Epinephrine FAQs

FAQs - Epinephrine

The Resources section of this page contains website links utilized to develop this FAQ.

If you are looking for something specific and don't see the answer, reference the complete NYSED Guidelines for Medication Management in Schools and Guidelines for Allergies and Anaphylaxis and utilize the resources section below.

Notification & Reporting

Nurses Patient-Specific vs. Non-Patient-Specific Epinephrine Orders

Patient specific

Q. What is required for a student to be considered ‘independent’ and able to self-carry and self-administer their own epinephrine?
A. For a student to be considered ‘independent’ and able to self-carry and self-administer their own epinephrine, the school must be provided with a health care provider order and an attestation along with written parent/guardian consent. The attestation by the health care provider confirms the following:

the student’s diagnosis of an allergy for which epinephrine is necessary; and
the student has demonstrated that they can self-administer the prescribed epinephrine effectively. See the Guidelines for Medication Administration in Schools and the Guide to Determining Levels of Assistance in Medication Delivery.

Q. What should a school nurse (RN) do if they receive a patient specific order for epinephrine, but the parent/guardian does not supply the emergency medication?
A. If the parent/guardian fails to supply the emergency medication for a student, the student should not be excluded from school or school-sponsored activities. If the school does not have non-patient specific orders from the district’s medical director permitting the school nurse to administer emergency epinephrine, the school should communicate in writing to the parent/guardian that, in the absence of the medication, emergency medical services (EMS) will be called per district policy. The district’s director of school health services (a.k.a., medical director) or school nurse should also communicate this information to the prescriber.

Schools should be cognizant of the financial constraints a family may face in obtaining the medication. Information on obtaining health insurance or reduced cost medications from manufacturers should be provided in order to ensure the safety of their child while at school.

If all attempts to have the parent/guardian provide the medication fail, the school may need to consider notifying Child Protective Services (CPS). Refer to page 31 in the Guidelines for Medication Administration in Schools.

Non-patient specific

Q. Who can follow non-patient specific orders for epinephrine administration?
A. Non-patient specific orders can only be followed by school nurses (RNs).
For details, see the Options Chart for Administration of Epinephrine in Schools.

Q. May an LPN administer emergency epinephrine under a non-patient specific order from a medical director?
A. No. An LPN cannot administer emergency epinephrine under a non-patient specific order. LPNs cannot administer any medication under a non-patient specific order. LPNs may only administer emergency epinephrine following a patient-specific order or as directed by an RN, the medical director, or other appropriate licensed health professional (e.g., PA, NP). (Assuming the LPN is appropriately trained and competent to provide the service.)

Q. Can a school nurse (RN) administer epinephrine to any person experiencing signs and symptoms of anaphylaxis at school or school-sponsored events under a non-patient specific order from a medical director?
A. Yes, a school nurse (RN) can administer epinephrine to any person experiencing signs and symptoms of anaphylaxis at school or school-sponsored events under a non-patient specific order from a nurse practitioner or physician.

Q. Can a school medical director order a second dose of epinephrine in their non-patient specific order for school nurses?
A. Yes, a school medical director can order a second dose of epinephrine when writing a non-patient specific order for the school nurse (RN).

Q. Does the school nurse (RN) need to take the approved NYSDOH/NYSED training to administer epinephrine under a non-patient specific order?
A. No, a school nurse (RN) does not need to take the NYSDOH/NYSED training to administer a non-patient specific order of epinephrine. The RN's scope of practice permits the administration of medications in accordance with a provider order.

Obtaining, Monitoring, & Record Keeping

Q. How can the district obtain epinephrine devices for use at school?
A. A school district may obtain epinephrine devices for use at school by obtaining a non-patient specific order for epinephrine from their director of school health services (medical director) or from a NYS licensed physician or nurse practitioner. The order may be submitted directly to a medical supply company, local pharmacy, or the EPIPEN4SCHOOLS program. The neffyinschools program provides information for schools to obtain free neffy (nasal epinephrine).

Please Note: The New York State Education Department (NYSED) and NYS Center for School Health (NYSCSH) do not endorse individual vendors, products, or services. Links to vendors, products, or services by trade name, trademark, or manufacturer are provided for educational purposes only.

Q. How often do schools need to check the epinephrine expiration date and the location security?
A. Schools storing student and stock medications should have a method to track the expiration dates of medication. The tracking method should be clearly outlined in the school‘s health services policies and protocols. The expiration date of the epinephrine may be entered on the student’s Medication Administration Record (MAR) or the NYSCSH’s Medication Expiration Tracking Tool may be used.

A stock epinephrine device may be stored with the automatic external defibrillator (AED), and the epinephrine device expiration date may be entered on the daily NYSCSH’s Epinephrine-AED Maintenance Checklist.

Q. Is there a document available to monitor epinephrine location, type, dose, and expiration date?
A. NYSCSH created a Sample Epinephrine Device Log, which is found on our Samples I Forms page and may be modified and utilized by school districts.

Page Updated 1/27/26

Other

Storage

Q. How does stock epinephrine need to be stored?
A. Schools that have chosen to stock emergency medications allowed by state laws (epinephrine devices and opioid antagonists) should store these medications in a manner specified in the laws and regulations governing their use. Stock emergency medications should be stored in a secure location that is readily accessible to unlicensed trained school personnel. AED cabinets are commonly used since the AEDs need to be checked at the same frequency as the medications are to be inventoried, are centrally located, and can be secured with plastic break away locks are recommended to be used. For details, see page 43 in the Guidelines for Medication Administration in Schools.

Page Updated 1/27/26

Training

Q. Can bus drivers administer epinephrine devices to a student with a patient specific order?
A. Trained unlicensed school personnel or contractors of the school, including bus drivers, may be trained to administer epinephrine devices to a student with a patient specific order in accordance with Commissioner’s regulation section 136.7. For details, see page 24 in the Guidelines for Medication Management in Schools. The trained unlicensed school personnel should receive a copy of the Emergency Care Plan (ECP) and know the location of the epinephrine device (e.g., student’s backpack).

Q. What are the requirements a school district must have in place to permit trained unlicensed school personnel to administer stock epinephrine devices to students and staff having anaphylactic symptoms in a school building?
A. The requirements to permit trained unlicensed school personnel to administer stock epinephrine devices to students and staff having anaphylactic symptoms include:

Development of a policy regarding possession and use of epinephrine devices pursuant to Public Health Law §3000-c and Education Law §921 which includes the mandated training regarding responding to anaphylaxis;
Written district policy on calling for emergency transport or 911, including which school personnel will accompany the student until the parent/guardian is present;
Evaluation, review, and periodic revision of policy, protocols, and procedures as necessary to keep them up to date with current best practice;
Identification of school personnel roles and responsibilities;
Identification and provision of professional development and education for both licensed and trained unlicensed school personnel;
Training of unlicensed school personnel on preventing and responding to anaphylaxis. Training can be conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment or through the NYSDOH approved course. Training shall include how to recognize signs and symptoms of severe allergic reactions, including anaphylaxis, recommended dosage for adults and children, standards and procedures for the storage and administration of an epinephrine devices and emergency follow-up procedures;
Sending a notification, at least once per calendar year, to the parents/guardians of all students to make them aware of the anaphylactic policies and informational materials in this document pursuant to Public Health Law Article 25 §2500-h(2)(f); and
Schools must provide teachers written informational material on the use of epinephrine devices that is created and approved by the Department of Health. The NYSDOH materials are not available yet. In the interim, schools are encouraged to use information from the manufacturer's website to be provided to teachers. The manufacturer information can be found on the Epinephrine Resource page.

Q. Who trains unlicensed school personnel to administer stock epinephrine devices to students or staff having anaphylactic symptoms in a school building?
A. Schools choosing to train unlicensed school personnel to administer emergency epinephrine devices must use training approved by the NYS Department of Health (NYSDOH). A free NYSDOH approved training webinar titled Managing Allergies and Anaphylaxis at School: Training for School Personnel, a post-test, and a skills training checklist are available on the NYS Center for School Health website.

Q. Who trains unlicensed school personnel to administer epinephrine to a student with a patient specific order?
A. Education Law §921 requires that unlicensed personnel are trained by an RN, NP, PA, or physician to administer an epinephrine device to a student with a patient specific order. This training, and the Emergency Care Plan review, must be completed annually.

Pursuant to Commissioner's regulation 136.7(f)(1), training must include:

Identification of the specific allergen(s) of the student(s), including review of each student’s emergency care plan if available;
Signs and symptoms of a severe allergic reaction warranting administration of epinephrine;
How to access emergency services per school policy;
The steps for administering the prescribed epinephrine device;
Observation of the trainee using an epinephrine training device;
Steps for providing ongoing care while awaiting emergency services;
Notification of appropriate school personnel;
Methods of safely storing, handling, and disposing of epinephrine devices

For details, see pages 24-25 in the Guidelines for Medication Management in Schools.

Q. Can unlicensed trained school personnel administer Neffy®?
A. Yes, unlicensed trained school personnel can administer Neffy®. Education Law §921 now allows unlicensed trained school personnel to administer epinephrine devices which includes nasal administration.

Page Updated 1/27/26

Unlicensed Staff Patient-Specific vs. Non-Patient-Specific Epinephrine Orders

Patient specific

Q. Can trained unlicensed school personnel administer an epinephrine device to a student with a patient specific order at school, on school property or transportation, and at any school-sponsored event?
A. Yes, appropriately trained unlicensed school personnel can administer an epinephrine device to a student with a patient specific order at school, on school property or transportation, and at any school-sponsored event. See page 24 in the Guidelines for Medication Administration in Schools for details on the training requirements.

Q. Can trained unlicensed school personnel administer a second dose of epinephrine to a student with a patient specific order if the student's symptoms do not improve?
A. Yes, appropriately trained unlicensed school personnel can administer a second dose of epinephrine if the health care provider order states the student is to receive more than one dose of epinephrine within a specified time frame. This would be in accordance with the student’s health care provider order and emergency care plan (ECP) and occur while awaiting emergency medical services transportation.

Non-patient specific

Q. Can trained unlicensed school personnel administer a stock epinephrine device to a student or staff member outside of a school building or off school grounds (e.g., field trips)?
A. No. Trained unlicensed school personnel cannot administer non-patient specific (stock) epinephrine devices to a student or staff member outside of a school building or off school grounds (e.g., field trips). Education Law Article 19 §921-a limits trained unlicensed school personnel to administration of an epinephrine device to students or staff having anaphylactic symptoms in school buildings only.

Q. Can trained unlicensed school personnel administer a second dose of stock epinephrine if the student/staff symptoms do not improve?
A. Yes, trained unlicensed school personnel can give a second dose of stock epinephrine if the student/staff symptoms do not improve in accordance with Public Health Law §3000-c training and according to the district policy and protocol. Emergency medical services must be called after the first dose is administered.

Page Updated 1/27/26