S3869

An Act concerning the emergency administration of epinephrine in schools, institutions of higher education, and youth camps, and amending various parts of statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 1 of P.L.1997, c.368 (C.18A:40-12.5) is amended to read as follows:

1. Each board of education or chief school administrator of a nonpublic school shall develop a policy in accordance with the guidelines established by the Department of Education pursuant to section 4 of P.L.2007, c.57 (C.18A:40-12.6a) for the emergency administration of one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a pupil for anaphylaxis provided that:

a. the parents or guardians of the pupil provide to the board of education or chief school administrator of a nonpublic school written authorization for the administration of the epinephrine;

b. the parents or guardians of the pupil provide to the board of education or chief school administrator of a nonpublic school written orders from the physician or advanced practice nurse that the pupil requires the administration of epinephrine for anaphylaxis;

c. the board or chief school administrator of a nonpublic school informs the parents or guardians of the pupil in writing that the district and its employees or agents or the nonpublic school and its employees or agents shall have no liability as a result of any injury arising from the administration of the one unit dose epinephrine [via a pre-filled auto-injector mechanism];

d. the parents or guardians of the pupil sign a statement acknowledging their understanding that the district or the nonpublic school shall have no liability as a result of any injury arising from the administration of the one unit dose epinephrine [via a pre-filled auto-injector mechanism] to the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees or agents or the nonpublic school and its employees or agents against any claims arising out of the administration of the one unit dose epinephrine [via a pre-filled auto injector mechanism]; and

e. the permission is effective for the school year for which it is granted and is renewed for each subsequent school year upon fulfillment of the requirements in subsections a. through d. of this section.

The policy developed by a board of education or chief school administrator of a nonpublic school shall require:

(1) the placement of a pupil's prescribed epinephrine in a secure but unlocked location easily accessible by the school nurse and designees to ensure prompt availability in the event of an allergic emergency at school or at a school-sponsored function. The location of the epinephrine shall be indicated on the pupil's emergency care plan. Back-up one unit dose epinephrine [via a pre-filled auto-injector mechanism] shall also be available at the school if needed;

(2) the school nurse or designee to be promptly available on site at the school and school-sponsored functions in the event of an allergic reaction; and

(3) the transportation of the pupil to a hospital emergency room by emergency services personnel after the administration of epinephrine, even if the pupil's symptoms appear to have resolved.

f. The policy developed by a board of education or chief school administrator of a nonpublic school shall also:

(1) permit the school nurse or trained designee to administer one unit dose epinephrine [via a pre-filled auto-injector mechanism] to any pupil without a known history of anaphylaxis or any pupil whose parent or guardian has not met the requirements of subsections a., b., and d. of this section and has not received the notice required pursuant to subsection c. of this section when the nurse or designee in good faith believes that the pupil is having an anaphylactic reaction; and

(2) require each public and nonpublic school to maintain in a secure but unlocked and easily accessible location a supply of [epinephrine auto-injectors] one unit dose epinephrine administration devices that is prescribed under a standing protocol from a licensed physician or an advanced practice nurse, and is accessible to the school nurse and trained designees for administration to a pupil having an anaphylactic reaction.

(cf: P.L.2015, c.13, s.1)

2. Section 2 of P.L.1997, c.368 (C.18A:40-12.6) is amended to read as follows:

2. The policy for the administration of medication to a pupil shall provide that the school nurse shall have the primary responsibility for the administration of the epinephrine. The school nurse shall designate, in consultation with the board of education, or chief school administrator of a nonpublic school additional employees of the school district or nonpublic school who volunteer to administer one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a pupil for anaphylaxis when the nurse is not physically present at the scene. In the event that a licensed athletic trainer volunteers to administer epinephrine, it shall not constitute a violation of the "Athletic Training Licensure Act," P.L.1984, c.203 (C.45:9-37.35 et seq.).

Except as otherwise provided pursuant to subsection f. of section 1 of P.L.1997, c.368 (C.18A:40-12.5), the school nurse shall determine that:

a. the designees have been properly trained in the administration of the one unit dose epinephrine [via a pre-filled auto-injector mechanism] using standardized training protocols established by the Department of Education in consultation with the Department of Health;

b. the parents or guardians of the pupil consent in writing to the administration of the one unit dose epinephrine [via a pre-filled auto-injector mechanism] by the designees;

c. the board or chief school administrator of a nonpublic school informs the parents or guardians of the pupil in writing that the district and its employees or agents or the nonpublic school and its employees and agents shall have no liability as a result of any injury arising from the administration of the epinephrine to the pupil;

d. the parents or guardians of the pupil sign a statement acknowledging their understanding that the district or nonpublic school shall have no liability as a result of any injury arising from the administration of the one unit dose epinephrine [via a pre-filled auto-injector mechanism] to the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees or agents against any claims arising out of the administration of the one unit dose epinephrine [via a pre-filled auto-injector mechanism] to the pupil; and

The Department of Education, in consultation with the Department of Health, shall require trained designees for students enrolled in a school who may require the emergency administration of epinephrine for anaphylaxis when the school nurse is not available.

Nothing in this section shall be construed to prohibit the emergency administration of one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a pupil for anaphylaxis by the school nurse or other employees designated pursuant to this section when the pupil is authorized to self-administer epinephrine pursuant to section 1 of P.L.1993, c.308 (C.18A:40-12.3), or when there is a coexisting diagnosis of asthma, or when a prescription is received from a licensed health care professional for epinephrine coupled with another form of medication, or when the epinephrine is administered pursuant to subsection f. of section 1 of P.L.1997, c.368 (C.18A:40-12.5).

(cf: P.L.2015, c.13, s.2)

3. Section 1 of P.L.1993, c.308 (C.18A:40-12.3) is amended to read as follows:

1. a. A board of education or the governing board or chief school administrator of a nonpublic school shall permit the self-administration of medication by a pupil for asthma or other potentially life-threatening illnesses, a life-threatening allergic reaction, or adrenal insufficiency provided that:

(1) the parents or guardians of the pupil provide to the board of education or the governing board or chief school administrator of a nonpublic school written authorization for the self-administration of medication;

(2) the parents or guardians of the pupil provide to the board of education or the governing board or chief school administrator of a nonpublic school written certification from the physician of the pupil that the pupil has asthma or another potentially life-threatening illness, is subject to a life-threatening allergic reaction, or has adrenal insufficiency and is capable of, and has been instructed in, the proper method of self-administration of medication;

(3) the board of education or the governing board or chief school administrator of a nonpublic school informs the parents or guardians of the pupil in writing that the district and its employees or agents or the nonpublic school and its employees or agents shall incur no liability as a result of any injury arising from the self-administration of medication by the pupil;

(4) the parents or guardians of the pupil sign a statement acknowledging that the district or the nonpublic school shall incur no liability as a result of any injury arising from the self-administration of medication by the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees or agents or the nonpublic school and its employees or agents against any claims arising out of the self-administration of medication by the pupil; and

(5) the permission is effective for the school year for which it is granted and is renewed for each subsequent school year upon fulfillment of the requirements in paragraphs (1) through (4) of this subsection.

b. Notwithstanding any other law or regulation to the contrary, a pupil who is permitted to self-administer medication under the provisions of this section shall be permitted to carry an inhaler or prescribed medication for allergic reactions, including a [pre-filled auto-injector mechanism] one unit dose epinephrine, or prescribed medication for adrenal insufficiency at all times, provided that the pupil does not endanger himself or other persons through misuse.

c. Any person who acts in good faith in accordance with the requirements of this act shall be immune from any civil or criminal

liability arising from actions performed pursuant to this act.

(cf: P.L.2019, c.118, s.1)

4. Section 3 of P.L.2013, c.211 (C.18A:61D-13) is amended to read as follows:

3. As used in this act:

"Institution of higher education" means a public or independent institution of higher education.

"Licensed campus medical professional" means a physician, physician assistant, advanced practice nurse, or registered nurse who is appropriately licensed by the State of New Jersey and is designated by an institution of higher education to oversee the institution's epinephrine administration and training program.

"Member of the campus community" means an individual who is a student, faculty, or staff member of an institution of higher education.

"Secretary" means the Secretary of Higher Education.

"Trained designee" means a member of the campus community trained by a licensed campus medical professional in the emergency administration of one unit dose epinephrine [via a pre-filled auto-injector mechanism].

(cf: P.L.2013, c.211, s.3)

5. Section 4 of P.L.2013, c.211 (C.18A:61D-14) is amended to read as follows:

4. a. An institution of higher education may develop a policy, in accordance with the guidelines established by the secretary pursuant to section 6 of P.L.2013, c.211 (C.18A:61D-16), for the emergency administration of one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a member of the campus community for anaphylaxis when a medical professional is not available. The policy shall:

(1) permit a trained designee, under the guidance of a licensed campus medical professional, to administer one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a member of the campus community for whom the designee is responsible, when the designee in good faith believes that the member of the campus community is having an anaphylactic reaction;

(2) permit a trained designee, when responsible for the safety of one or more members of the campus community, to carry in a secure but easily accessible location a supply of [pre-filled] one unit dose epinephrine [auto-injectors] that is prescribed under a standing protocol from a licensed physician; and

(3) provide that the licensed campus medical professional shall have responsibility for : training designees on how to identify an anaphylactic reaction, how to identify the indications for when to use epinephrine, and how to administer one unit dose epinephrine [via a pre-filled auto-injector mechanism]; and distributing prescribed [pre-filled] one unit dose epinephrine [auto-injectors] to trained designees.

b. Each institution of higher education that develops a policy pursuant to subsection a. of this section shall designate a physician, physician assistant, advanced practice nurse, or registered nurse who is appropriately licensed by the State of New Jersey to serve as the licensed campus medical professional.

c. A licensed campus medical professional is authorized to:

(1) establish and administer a standardized training protocol for the emergency administration of epinephrine by trained designees;

(2) ensure that trained designees have satisfactorily completed the training protocol;

(3) obtain a supply of [pre-filled] one unit dose epinephrine [auto-injectors] under a standing protocol from a licensed physician; and

(4) control distribution to trained designees of [pre-filled] one unit dose epinephrine [auto-injectors].

(cf: P.L.2013, c.211, s.4)

6. Section 8 of P.L.2013, c.211 (C.18A:61D-18) is amended to read as follows:

8. Nothing in this act shall be construed to:

a. permit a trained designee to perform the duties or fill the position of a licensed medical professional;

b. prohibit the administration of [a pre-filled] one unit dose epinephrine [auto-injector mechanism] by a person acting pursuant to a lawful prescription;

c. prevent a licensed and qualified member of a health care profession from administering a [pre-filled] one unit dose epinephrine [auto-injector mechanism] if the duties are consistent with the accepted standards of the member's profession; or

d. violate the "Athletic Training Licensure Act," P.L.1984, c.203 (C.45:9-37.35 et seq.) in the event that a licensed athletic trainer administers epinephrine to a member of the campus community as a trained designee pursuant to this act.

(cf: P.L.2013, c.211, s.8)

7. Section 3 of P.L.2015, c.231 (C.26:12-19) is amended to read as follows:

3. As used in this act:

"Commissioner" means the Commissioner of Health.

"Member of the youth camp community" means a person who is a camper at, or a staff member of, a youth camp.

"Professionally qualified health care provider" means a licensed health care professional whose authorized scope of practice includes the administration of medication, whether independently, or through a joint protocol or standing order from a physician.

"Trained designee" means a youth camp staff member who has been trained by the youth camp health director or, if the youth camp health director is not professionally qualified to administer epinephrine, by a professionally qualified health care provider, in the detection of anaphylaxis and the emergency administration of one unit dose epinephrine [using a pre-filled auto-injector mechanism].

"Youth camp" means the same as that term is defined by section 3 of P.L.1973, c.375 (C.26:12-3).

"Youth camp health director" means and includes a person, 18 years of age or older, who meets the qualifications required by N.J.A.C.8:25-5.2 and who is responsible for the proper medical recordkeeping, care, and treatment of campers at a youth camp. Youth camps that do not have a health director who is a medical professional may use one of the following options: a youth camp health director trained in the emergency administration of one unit dose epinephrine [via a pre-filled auto-injector mechanism] by the professionally qualified health care provider responsible for writing the prescription with documentation; an emergency medical technician certified in emergency epinephrine [auto-injector] administration; or an individual trained in the detection of anaphylaxis and the emergency administration of one unit dose epinephrine [using a pre-filled auto-injector device].

"Youth camp operator" means the same as that term is defined by section 3 of P.L.1973, c.375 (C.26:12-3).

(cf: P.L.2015, c.231, s.3)

8. Section 4 of P.L.2015, c.231 (C.26:12-20) is amended to read as follows:

4. a. A youth camp operator, as part of a youth camp medical program, and in accordance with the provisions of the "New Jersey Youth Camp Safety Act," P.L.1973, c.375 (C.26:12-1 et seq.) and rules and regulations adopted by the Department of Health pursuant thereto, may develop a policy for the emergency administration of a one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a member of the youth camp community for anaphylaxis when a professionally qualified health care provider is not immediately available. The policy shall:

(1) permit the youth camp health director and trained designees to administer a one unit dose epinephrine [via a pre-filled auto-injector mechanism] to a member of the youth camp community for whom the youth camp health director or trained designee is responsible, when the youth camp health director or trained designee believes, in good faith, that the member of the youth camp community is having an anaphylactic reaction; and

(2) permit the youth camp health director and trained designees, when responsible for the safety of one or more members of the youth camp community, to carry, in a secure but easily accessible location, a supply of [pre-filled] one unit dose epinephrine [auto-injectors] that is prescribed under a standing protocol from a licensed physician or other authorized prescriber.

b. If a youth camp develops a policy for the emergency administration of one unit dose epinephrine [via a pre-filled auto-injector mechanism], the youth camp operator, in cooperation with the youth camp health director, shall:

(1) maintain and adhere to a standardized training protocol for the emergency administration of epinephrine by trained designees under the youth camp medical program, which training protocol shall be established and administered by a professionally qualified health care provider;

(2) ensure that trained designees have satisfactorily completed the training protocol;

(3) obtain and maintain a supply of [pre-filled] one unit dose epinephrine [auto-injectors], pursuant to a standing protocol from a licensed physician or other authorized prescriber, for use by the youth camp health director and trained designees in emergency anaphylaxis situations; and

(4) establish protocols and one or more secure locations for the safe and accessible storage of the youth camp's supply of [pre-filled] one unit dose epinephrine [auto-injectors].

(cf: P.L.2015, c.231, s.4)

9. Section 6 of P.L.2015, c.231 (C.26:12-22) is amended to read as follows:

6. Nothing in this act shall be construed to:

a. permit a trained designee to perform the duties or fill the position of a licensed medical professional;

b. prohibit the administration of a [pre-filled] one unit dose epinephrine [auto-injector mechanism] by a person acting pursuant to a lawful prescription;

d. violate the "Athletic Training Licensure Act," P.L.1984, c.203 (C.45:9-37.35 et seq.) in the event that a licensed athletic trainer administers epinephrine to a member of the youth camp community as a trained designee pursuant to this act; or

e. require written authorization from a camper's parent or guardian, or from any youth camp staff member, prior to the emergency administration of epinephrine when:

(1) there is no identified medical diagnosis involving risk of anaphylaxis on record with the youth camp health director; or

(2) there is a medical diagnosis involving risk of anaphylaxis recorded with the youth camp health director, but the [pre-filled] one unit dose epinephrine [auto-injector mechanism] was not provided to the youth camp by the camper or by the camper's parent or authorized guardian.

(cf: P.L.2015, c.231, s.6)

10. This act shall take effect immediately.

STATEMENT

This bill modifies current law regulating the method in which epinephrine is administered in schools, institutions of higher education, and youth camps during emergency circumstances where an individual is experiencing anaphylaxis. Specifically, the bill removes references in current law requiring the use of a pre-filled auto-injector mechanism to administer epinephrine and replaces it with the term “one use dose epinephrine.” In doing so, this bill expands the emergency use of epinephrine in these settings to include epinephrine nasal spray, as well as future advances in this area of medicine.