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Allergy Safety On the Special Needs Bus S p e c i a l N e e d s D r i v e r T e a m O n l i n e C u r r i c u l u m Copyright, 2014. by Dr. Ray Turner. All rights reserved. White Buffalo Press. Please Read Disclaimer. White Buffalo Special Needs Driver Press Team Online Curriculum Page 2 Introduction What are the types of Driver Teams on special needs buses must be sensitive to students insects that children with disabilities and severe allergic reactions. Many of the special han- are most likely to dling procedures for specific students with disabilities may have to be have a severe allergic modified because of their severe allergens. Conventional bus proce- reaction? Various dures may have to be altered for the safety of one or more students insects encroaching on board even though no other students riding the special needs bus onto the special have any severe allergic reactions. This newsletter will provide some needs bus can cause important guidelines for transporting students with disabilities and allergic reactions. who have severe allergic reactions. Wasps, honey bees, hornets, yellow Insect Sting Allergies jackets and ants are the insects most likely on the Special Needs Bus to cause strong allergic reactions. Some biting insects When are insect bites most likely to occur on the special needs (mosquitoes, flies, bus? One of the most common severe allergic reactions of student lice, kissing bugs and riders with disabilities on the special needs bus are students with se- fleas) can cause vere allergic reactions to insect bites. 4 of every 1000 people of all allergies as well ages are affected. Each year 50 to 100 people in the U. S. die from re- because they inject actions to stings. Insect bites are more likely to occur during warm cli- saliva to thin the mates, across the southern tier of states and far less likely to occur blood when they bite. during cooler weather or winter weather. Precautions on the special Finally, some needs bus must be in place throughout the warm weather season for a caterpillars are child on board with severe insect allergic reactions. covered with hairs that contain a substance What are the types of insects that children are most likely to have a irritating to human severe allergic reaction? Various insects encroaching onto the spe- skin and this can cial needs bus can cause allergic reactions. Wasps, honey bees, hor- sometimes cause nets, yellow jackets and ants are the insects most likely to cause allergic reactions. strong allergic reactions. Some biting insects (mosquitoes, flies, lice, kissing bugs and fleas) can cause allergies as well because they inject saliva to thin the blood when they bite. Finally, some caterpillars are covered with hairs that contain a substance irritating to human skin and this can sometimes cause allergic reactions. White Buffalo Allergy Safety on the Press Special Needs Bus Page 3 What are specific precautions that should be in place on the special needs bus when Driver Teams know that there is a student on board who would have a severe, if not fatal, allergic reaction to insect Use bus air bites? What can Driver Teams do to avoid children being bitten by conditioning insects for which they are severely allergic? Specific special han- throughout the dling or precautions on the special needs bus should include: summer months or whenever certain Use bus air conditioning throughout the summer months or when- insects are known to ever certain insects are known to exist in the environment. exist in the environment. Keep all windows on the bus closed during the period of time when the special needs child is on board during the AM or PM run. At other Keep all windows on times, and only if necessary, the windows can be opened for rider comfort. the bus closed during the period of time when the special Keep the time the front exit door is open to a minimum to allow board- needs child is on ing or exiting of any students. Driver Teams will notice that, many board during the AM times without realizing it, the Driver keeps the stairwell door open far or PM run. At other longer than necessary. times, and only if necessary, the The Driver must be observant of insects in the area of the stairwell windows can be door outside the bus and wait for a short period of time for the insect opened for rider to leave the area and to disallow it from entering onto the bus. comfort. The Bus Assistant must also be observant of insects in the area of Keep the time the the stairwell and the outside door and get the child who is severely front exit door is open allergic boarded as quickly as possible and shutting the door behind to a minimum to allow them. boarding or exiting of any students. Driver Wasp or other biting insect killing spray cans may be necessary Teams will notice that, when a biting insect gets on board the enclosed bus. Use of this kill- many times without ing spray must be done very carefully to avoid allergic reactions from realizing it, the Driver others who are sensitive to the chemicals in the insect killing spray. If keeps the stairwell the insect spray is handled only by the Driver and stored away from door open far longer the students fairly safe operation on the bus can be done. than necessary. After use of the insect killing spray, the area that has been sprayed must not be used by any student until it is cleaned up at the end of the bus route. Universal Precautions and associated cleanup procedures for the insect spray effected area are in order. White Buffalo Special Needs Driver Press Team Online Curriculum Page 4 Student Reactions to Insect Stings–Strategies to Save a Life Three kinds of reactions students have on your bus to insect stings. Five hundred stings The most serious within a short time symptoms are the closing The first kind, normal reactions, involve are considered likely of airways and shock symptoms including pain, redness, to kill because of the (anaphylaxis) since they swelling, itching, and warmth at the site quantity of venom can be fatal if not treated of the sting. involved. As few as quickly and effectively. ten stings within a Allergic reactions may The second kind, toxic reactions, are short time can cause begin within ten to twenty the result of multiple stings. Symptoms serious illness. minutes after the sting or of toxic reactions include muscle they may be delayed. cramps, headache, fever, and drowsi- Usually, the sooner the ness. reaction starts, the more severe it will be. Allergic reactions are the third type involve some of the same symptoms as toxic reactions, but may be triggered by a single sting or a minute amount of venom. Any non-local reaction to a single sting should be considered allergic until proven otherwise. Allergic reactions may be local or systemic. An allergic reaction is considered local if it involves only the stung limb, regardless of the amount of swelling. A slight systemic reaction may involve hives and itching on areas of the body distant from the sting site as well as feelings of anxiety and being run down. A moderate systemic reaction may include any of the above plus at least two of edema (swelling), sneezing, chest constric- tion, abdominal pain, dizziness, and nausea. A severe systemic reaction has the symptoms already described plus at least two of difficulty in swallowing, labored breathing, hoarseness, thickened speech, weakness, confusion, and feelings of impending disas- ter. White Buffalo Allergy Safety on the Press Special Needs Bus Page 5 Anaphylactic reactions are general, Anaphylactic Reactions dramatic reactions that can result in collapse and possibly Anaphylactic reactions require the special needs Driver Team to call death. It is caused by a 911 immediately. Generally, after the 911 call it is better for the spe- sudden release of cial needs bus to remain at the site for the emergency crew to ar- histamines and other rive rather than to drive the bus (with other students on it who are chemicals that not in an emergency) to a fire station, a police station or to a hospi- overwhelm the body. tal or clinic. The onset is usually quite rapid and Anaphylactic reactions are general, dramatic reactions that can result symptoms occur in collapse and possibly death. It is caused by a sudden release of his- within minutes. Death tamines and other chemicals that overwhelm the body. The onset is can potentially occur usually quite rapid and symptoms occur within minutes. Death can immediately or within potentially occur immediately or within two hours. The first sign may two hours. The first be swelling and redness of the skin or may be a non-visible internal sign may be swelling reaction such as swelling of the airway, a drop in blood pressure, and redness of the shock, or nausea. The allergic person may also have a feeling of great skin or may be a non- anxiety. Immediate action is needed. Persons who know they are visible internal prone to these reactions (allergies to peanuts, shellfish, and insect reaction such as stings can be of this type), should consult with their doctor about a swelling of the airway, small emergency kit to carry with them. For this type of reaction, call a drop in blood pres- for medical help immediately. Minutes are vital. sure, shock, or nausea. The allergic First Aid for Anaphylactic Reactions person may also have a feeling of great On the Special Needs Bus anxiety. Immediate action is needed. Standard treatments used to control severe reactions are epinephrine, oxygen, and intravenous fluids. Antihistamines and corticoster- oids can also be used. The person needs to be under medical supervision until the reaction is under control. Medical packs can be kept on the bus for use with a student who is having an anaphylactic reaction and can be administered by the Bus Assistant or Driver Team only if absolutely necessary. The IEP Committee and the child’s physician must provide written orders for the Driver Team to have documentation on board the special needs bus for this procedure to be done. Applying an epinephrine syringe into the child’s leg muscle or buttock. This procedure is not the end of the problem even when done by the Driver Team in a timely manner and the EMS has been called to arrive quickly. The child must be transported via ambulance or EMS to the hospital for followup. White Buffalo Special Needs Driver Press Team Online Curriculum Page 6 Sunshine Allergic Reactions On the Special Needs Bus Allergies can show themselves through various skin reactions. The main reactions are rashes (small bumps or larger red patches), hives (also called urticaria; itchy, red raised patches on the skin), or eczema (also called atopic dermatitis; an itchy, weeping rash). These symptoms can have various causes. Most often it is allergies, but some students get hives from heat, cold or sun exposure. NOTE: Many students with disabilities are reported to have allergic reactions to sunshine due to the side effects of medications they take. There are several general things to have in place on the special needs bus: Special needs buses must have tinted Special needs buses must have tinted windows both for reducing the windows both for interior heat, reducing the amount of air conditioning required for reducing the interior comfort as well as protection from ultraviolet light from the sun or heat, reducing the sunlight allergies by any students on board. Students with sunshine amount of air allergic reactions must be properly clothed throughout the school conditioning required year to cover much or all of their bodies from any exposure to the for comfort as well as sun. Sun glasses, while they may be “banned” from school or from protection from the special needs bus, must be worn by the child with severe sun- ultraviolet light from shine allergic reaction. Students with disabilities, like other students the sun or sunlight of comparable age, want to go out and play, to stick their arms out of allergies by any the bus to feel the wind, to enjoy the opened window during the bus students on board. ride, etc. These things, while enjoyable for children, are not safe pro- Students with cedures for students with or without allergic reactions to sunshine. sunshine allergic reactions must be properly clothed Contact Allergic Reactions throughout the school or Dermatitis year to cover much or all of their bodies On the Special Needs Bus from any exposure to the sun. Sun glasses, Contact allergies/dermatitis is defined as a skin rash caused by di- while they may be rect contact with a substance to which the skin is sensitive. Symp- “banned” from school toms include a red rash, swelling, and itching. In more severe cases, or from the special blisters can form. Many substances can cause allergic contact derma- needs bus, must be titis: poison ivy and other plants (such as tomato plants), wool, per- worn by the child with fumes and dyes (in soaps, detergents, lotions, etc.), metals (in jew- severe sunshine elry, hair clips, etc.), locally applied medicinal ointments such as anti- allergic reaction. biotic creams, and latex (often used in latex gloves). White Buffalo Allergy Safety on the Press Special Needs Bus Page 7 Specific precautions for student contact allergic reactions to be taken on the special needs bus include: Specific precautions for student contact Avoid on field trips any contact with poisonous plants. Special allergic reactions to needs field trips may have to be done in areas where there is no or be taken on the spe- minimal risk for contact allergic reactions. cial needs bus include: 1. Avoid on All food shall not be eaten on the special needs bus by the students field trips any contact or the Driver Team. Food allergies can be avoided when school lunch with poisonous plants. boxes are under the control of the Driver Team during the special Special needs field needs bus ride to avoid any student eating their own lunch or the foods trips may have to be brought on board by other students during the bus ride. done in areas where there is no or minimal Rearrange student seating assignments to distance students with risk for contact aller- severe contact allergies to perfumes, soap or detergents or other sub- gic reactions. 2. All stances worn or used by other students on board. A thorough clean- food shall not be ing of student seats and other contact points on the bus, aisle seat eaten on the special edges, handrails, door post, etc. can reduce the risk for contact aller- needs bus by the stu- gic reactions from some special needs students. dents or the Driver Team. Food allergies A very common source of contact allergic can be avoided when reactions may come from the Driver or Bus school lunch boxes Assistant in the use they have of particular are under the control Severe allergic reactions perfumes, colognes, soap, detergents, etc. of the Driver Team can occur at any age and If the allergic reaction source is known and during the special can appear at any time. the Driver Team can avoid using or needs bus ride to It can take years for a wearing that allergic reaction producing avoid any student eat- sensitivity to a particular substance then they should avoid it at all ing their own lunch or substance to develop, times during their work hours. the foods brought on so "I've used this for board by other stu- years"isn't a reason to First Aid or Treatment of contact dermati- exclude anything from dents during the bus tis generally consists of avoiding the aller- the possible allergen ride. 3.Rearrange stu- gen. To determine whether or not some- list. Symptoms may dent seating assign- thing is the cause, patch tests (a small appear as soon as 7 to ments to distance stu- amount of the substance applied to the 10 days from first dents with severe con- skin, then covered and left for 24 hours) contact. Once a tact allergies to per- shows if that substance causes the reac- sensitivity develops, fumes, soap or deter- tion. The physician does this test for stu- however, the reaction gents or other sub- dents who are suspected or known to have can occur in 24-48 stances worn or used severe contact allergies. The end result of hours. by other students on the test is a set of guidelines that the stu- board. dent, the parents, the school and the Driver Team must adhere to strictly. White Buffalo Special Needs Driver Press Team Online Curriculum Page 8 Driver Teams must have medical documentation on board the bus re- garding known contact allergies of specific students to know how to Special handling on avoid those substances on board the bus as much as possible. the bus for students with Eczema or hives reactions include: Eczema and Hives Reactions Of Special Needs 1. Avoid all food contact or eating on the Students on the Bus bus for students and Driver Teams alike. Eczema is often caused by a food allergy, though there may be other causes. Cow's milk is a particularly common allergen for those with 2. Clean the seat and eczema. Severe reactions to peanuts or peanut included products is other contact points one of the most common. Avoiding allergens provides runny eyes, on the bus that may lethargy, or asthma symptoms. Symptoms are generally worst in the have substance resi- early morning when pollen counts are highest or when the child has dues that particular been sleeping for hours in a room filled with dust and/or mold. Emer- students are very al- gency inhalant use may occur at any time of the day--during AM or PM lergic to when they runs--but may be more likely to occur in the mornings as special come in contact with needs students board the bus. these substances. Hives can be caused by a number of factors, not just allergies. Hives 3.Avoid sun exposure occur suddenly and may end suddenly, though there are chronic of students with this cases where hives are present for a month or more. Other causes of contact allergy during hives are sun exposure, heat and cold. Again, avoidance is the pri- boarding or exiting mary treatment. the special needs bus. Tinted windows is Special handling on the bus for students with Eczema or hives reac- also an important fea- tions include: ture for special needs buses. Avoid all food contact or eating on the bus for students and Driver Teams alike. Clean the seat and other contact points on the bus that may have substance residues that particular students are very allergic to when they come in contact with these substances. Avoid sun exposure of students with this contact allergy during boarding or exiting the special needs bus. Tinted windows is also an important feature for special needs buses. White Buffalo Allergy Safety on the Press Special Needs Bus Page 9 Inhaled Allergens On the Special Needs Bus Special handling on the bus for children The most common inhaled allergen is with mold, pollen and dust--from dust mites and their Interior bus cleaning with animal dander allergic wastes (every house has them, no include all surfaces cleaned reactions may matter how clean). Other sources in- thoroughly including the include: clude: mold, pollen (hay fever), ani- interior ceiling, under every Use of a HEPA type mal dander (especially cats), chemi- school bus bench seat and air filtration system cals and perfumes. Symptoms may within the seat separation powered by the bus include: Clear runny nose and sneez- (known as the “seat bight”). using an 12 volt ing, itchy or stuffed nose, itchy, The seat bight is an amazing power source and an runny eyes, lethargy, or asthma source of Allergens since it inverter to 110-120 symptoms. Symptoms are generally builds up over time through volt AC power. The worst in the early morning when pol- student use in a variety of HEPA filtration len counts are highest or when the environments. Driver Teams system unit may be child has been sleeping for hours in consider their bus to be clean placed closed to the a room filled with dust and/or mold. when the obvious surfaces are seating assignment Emergency inhalant use may occur carefully cleaned. Yet they area of a student with at any time of the day--during AM or often forget the hidden areas PM runs--but may be more likely to that carry allergen-producing severe allergic occur in the mornings as special substances. reactions to pollen. needs students board the bus. Avoid all transporting of pets, science projects that may Special handling on the bus for children with mold, pollen and animal involve contact dander allergic reactions may include: Allergens. Clean the bus Use of a HEPA type air filtration system powered by the bus using completely and an 12 volt power source and an inverter to 110-120 volt AC power. thoroughly at least The HEPA filtration system unit may be placed closed to the seating once a week. This assignment area of a student with severe allergic reactions to pollen. type of cleaning is far more than a wash Avoid all transporting of pets, science projects that may involve windows, wipe seats contact Allergens. off and wash down the floor. Clean the bus completely and thoroughly at least once a week. This type of cleaning is far more than a wash windows, wipe seats off and wash down the floor. White Special Needs Driver Buffalo Press Team Online Curriculum Page 10 Have the inhaler Antihistamines stored in the backpack of the student and the back- Histamines are responsible for many of the symptoms of allergies pack separated from and allergic reactions, including nasal congestion, itching, watery all student access eyes, and hives. Antihistamines act by blocking histamine receptors, during the bus ride. so that the histamines can not cause a reaction. While effective for a Backpacks may often runny nose that is caused by allergies, the nasal congestion that is look identical. The part of an upper respiratory infection is not related to histamine, and student with an so these medicines are not very effective. It is the side effects of the inhaler in the antihistamines that can make them useful in upper respiratory ill- backpack must be nesses, including causing drowsiness and a dry mouth and nose. clearly marked for quick access when Common antihistamines include: needed by the Bus Assistant. Diphenhydramine (Benadryl); Brompheniramine (Dimetapp, Brom- fed), Chorpheniramine (Chor-trimeton, Pediacare, Naldecon, Rynatan, 2. The Driver Team Triaminic); Triprolidine (Actifed) , pyrilamine, clemastine (Tavist), and must assure that Carbinoxamine (Rondec). These are usually a part of multi-symptom other students do not cold relievers. touch, use or abuse inhalant drugs Cyproheptadine (Periactin) is a long acting prescription antihista- provided for one mine, sometimes used for prophylaxis for frequent migraines. Hy- student. droxyzine (Atarax or Vistaril) is a long acting prescription antihistamine. 3. The Driver Team must document every Loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra) are instance of required newer, second generation antihistamines that are available by pre- use of this scription to treat allergies. antihistamine medication applied by Use of Student Prescription the student on the special needs bus. Inhalants on the That documentation Special Needs Bus should be given daily to the school nurse Prescription inhalers or other devices to deliver medication can be and to the parents for used by students on the bus while under the direct supervision of the their tracking the Driver Team just as they would be supervised at school by the school student’s health and nurse or at home by the parents. Bringing these types of medications use of medication on board the bus suggests several extra precautions to be done by while on the special the Driver Team for the safety of all including: needs bus.