The death Monday of a Chesterfield County elementary school student from an allergic reaction to food was a rare occurrence but one that teachers and administrators try to prevent.
In most local school systems, there are specific protocols for everything from how and when parents should notify school officials about a child's allergies to how school personnel should react if something goes wrong.
In Chesterfield, the process starts with the parent and ultimately includes up to 10 people, who together are responsible for as many as 68 steps to identify problems and deal with them.
A similar plan in Henrico County involves as many as nine people. Menu information may be provided to parents to allow them to make decisions about food choices for their child.
In Hanover County, school cafeterias have designated tables at which students with food allergies can sit to avoid contact with food items that may produce an allergic reaction.
Hanover and Richmond, among others, also use computerized messaging systems in their school cafeterias to alert cashiers when students with allergies try to purchase items they may be sensitive to.
"Because it is difficult to predict the time or severity of an allergic reaction, it is vital to be prepared to respond rapidly in order to maintain a safe educational environment for all students," said Shawn Smith, a Chesterfield schools spokesman. "Supporting the success of a student with a severe allergy requires a team approach and a coordinated plan, so that all team members understand their roles."
Smith said the 7-year-old Hopkins Road Elementary School student who died had a pre-existing medical condition.
"Our thoughts and prayers are with the family," he said in a statement. "The school division will continue to provide additional services to support students and staff in this difficult time."
Chesterfield police are investigating the death of the child, a first-grader who went into cardiac arrest after apparently suffering an allergic reaction to something she ate.
Authorities received an emergency call from the school at 2:26 p.m. Monday, said Chesterfield police Lt. Randy Horowitz. The child was in cardiac arrest when paramedics arrived and she was pronounced dead after being taken to CJW Medical Center (Chippenham), said Chesterfield Fire & EMS spokesman Lt. Jason Elmore. Investigators are waiting for a report from the state Medical Examiner's Office on the child's cause of death.
Horowitz said school records indicate the child had an allergy, but he declined to provide specifics.
The privacy provision of the federal Health Insurance Portability and Accountability Act prohibits authorities from providing more detail about the girl's allergy condition, Elmore said.
Estimates are that between 5 and 10 percent of school-age children have food allergies, said physician Michael Z. Blumberg of Allergy Partners of Richmond.
"Food allergy is common, though dying from food allergy is uncommon," Blumberg said.
"The schools have been very cooperative, and there are certain laws out there that require that they provide a safe environment for children," Blumberg said.
"The American Academy of Pediatrics has a form that we fill out for all our food allergy patients," Blumberg said. "It tells the people at the school … how to treat different kinds of reactions. For instance, if you have hives, you don't need to give a shot. … If you start vomiting or have shortness of breath or difficulty swallowing, then you need to give that shot immediately."
There should be two epinephrine autoinjectors available, Blumberg said.
"They need two EpiPens together because, in about 25 to 30 percent of bad reactions, the second shot is necessary," Blumberg said.
"If the first shot doesn't work, five to 10 minutes later you give the second shot. Obviously, as soon as you give the first shot, you are either calling 911 or on the way to the emergency room," Blumberg said.
According to the Virginia Department of Education's Specialized Health Care Procedures Manual, "all school personnel who have contact with the student with food allergies should know how to decrease the risk of allergic reactions and how to activate the Food Allergy Action Plan or established school emergency plan for the student."
The manual also states that any student prescribed epinephrine should have an individualized health care plan that discusses monitoring, emergency plans and evaluation.
Epinephrine autoinjectors are prescription medicines. Some schools may allow older children to carry their own EpiPens, but elementary schools may have the devices stored for emergency access.
The Fairfax-based Food Allergy & Anaphylaxis Network is backing legislation that would include epinephrine injectors in school first-aid kits, available to respond to any child having a severe allergic reaction. One study estimates that 25 percent of food allergy reactions in schools occur in kids previously undiagnosed.
Maria L. Acebal, CEO of the network, said school preparedness to deal with such emergencies run the gamut.
"One thing we most strongly advocate is training for (school) staff on food allergy safety," Acebal said. "If you review it annually, it will start to become second nature."
"I come to this job as a food allergy mom," said Acebal, whose 10-year-old daughter was diagnosed with a food allergy at age 2.
"For all of us parents with a food-allergic child, it's our worst fear come true — to get that phone call from the school," Acebal said. "All of us that have a child with this condition, we know the second our cellphone rings during school hours we check to make sure it's not the school."
Federal regulations say that schools participating in a federally funded school nutrition program "may make substitutions for non-disabled students with medically-certified dietary needs."
A form is also required to be completed and submitted to the school nutrition program for each student with special dietary needs.
Charles B. Pyle, a spokesman for the state Education Department, said the department also refers school divisions to the Food Allergy and Anaphylaxis Network for guidance.
The department also encourages local school divisions to develop policies and procedures to care for students with food allergies. Eight resources are provided to aid school divisions.