A kindergartner gets on the school bus after eating a bagel with peanut butter for breakfast. With a smear on his hand, he uses the rail to hoist himself up the steps.

A kindergartner gets on the school bus after eating a bagel with peanut butter for breakfast. With a smear on his hand, he uses the rail to hoist himself up the steps.

Another student, one with a severe peanut allergy — 5-year-old Audra Ryan of Western Springs, Ill., for instance — uses the same handrail and then touches her eyes or mouth. Within minutes, experts say, the child could be in the midst of an anaphylactic reaction — a severe, potentially life-threatening allergic response.

"It’s just such a time-sensitive thing," said Audra’s mother, Christina West. "It sounds silly (because) we are in a small town. (People think they could just) pull over and call 911; the ambulance would be there so quickly. But it counts. Those seconds count."

West said she worries every day when her daughter takes the bus to Field Park Elementary School in Western Springs for kindergarten; in the fall, she’ll then go from Field Park to a Montessori school for after-school activities.

She has pressed Western Springs Elementary District 101 officials about the possibility of training bus drivers on how to react to allergic responses in students — something she said is increasingly important as more children with serious allergic reactions show up in hospitals.

West would like bus drivers to be able to identify anaphylaxis and use epinephrine autoinjectors — commonly called EpiPens — if necessary. Dr. Sakina Bajowala, Audra’s allergist, said the EpiPen ideally should be administered at the first sign of an anaphylactic reaction.

Audra’s most serious food allergy is to peanuts, and the girl could have a reaction if she comes in contact with them, Bajowala said.

"The only medication that has been proven to successfully treat the symptoms of anaphylaxis is epinephrine," Bajowala said.

First Student, the company used by District 101 and Hinsdale-Clarendon Hills (Ill.) Elementary District 181, trains its bus drivers to contact dispatchers, who then will call 911, if the driver notices a child is having a severe allergic reaction, said Chris Kemper, a First Student spokesman. The driver can also pull the bus over if it is safe to do so, Kemper said.

The national bus company does not train its drivers to use epinephrine autoinjectors, he said. The drivers go through training, but health care procedures, including CPR and the Heimlich maneuver, are not a focus of the training, Kemper said.

"The challenge is, in the process of trying to help a student with an allergic reaction, we don’t want drivers to focus on the one student and put other students in danger," Kemper said.

Bajowala said it takes less than a half-hour to train someone on how to recognize anaphylactic reactions and less than 10 minutes to train someone how to use an epinephrine autoinjector.

"It’s not OK to say, ‘We won’t give epinephrine, we will just wait for 911 to get here,’" she said. "Five minutes literally can be the difference between saving that child’s life and losing that child."

For children in Illinois with severe food allergies, the rate of emergency room visits and hospitalizations has nearly tripled, according to a study released in June by Northwestern Medicine. The study includes discharge data from 1,893 emergency room visits at about 200 Illinois hospitals from 2008 to 2012, according to a recent Tribune report.

District 101 Superintendent Brian Barnhart said he spoke with First Student about training bus drivers in responding to allergies and that they explained why they opted not to do so. He said he thought the company’s policy was fair.

"They have a reasonable rationale for that. A bus driver is responsible for all students," Barnhart said.

Barnhart said the district has other options to consider in keeping Audra safe but declined to go into detail, saying the situation is case-sensitive.

Every year, District 101 teachers and staff have medical training with the school nurses that includes automated external defibrillator and allergy-reaction instruction, Barnhart said. Teachers who have students with known food allergies go through additional training regarding that student’s specific allergy, he said.

District 101 schools also have other food-allergy procedures, such as creating nut-free lunch tables where students with allergies can sit during lunch, Barnhart said.

District 181 teachers and employees are trained on how to respond to anaphylaxis and how to use an epinephrine autoinjector, said Ken Surma, assistant superintendent for the district. They also go through an online tutorial on allergy-reaction response. Teachers who have students with severe allergic reactions are given a medical plan from the nurse that lists how they should respond to that student’s specific reaction, he said.

Parents are responsible for reporting that a student has a food allergy through an online registration system, Surma said. The school nurse will then contact the parent to discuss a medical plan, and the nurse is also responsible for coming up with solutions to minimize exposure, he said.

Once parents fill out the registration form, the school nurse has the option of giving bus drivers a list of students riding their routes who have allergies, he said.

"I think what we can do as a district is communicate with the bus company about what our children are allergic to," Surma said. "I don’t think they were aware of all students that would be allergic to something."

Elgin-area School District U46 has similar policies — schools can establish nut-free zones if needed, for example — Mary Fergus, director of school and community relations for the district, wrote in an email.

U46 also requires that all employees, including bus drivers, complete an online tutorial on anaphylactic reactions and administering epinephrine autoinjectors every two years, Fergus said. District U46 runs its own fleet of buses and drivers, she said.

Maercker School District 60 allows students with severe food allergies to have meal modifications to restrict their diets, according to the district’s food allergy management plan. All district employees also are trained on allergy response, including how to administer an epinephrine autoinjector.

At Field Park, Audra’s teacher will be the primary adult responsible for administering her epinephrine autoinjector if needed, West said. Still, she is concerned that there is no one on the bus who can do the same if need be.

"That’s a time where we need to have that coverage of somebody willing and able to administer epinephrine to be with her at all times," West said. "We either need to train the bus drivers, or otherwise have some way of transporting her with somebody who is capable of administering an epinephrine."

West said she looks forward to finding a solution for her daughter and believes all bus drivers should be trained.

"I feel like it’s just time. It’s time for them to deal with (food allergy training), even if it is not what the preference would have been. I think they should be protected under state or federal laws in case of mistakes."


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