1. Purpose
Any service that gives vaccines or injections must be ready to recognise and treat anaphylaxis, a rare but life-threatening allergic reaction that can happen within minutes. A travel clinic gives many injections, so it must have the right equipment, trained staff and a clear plan. This policy sets out how the Service prevents, recognises and treats anaphylaxis and learns from any event.
The Service must verify this policy against current Resuscitation Council UK anaphylaxis guidance and the Green Book chapter on adverse reactions before adoption.
2. Sources to verify before adoption
- Resuscitation Council UK, emergency treatment of anaphylaxis guidance: https://www.resus.org.uk/
- Immunisation against infectious disease (the Green Book), the chapter on adverse reactions: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
- MHRA Yellow Card scheme for adverse drug and vaccine reactions: https://yellowcard.mhra.gov.uk/
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
3. Scope
This policy applies to:
- every vaccine or injection the Service gives
- the recognition and treatment of anaphylaxis on the premises
- the clinicians who inject and any staff who would assist in an emergency
4. Reducing the risk
- before any vaccine the Service checks for known allergies and previous reactions to a vaccine or its components
- where a traveller has a history that raises the risk, the Service takes advice and acts on it before giving the vaccine
- travellers are advised to wait on the premises for a short period after vaccination so that an early reaction can be seen and treated, and the Service states that period
5. Recognising anaphylaxis
Staff are trained to tell anaphylaxis apart from a simple faint. Anaphylaxis is a sudden reaction with airway, breathing or circulation problems, often with skin changes. A faint usually settles quickly when the person lies down. When in doubt, the Service treats it as anaphylaxis, because delay is the main cause of harm.
6. Immediate treatment
The Service follows the current Resuscitation Council UK anaphylaxis algorithm. In outline:
- call for help and call 999 for an ambulance early
- give intramuscular adrenaline at the correct dose for the person's age and weight, into the outer mid-thigh, and repeat after five minutes if there is no improvement
- position the person appropriately for their symptoms (lying with legs raised for circulation problems; sitting up if breathing is the main problem; recovery position if unconscious and breathing)
- give oxygen and other treatment, and monitor, as the algorithm and the team's training allow
- stay with the person until the ambulance arrives and hand over clearly
The Service confirms the exact doses and steps against the current Resuscitation Council UK guidance.
7. Equipment and medicines
- an anaphylaxis kit with in-date adrenaline at the right strengths, plus the other items the algorithm needs, is immediately available wherever injections are given
- the kit and its contents are checked regularly and after any use, restocked, and kept in date, with the checks recorded
- resuscitation equipment appropriate to the Service is available and maintained
8. After an event
- the person is referred to hospital for observation, because a reaction can return after it first settles
- the event is recorded in full, logged as a patient-safety incident, and reviewed
- the reaction is reported through the MHRA Yellow Card scheme
- the traveller is given clear advice for the future, including which vaccine or component to avoid
9. Training and drills
- everyone who gives injections, and the staff who would assist, are trained in anaphylaxis recognition and treatment and in resuscitation to the level the Service requires, and refreshed on a stated cadence
- the Service runs occasional drills so the team can act quickly and knows where the kit is
- the Service records who is trained and the next refresher date
10. Audit cadence
The Service checks, on a stated cadence, that:
- the anaphylaxis kit and adrenaline are present, in date and checked, wherever injections are given
- staff who inject are trained in anaphylaxis and resuscitation and are in date
- any anaphylaxis event was treated per the algorithm, recorded, referred, reported and reviewed
- allergy histories are checked before vaccination and post-vaccination waiting is offered
The Registered Manager and the clinical lead review the results and record the improvement actions that follow.