Deaths Show Schools Need Power of the EpiPen: Margaret Carlson

All children’s deaths are tragic, but some are absurdly so. First-grader Ammaria Johnson had just returned to her Virginia grade school after the Christmas holiday and inadvertently ate a peanut at recess. Feeling sick, Ammaria went to a teacher who rushed her to the school clinic, where someone called 911.

By the time the ambulance arrived, Ammaria was in anaphylactic shock and cardiac arrest. She died shortly thereafter at Chippenham Hospital in Richmond. A $112 device, the most common of which is called an EpiPen, could’ve saved her.

EpiPens aren’t as widely available as defibrillators, though they should be -- especially in schools. As the device’s name suggests, it is the size of a thick Sharpie marker and contains a dose of epinephrine, which is injected into the thigh. It gives an adrenaline jolt to the heart, dilates breathing passages and buys time to get a patient to the hospital before anaphylaxis sets in. It’s simple enough for a child to use.

There were EpiPens in the school clinic, but they had been prescribed for other children. None, by law, could be used for Ammaria, even in an emergency, according to Chesterfield schools spokesman Shawn Smith. To remedy that, the Virginia General Assembly, following the example of six other states, is now considering changing the law to make undesignated EpiPens available for general use in school clinics.

Parental Wars

Americans simply don’t take allergies as seriously as, say, a potential heart attack, expecting that they produce at worse a rash or an upset stomach. At school, the war between parents arguing for and against a peanut-free zone is topped only by the one raging between working and stay-at-home mothers. Ask a parent bearing homemade cupcakes about the ingredients and you would think you’d picked up the tray and slid the contents into the trash. At PTA meetings, it’s a toxic subject, considered a fetish of helicopter parents and hypochondriacs. After all, the argument goes, all these dubious allergies didn’t exist when I was a kid.

That’s true, and no one knows exactly why. An estimated 4 percent to 6 percent of American children now have food allergies; the number increased 18 percent from 1997 to 2007, according to the U.S. Centers for Disease Control and Prevention. Food allergens are responsible for 300,000 emergency room visits annually by children under 18. They also cause 30 percent of fatal cases of anaphylaxis. A 2005 study published in the journal Pediatrics found that 24 percent of anaphylactic reactions occurred in children with no prior history of life- threatening allergies.

Prevention and education isn’t enough, particularly given children who can’t remember their backpacks let alone to put their EpiPens inside. It’s essential to be prepared for attacks.

Defibrillators made their way into offices, airplanes, restaurants, health clubs and other public places only after a campaign by the American Heart Association and allies. President Bill Clinton signed a bill in 2000 that provided good Samaritan protection from liability to anyone who uses a defibrillator in an emergency. The bill also established grants to purchase machines and train users.

The difference between acceptance of the defibrillator and of the EpiPen has less to do with health and expense than with politics. Adults with heart ailments are a far more powerful and organized bloc than victims of allergies. If allergies were taken as seriously as heart attacks, would General Mills Inc. have just introduced peanut butter Cheerios, which look exactly like the original? How’s a 5-year-old to know if the kid he’s playing kickball with is offering a snack or a death sentence?

Proposed Solution

After a 13-year-old in Chicago died from eating Chinese food cooked in peanut oil at a class party, Illinois Senators Dick Durbin and Mark Kirk introduced a bill modeled on the defibrillator legislation signed by Clinton. It would allow schools in every state to stock unprescribed EpiPens. In addition, the legislation would remove civil liability for the emergency use of EpiPens and provide incentives for underfunded schools to purchase them.

There no doubt will be legislators who complain about government spending and unfunded mandates. But to save a child like Ammaria isn’t hard. You don’t need to find a cure for a complex disease like cancer. You don’t need to revolutionize an industry, as Ralph Nader did with auto safety. All you need is empathy, common sense and a hundred bucks.

(Margaret Carlson is a Bloomberg View columnist. The opinions expressed are her own.)

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To contact the writer of this article: Margaret Carlson in Washington at mcarlson3@bloomberg.net.

To contact the editor responsible for this article: Francis Wilkinson at fwilkinson1@bloomberg.net.

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