-0035

Circumstances in Which Trained Persons May Administer Epinephrine or Glucagon

(1) A person who holds a current statement of completion pursuant to OAR 333-055-0030 may administer, in an emergency situation when a licensed health care professional is not immediately available, epinephrine to any person suffering a severe allergic response to an insect sting or other allergen. The decision to give epinephrine should be based upon recognition of the signs of a systemic allergic reaction and need not be postponed for purposes of identifying the specific antigen which caused the reaction.

(2) A person who holds a current statement of completion pursuant to OAR 333-055-0030 may administer, in an emergency situation involving an individual who is experiencing hypoglycemia and when a licensed health care professional is not immediately available, physician-prescribed glucagon to a person for whom glucagon is prescribed, when other treatment has failed or cannot be initiated. The decision to give glucagon should be based upon recognition of the signs of severe hypoglycemia and the inability to correct it with oral intake of food or drink.

Stat. Auth.: ORS 433.810
Stats. Implemented: ORS 433.800 - 433.830
Hist.: HD 10-1982, f. & ef. 5-25-82; OHD 7-1998, f. & cert. ef. 7-28-98; PH 10-2004, f. & cert. ef. 3-23-04; PH 14-2012, f. & cert. ef. 9-19-12

Notes
1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2011.

2.) Copyright 2012 Oregon Secretary of State: Terms and Conditions of Use

Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • oregon.sos@state.or.us

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