BILLASPASSEDBYTHEHOUSE H.209
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H.209
IntroducedbyRepresentativeGoldmanofRockingham
ReferredtoCommitteeon
Date:
Subject:Health;education;intranasalepinephrine;prescribinganddispensing
authority;schools
Statementofpurposeofbillasintroduced:Thisbillproposestoallowahealth
careprofessionaltoprescribeandissuestandingordersfortheuseof
intranasalepinephrineinschools.Itproposestoallowaschooltomaintaina
stocksupplyofintranasalepinephrine.Thebillfurtherproposestoallowa
schooladministratortoauthorizeschoolnursesorotherdesignatedpersonnel
toadministerorhaveastudentself-administerintranasalepinephrinein
accordancewithastudent’splanofactionformanagingthestudent’slife-
threateningallergy.
Anactrelatingtointranasalepinephrineinschools
ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
Sec.1.16V.S.A.§ 1388isamendedtoread:
§1388.STOCKSUPPLYANDEMERGENCYADMINISTRATIONOF
EPINEPHRINEAUTO-INJECTORS
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(a)Asusedinthissection:
(1)“Designatedpersonnel”meansaschoolemployee,agent,or
volunteerwhohasbeenauthorizedbytheschooladministratortoprovideand
administerepinephrineauto-injectorsandintranasalepinephrineunderthis
sectionandwhohascompletedthetrainingrequiredbyStateBoardpolicy.
(2)“Epinephrineauto-injector”meansasingle-usedevicethatdeliversa
premeasureddoseofepinephrine.
(3)“Healthcareprofessional”meansaphysicianlicensedpursuantto26
V.S.A.chapter23or33,anadvancedpracticeregisterednurselicensedto
prescribedrugsandmedicaldevicespursuantto26V.S.A.chapter28,ora
physicianassistantlicensedtoprescribedrugsandmedicaldevicespursuantto
26V.S.A.chapter31.
(4)“Intranasalepinephrine”meansanasalspraydeliveringadosea
epinephrine.
(5)“School”meansapublicorapprovedindependentschooland
extendstoschoolgrounds,school-sponsoredactivities,school-provided
transportation,andschool-relatedprograms.
(5)(6)“Schooladministrator”meansaschool’sprincipalorheadmaster.
(b)(1)Ahealthcareprofessionalmayprescribeanepinephrineauto-
injectororintranasalepinephrine,orboth,inaschool’sname,whichmaybe
maintainedbytheschoolforuseasdescribedinsubsection(d)ofthissection.
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Thehealthcareprofessionalshallissuetotheschoolastandingorderforthe
useofanepinephrineauto-injectorprescribedunderthissection,including
protocolsfor:
(A)assessingwhetheranindividualisexperiencingapotentiallylife-
threateningallergicreaction;
(B)administeringanepinephrineauto-injectorandintranasal
epinephrinetoanindividualexperiencingapotentiallylife-threateningallergic
reaction;
(C)caringforanindividualafteradministeringanepinephrineauto-
injectortohimorherorintranasalepinephrine,includingcontacting
emergencyservicespersonnelanddocumentingtheincident;and
(D)disposingofusedorexpiredepinephrineauto-injectorsand
intranasalepinephrine.
(2)Apharmacistlicensedpursuantto26V.S.A.chapter36orahealth
careprofessionalmaydispenseprescribedepinephrineauto-injectors
prescribedorintranasalepinephrine,orboth,toaschool.
(c)Aschoolmaymaintainastocksupplyofepinephrineauto-injectorsor
intranasalepinephrine,orboth.Aschoolmayenterintoarrangementswith
epinephrineauto-injectormanufacturersorsuppliersofepinephrineauto-
injectorsorintranasalepinephrine,orboth,toacquireepinephrineauto-
injectorstheseproductsforfreeoratreducedorfairmarketprices.
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(d)Theschooladministratormayauthorizeaschoolnurseordesignated
personnel,orboth,to:
(1)provideanepinephrineauto-injectororintranasalepinephrinetoa
studentforself-administrationaccordingtoaplanofactionformanagingthe
student’slife-threateningallergymaintainedinthestudent’sschoolhealth
recordspursuanttosection1387ofthistitle;
(2)administeraprescribedepinephrineauto-injectororintranasal
epinephrinetoastudentaccordingtoaplanofactionmaintainedinthe
student’sschoolhealthrecords;and
(3)administeranepinephrineauto-injectororintranasalepinephrine,in
accordancewiththeprotocolissuedundersubsection(b)ofthissection,toa
studentorotherindividualataschoolifthenurseordesignatedpersonnel
believeingoodfaiththatthestudentorindividualisexperiencinganaphylaxis,
regardlessofwhetherthestudentorindividualhasaprescriptionforan
epinephrineauto-injectororintranasalepinephrine.
(e)Designatedpersonnel,aschool,andahealthcareprofessional
prescribinganepinephrineauto-injectororintranasalepinephrine,orboth,toa
schoolshallbeimmunefromanycivilorcriminalliabilityarisingfromthe
administrationorself-administrationofanepinephrineauto-injectoror
intranasalepinephrineunderthissection,unlesstheperson’sconduct
constitutedintentionalmisconduct.Providingoradministeringanepinephrine
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auto-injectororintranasalepinephrineunderthissectiondoesnotconstitute
thepracticeofmedicine.
(f)OnorbeforeJanuary1,2014,theTheStateBoard,inconsultationwith
theDepartmentofHealth,shalladoptpoliciesformanagingstudentswithlife-
threateningallergiesandotherindividualswithlife-threateningallergieswho
maybepresentataschool.Thepoliciesshall:
(1)establishprotocolstopreventexposuretoallergensinschools;
(2)establishproceduresforrespondingtolife-threateningallergic
reactionsinschools,includingpostemergencyprocedures;
(3)implementaprocessforschoolsandtheparentsorguardiansof
studentswithalife-threateningallergytojointlydevelopawritten
individualizedallergymanagementplanofactionthat:
(A)incorporatesinstructionsfromastudent’sphysicianregarding
thestudent’slife-threateningallergyandprescribedtreatment;
(B)includestherequirementsofsection1387ofthistitle,ifastudent
isauthorizedtopossessandself-administeremergencymedicationatschool;
(C)becomespartofthestudent’shealthrecordsmaintainedbythe
school;and
(D)isupdatedeachschoolyear;
(4)requireeducationandtrainingforschoolnursesanddesignated
personnel,includingtrainingrelatedtostoringandadministeringan
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epinephrineauto-injectororintranasalepinephrineandrecognizingand
respondingtoalife-threateningallergicreaction;and
(5)requireeachschooltomakepubliclyavailableprotocolsand
proceduresdevelopedinaccordancewiththepoliciesadoptedbytheState
Boardunderthissection.
Sec.2.EFFECTIVEDATE
ThisactshalltakeeffectonJuly1,2025.
Sec.1.16V.S.A.§ 1388isamendedtoread:
§1388.STOCKSUPPLYANDEMERGENCYADMINISTRATIONOF
EPINEPHRINEAUTO-INJECTORS
(a)Asusedinthissection:
(1)“Designatedpersonnel”meansaschoolemployee,agent,or
volunteer,orpracticalnurselicensedpursuantto26V.S.A.chapter28who
hasbeenauthorizedbytheschooladministratornursetoprovideand
administerepinephrineauto-injectorsandintranasalepinephrineunderthis
sectionandwhohascompletedthetrainingrequiredbyStateBoardpolicy.
(2)“Epinephrineauto-injector”meansasingle-usedevicethatdelivers
apremeasureddoseofepinephrine.
(3)“Healthcareprofessional”meansaphysicianlicensedpursuantto
26V.S.A.chapter23or33,anadvancedpracticeregisterednurselicensedto
prescribedrugsandmedicaldevicespursuantto26V.S.A.chapter28,ora
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physicianassistantlicensedtoprescribedrugsandmedicaldevicespursuantto
26V.S.A.chapter31.
(4)“Intranasalepinephrine”meansanasalspraydeliveringadoseof
epinephrine.
(5)“School”meansapublicorapprovedindependentschooland
extendstoschoolgrounds,school-sponsoredactivities,school-provided
transportation,andschool-relatedprograms.
(5)(6)“Schooladministrator”meansaschool’sprincipalor
headmaster.
(7)“Schoolnurse”meansaschoolnurseendorsedbytheAgencyof
EducationpursuanttotheLicensingofEducatorsandthePreparationof
EducationalProfessionalsrule(CVR22-000-010).
(b)(1)Ahealthcareprofessionalmayprescribeanepinephrineauto-
injectororintranasalepinephrine,orboth,inaschool’sname,whichmaybe
maintainedbytheschoolforuseasdescribedinsubsection(d)ofthissection.
Thehealthcareprofessional,inconsultationwiththeschoolnurse,shallissue
totheschoolastandingorderfortheuseofanepinephrineauto-injector
prescribedunderthissection,includingprotocolsfor:
(A)assessingwhetheranindividualisexperiencingapotentiallylife-
threateningallergicreaction; BILLASPASSEDBYTHEHOUSE H.209
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(B)administeringanepinephrineauto-injectorandintranasal
epinephrinetoanindividualexperiencingapotentiallylife-threatening
allergicreaction;
(C)caringforanindividualafteradministeringanepinephrineauto-
injectortohimorherorintranasalepinephrine,includingcontacting
emergencyservicespersonnelanddocumentingtheincident;and
(D)disposingofusedorexpiredepinephrineauto-injectorsand
intranasalepinephrine.
(2)Apharmacistlicensedpursuantto26V.S.A.chapter36orahealth
careprofessionalmaydispenseprescribedepinephrineauto-injectors
prescribedorintranasalepinephrine,orboth,toaschool.
(c)Aschoolmaymaintainastocksupplyofepinephrineauto-injectorsor
intranasalepinephrine,orboth.Aschoolmayenterintoarrangementswith
epinephrineauto-injectormanufacturersorsuppliersofepinephrineauto-
injectorsorintranasalepinephrine,orboth,toacquireepinephrineauto-
injectorstheseproductsforfreeoratreducedorfairmarketprices.
(d)Theschooladministratormayauthorizeaschoolnurseor,whointurn
mayauthorizedesignatedpersonnel,orboth,to:
(1)provideanepinephrineauto-injectororintranasalepinephrinetoa
studentforself-administrationaccordingtoaplanofactionformanagingthe BILLASPASSEDBYTHEHOUSE H.209
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student’slife-threateningallergymaintainedinthestudent’sschoolhealth
recordspursuanttosection1387ofthistitle;
(2)administeraprescribedepinephrineauto-injectororintranasal
epinephrinetoastudentaccordingtoaplanofactionmaintainedinthe
student’sschoolhealthrecords;and
(3)administeranepinephrineauto-injectororintranasalepinephrine,
inaccordancewiththeprotocolissuedundersubsection(b)ofthissection,toa
studentorotherindividualataschoolifthenurseordesignatedpersonnel
believeingoodfaiththatthestudentorindividualisexperiencinganaphylaxis,
regardlessofwhetherthestudentorindividualhasaprescriptionforan
epinephrineauto-injectororintranasalepinephrine.
(e)Designatedpersonnel,aschool,andahealthcareprofessional
prescribinganepinephrineauto-injectororintranasalepinephrine,orboth,to
aschoolshallbeimmunefromanycivilorcriminalliabilityarisingfromthe
administrationorself-administrationofanepinephrineauto-injectoror
intranasalepinephrineunderthissection,unlesstheperson’sconduct
constitutedintentionalmisconduct.Providingoradministeringanepinephrine
auto-injectororintranasalepinephrineunderthissectiondoesnotconstitute
thepracticeofmedicine.
(f)OnorbeforeJanuary1,2014,theTheStateBoard,inconsultationwith
theDepartmentofHealth,shalladoptpoliciesformanagingstudentswithlife- BILLASPASSEDBYTHEHOUSE H.209
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threateningallergiesandotherindividualswithlife-threateningallergieswho
maybepresentataschool.Thepoliciesshall:
(1)establishprotocolstopreventexposuretoallergensinschools;
(2)establishproceduresforrespondingtolife-threateningallergic
reactionsinschools,includingpostemergencyprocedures;
(3)implementaprocessforschoolsschoolnursesandtheparentsor
guardiansofstudentswithalife-threateningallergytojointlydevelopa
writtenindividualizedallergymanagementplanofactionthat:
(A)incorporatesinstructionsfromastudent’sphysicianhealthcare
professionalregardingthestudent’slife-threateningallergyandprescribed
treatment;
(B)includestherequirementsofsection1387ofthistitle,ifastudent
isauthorizedtopossessandself-administeremergencymedicationatschool;
(C)becomespartofthestudent’shealthrecordsmaintainedbythe
school;and
(D)isupdatedeachschoolyear;
(4)requireeducationandtrainingforschoolnursesanddesignated
personnel,includingtrainingrelatedtostoringandadministeringan
epinephrineauto-injectororintranasalepinephrineandrecognizingand
respondingtoalife-threateningallergicreaction;and BILLASPASSEDBYTHEHOUSE H.209
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(5)requireeachschooltomakepubliclyavailableprotocolsand
proceduresdevelopedinaccordancewiththepoliciesadoptedbytheState
Boardunderthissection.
Sec.2.EFFECTIVEDATE
ThisactshalltakeeffectonJuly1,2025.