Administration of Albuterol Inhalers

Minimum Standards for Training for the Administration of Stock Albuterol Inhalers in the School Setting

Schools may designate one or more volunteers at a school to receive initial and annual refresher training, based on the standards developed by the State Superintendent of Public Instruction, regarding the use of albuterol from the school nurse or other qualified person designated by an authorizing physician or surgeon (California Education Code Section 49414.7(a)). “Authorizing physician and surgeon” may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director (EC 49414.7(b)(2)). Minimum standards of training must include the following:

1.   Recognize Symptoms of Respiratory Distress
2.   Know and Follow Standards and Procedures for Storage, Restocking, and Emergency Use of Stock Albuterol Inhalers
3.   Know and Follow Respiratory Emergency Follow-Up Procedures
4.   Know and Are Able to Apply CPR and First Aid in Response to Respiratory or Cardiac Arrest
5.   Know How to Access Online Resources Covering the Subjects Above

1. Recognize Symptoms of Respiratory Distress

Staff administering albuterol inhalers must be trained to recognize the following symptoms of respiratory distress in students:

• Shortness of breath or difficulty breathing (this is often the most common symptom, so it should be emphasized early on)
• Sitting in a tripod position (where a person leans forward while supporting their upper body with their arms on their knees or another surface)
• Rapid or labored breathing (unable to speak or complete a full sentence without stopping to breathe)
• Wheezing (a high-pitched sound during exhalation)
• Coughing, particularly after physical activity
• Chest tightness or discomfort
• Blue-tinged lips, face, fingertips, or nail beds in severe cases
• Panic or anxiety due to difficulty breathing
• Use of accessory muscles (significant belly movement or “belly breathing,” retractions—visualization of ribs or inward motion of the abdomen just below the ribs or above the clavicles with each breath, flaring nostrils, grunting with expiration)

2. Know and Follow Standards and Procedures for Storage, Restocking, and Emergency Use of Stock Albuterol Inhalers

Storage:

• Stock inhalers and disposable spacers should be stored in a secure, easily accessible location (e.g., the school nurse’s office, front office, or another central location such as the principal's office) to ensure quick access during emergencies.
• Inhalers and disposable spacers should be stored at room temperature, away from direct sunlight or heat sources.
• The location of stock inhalers and disposable spacers should be clearly labeled, and staff should be made aware of this location through regular preparedness training.

Restocking:

• Ensure each inhaler is properly labeled with its expiration date. Inhalers should be inspected regularly to confirm they are not expired. Multiuse inhalers should be monitored for the number of doses remaining.
• A system should be in place to reorder inhalers before they expire or when supplies are running low. A system should also be in place to reorder disposable spacers when supplies are running low.
• Expired or damaged inhalers should be replaced immediately.

Emergency Use:

• Inhalers should only be used in emergencies for students with symptoms of respiratory distress and should be administered by trained personnel.
• A disposable spacer must be used as the minimum standard for delivering albuterol.
• Keep a logbook of each time a stock inhaler is used, recording the student’s name, date and time of use, dose provided, symptoms necessitating use, and any follow-up actions taken.
  • If a student is given emergency stock albuterol more than twice in one week, it’s recommended they seek treatment from their medical provider for possible underlying conditions.
• When applicable, follow the medication delivery device guidance from the student’s Asthma Action Plan.

3. Know and Follow Respiratory Emergency Follow-Up Procedures

Calling 911:

• After administering the albuterol inhaler, if the student's breathing does not improve, 911 should be called immediately.
• A staff member should stay with the student until emergency personnel arrive and monitor the student’s condition.

Contacting Parent/Guardian:

• The student's parent or guardian should be notified as soon as possible any time emergency use of albuterol is administered at school.
• If available, the student’s physician should also be contacted to inform them of the event.

Providing Emergency Information:

• When calling 911 or speaking with a parent/guardian or physician, staff should provide relevant details, including the student’s symptoms, the time the inhaler was administered, the dose provided, and how the student’s symptoms did or did not respond to treatment.

4. Know and Are Able to Apply CPR and First Aid in Response to Respiratory or Cardiac Arrest

• Certification in Cardiopulmonary Resuscitation (CPR) is highly recommended for all school/district personnel involved in the administration of stock albuterol inhalers. CPR may be required if the student goes into respiratory or cardiac arrest before emergency services arrive.
• Schools should offer regular training sessions for staff to become certified in CPR, including refresher courses.
• Staff should also be trained in basic first aid to handle situations that may arise during a respiratory emergency.

5. Know How to Access Online Resources Covering the Subjects Above

American Lung Association (ALA)
The ALA provides detailed information on asthma management and emergency treatment with stock albuterol inhalers.
Materials: "Asthma Action Plan" and "Managing Asthma in Schools"

Centers for Disease Control and Prevention (CDC)
The CDC offers guidelines on asthma care in schools, including how to use inhalers during emergencies.
Materials: "Asthma Basics" and "Strategies for Addressing Asthma in Schools"

American Academy of Pediatrics (AAP)
Information on asthma management in schools.
Materials: "Asthma Management in Schools"

American Lung Association's Open Airways for Schools
This program works with children ages 8 to 11 to learn how to better manage their own asthma.

By adhering to these standards, schools can ensure the safety and well-being of students experiencing respiratory distress and create an effective response system for emergencies.