The Nurse Who’s the Allergic Student’s Protector

in Food Allergy Advocates
Published: July 16, 2014

cathyowensWhen parents hand their children with food allergies over to the school system, they hope there will be someone like school nurse Cathy Owens around, setting anaphylaxis policy and ensuring kids are safe.

Owens has been passionate about anaphylaxis ever since the star of her school’s drama program came into her office struggling to breathe. Her on-the-spot decision to give him another student’s epinephrine auto-injector saved the young man’s life, and set the stage for California to become one of the first states to allow public schools to keep “stock” or unprescribed epinephrine auto-injectors on hand.

Owens, now the coordinator of health services for Murietta Valley Unified School District in California, has dedicated her career to improving the safety of students with anaphylaxis at school. She has become a trusted resource in the state and across the nation: she is an Epinephrine Resource School Nurse, has spoken at a national nursing conference and helped to write California’s standards for anaphylaxis training.

In the latest installment of The Allergy Advocates series, Allergic Living salutes Owens for her hard work and unwavering commitment to student safety. She is a person who goes above and beyond in her work to make epinephrine accessible to any student who might need it, says Connie Green, founder of the San Francisco Bay Area Food Allergy Network.

“I often hear about schools wanting to adopt stock epinephrine but not knowing how to – this is when I turn to Cathy. She has always, always helped by sharing her knowledge, experience and encouragement,” says Green.

Senior Allergic Living contributor Claire Gagné speaks to Cathy Owens about how she became the ultimate protector of students at risk of anaphylaxis.

The launching point for your anaphylaxis advocacy was quite dramatic, with a student going into anaphylaxis in your office – tell me what happened?

Retrospectively, it was probably more dramatic than it seemed at the time. Corey was a 15-year-old student who did not have a history of food allergies. He had mild asthma. He had come into the health office for another reason, and while there began to have breathing difficulties, which rapidly escalated.

My first assumption was ‘Corey is doing a good impression of someone either choking or having breathing difficulties,’ but then I looked at him and instantly knew this was not an act. I asked if he was choking and looked for outward signs or symptoms and there was nothing other than this significant breathing restriction. I told the health tech to call 911 and tried to get his breathing under control. But he escalated rapidly.

What happened then?

I had my stethoscope and I was able to listen to him, and there was just no air exchange. Panic set in. I knew at this point he wasn’t going to make it if we had to wait until the paramedics got there. He did not have an EpiPen but we did have another student who had a bee sting allergy. I had no other tools in my toolbox, so I grabbed that student’s auto-injector and gave it to him.

When the paramedics arrived about three or four minutes later, he was able to exchange a little bit of air, but was still having significant problems. They took him off to the ER. I followed and the parents met us there.

When the doctor came out, he said they had stabilized him, that he had had a severe anaphylactic reaction, but someone had given him epinephrine at school. [Since she hadn’t had authorization to do so,] that’s when I thought, ‘Uh, oh. Maybe I should just excuse myself and go back to school.’ But the doctor commended by actions. And Corey’s parents were extremely grateful.

What was the aftermath of that incident?

Corey’s father happened to be a media spokesperson, and he contacted the the local television and newspapers. It got statewide attention and national attention for the questions: ‘What do schools do for students who have undiagnosed anaphylaxis?’ and ‘How would schools be able to react and what would other school nurses do?’

A lot of nurses said to me, ‘I don’t know if I would have done that.’ But the doctor was very clear that if I had not done that, the outcome for Corey would have been extremely poor.

You used the auto-injector of a child with a sting allergy. Was there only one allergy at your school at the time?

When I first started as a school nurse back in 1990, we had very few students with food allergies, and none to the level where a parent provided us with epinephrine. We did have a few bee sting allergies. By 1997 [when this incident took place] we had maybe one or two EpiPens in each of our schools. Now we have upwards of 30 auto-injectors that are individually prescribed for each student.

This incident kickstarted a law to allow schools to stock epinephrine in schools. How did that lobbying get going?

Dey Laboratory, which used to produce the EpiPen, contacted me when they heard about the incident and formed an anaphylaxis task force. They were based in Napa, California and the assemblywoman who was representative of that area became involved and introduced the legislation, which got passed in 2001.

Did schools start stocking epinephrine?

Initially there were very few that got on board with it. This was a very new concept. There were a lot of questions. I was contacted by superintendents and school board members across the state with questions. ‘What about liability? What if someone accidentally gives it to somebody who doesn’t need it?’ There was a lot of concern.

It was a slow process in educating. I would send out information. I spoke at school districts, I spoke to school nurse organizations. We started seeing school districts deciding to step forward.

I’ve had some legal offices tell me that school districts might even be more liable for failing to have it [an epinephrine auto-injector] now, because the standard of practice is becoming much more that you should have it. That it does save lives.

You are now working with other food allergy advocates to get a new state bill, called SB 1266, passed. How is it different?

This bill would require, rather than allow, schools to stock epinephrine. But a caveat got added to the bill as it’s gone through the process, that says, ‘if there is someone in the district who is willing to be trained.’ That was not what we were hoping for, but it is still a very strong bill.

Has there been any opposition?

It has gone through three subcommittees with unanimous support in each of them. Unfortunately the California Teachers Association has spoken out in opposition to it, but none of the legislators were swayed by that.

The teachers have argued that this is a nursing procedure and that teachers shouldn’t be asked to do medical procedures. But teaching a teacher how to give an epinephrine auto-injector is not teaching them how to do a medical procedure. We train lay people all the time in CPR. And while you’d much rather have a nurse or a doctor there in an emergency, if there is no one else around, you want someone else to do CPR until help arrives.

In your role as the school nurse coordinator for your district, what other procedures do schools in your district have to keep kids with allergies safe?

In our cafeterias, we provide paper placemats for students to use to ensure where they are eating is clean. We have a district policy that absolutely no school projects or activities can involve food.

For parties, we don’t usually allow food from the outside to be brought in. If something with food is planned, it has to go through very particular steps, for example, all parents have to be notified ahead of time, and given the option to opt out. If someone objects, we cancel the food portion of the party.

Also, we do not lock up our auto-injectors. We keep them in a secure cabinet, but they are not locked. I don’t want someone coming in there and saying, ‘for heaven’s sake, who has the med key?’

Do you have a personal connection to food allergies in your family or yourself?

No, I’ve never had a person in my family with food allergies. I don’t have food allergies. I have become passionate about it just because of the students that I’ve worked with and the families I’ve worked with.

Are you still in contact with Corey and his family?

His father just spoke at the Capitol about this new bill. [Corey went on to have other anaphylactic reactions, but doctors have not been able to figure out what he reacts to.] Corey has recently been married and they are now expecting their first child. His father brought an 8 by 10 picture of Corey and said, ‘This man would not be here .…’ He gave way too much credit to me, but he was very complimentary and he was very passionate.

He said there are children who have died from food allergies and those parents are not going to see their child grow up and get married and have children. He implored with the legislators to please support this bill. It’s going to do nothing but save student’s lives.

Learn how you can support California’s proposed mandatory stock epinephrine bill here.

Honorees in The Allergy Advocates Series
Lisa Rutter: A Force of Good for Food Allergy
Karen Harris: Food Allergy’s Educating Dynamo
Jenny Sprague: Courageous Woman who Unites Allergy Bloggers
Gina Mennett Lee: A Voice of Reason for Food Allergy at School, Daycare

To submit an “Allergy Advocate” candidate for consideration, write to [email protected], and tell us what’s special about your nominee.