Spare Emergency Adrenaline Auto-Injectors (AAIs) in Schools
A Step-by-Step Implementation Guide
New allergy guidance is on the way for schools.
Following the government’s consultation on Supporting Children and Young People with Medical Conditions and Allergy, updated statutory guidance is expected to strengthen allergy safety in schools across England.
This long-awaited change, championed by families, clinicians, and allergy charities, will mean schools are expected to:
- Provide allergy training for all staff.
- Develop a clear allergy policy.
- Ensure pupils with allergies have Individual Healthcare Plans.
- Hold spare emergency adrenaline auto-injectors (AAIs) on site.
To help schools prepare, we’ve created a simple step-by-step guide explaining how to introduce spare emergency AAIs safely and confidently.
What the guidance says — and what it means
Anaphylaxis can happen suddenly and without warning. The updated guidance makes it clear that schools are expected to take a proactive approach to allergy safety, including holding spare emergency AAIs for use in emergencies.
Under the Human Medicines (Amendment) Regulations 2017, schools in England can purchase spare AAI devices without a prescription for emergency use.
However, these devices should always be considered spare devices – not a replacement for a pupil’s own prescribed AAIs. Pupils at risk of anaphylaxis should continue to carry or have immediate access to their own prescribed devices at all times.
Step 1: Work out which devices you’ll need
Not all AAIs are the same. The two doses commonly used in schools are:
- Junior (150 micrograms) — for children under 6 years old.
- Adult (300 micrograms) — for children over 6 years old.
Many primary schools will require a mixture of both Junior and Adult devices, while secondary schools may only need Adult devices.
Recommended number of spare AAIs
| School Type | Under 6 Years (150mcg) | Over 6 Years (300mcg) |
| Nursery | 2 spare devices | n/a |
| Primary | 2 spare devices | 2 spare devices |
| Secondary | n/a | 2–4 spare devices* |
| Special Schools | 2 spare devices** | 2 spare devices** |
* The number for secondary schools will depend on pupil numbers and site size.
** Schools operating across multiple sites should ensure appropriate devices are available on each site.
For most schools, this means keeping around four spare devices on site to ensure rapid access in an emergency.
You should also consider which brand of AAI to purchase. Schools are advised to buy the brand that is most commonly prescribed within their setting so staff become familiar and confident with how that particular device is administered. Although all AAIs contain the same medication (adrenaline), there are slight differences in how each brand is used, which could cause confusion during an emergency if staff are unfamiliar with the device.
However, it is important to know that different brands can still be used safely together if needed. For example, if a pupil normally carries a Jext® device but requires a second dose and only an EpiPen® is available, it is safe to administer the EpiPen®. The medication is the same – the only difference is the device manufacturer and administration technique.
Step 2: Choose smart storage locations
Spare AAIs should be stored in locations that are:
- Clearly labelled.
- Easy to access.
- Quick to reach in an emergency.
Devices should never be locked away and should be accessible within five minutes of where they may be needed.
In larger schools, it may be appropriate to keep more than one emergency kit on site – for example, one near the dining hall and another near playground or sports areas. Spare AAIs should always be stored in pairs so that a second dose is immediately available if needed.
Many schools choose to store spare AAIs in a clearly labelled Emergency Anaphylaxis Kit, such as a red medical box. This can also contain:
- The school’s emergency asthma inhaler.
- Spacer devices.
- Simple emergency instructions.
Legislation also allows schools to purchase an emergency salbutamol inhaler and spacer device without a prescription for asthma emergencies. These can be used when a pupil’s own inhaler is unavailable, such as if it is empty, broken, or inaccessible. For this reason, many schools store emergency asthma inhalers alongside spare AAIs within the same emergency kit.
While devices should remain easily accessible to staff, they must also be stored securely and kept out of reach of younger children.
Step 3: Tell everyone
Building a whole-school approach to allergy safety relies on open communication. Once your school decides to hold spare emergency AAIs, make sure everyone knows how they will be used and why they are there:
- Parents and carers – via letters, newsletters, or policy updates on the website.
- Staff – through meetings and training sessions.
- Pupils – in assemblies or PSHE lessons to build understanding and reduce stigma.
Clear, proactive communication reassures families and prepares the whole community to respond confidently if an emergency occurs.
Step 4: Getting Consent
Pupils who have been prescribed an adrenaline auto-injector (AAI) should also have a BSACI Allergy Action Plan in place. This plan is authorised by the prescribing healthcare professional and includes written parental consent for emergency treatment in school.
If parents state that they do not currently have an Allergy Action Plan, these can be downloaded from the BSACI website and taken to the child’s GP or allergy specialist for completion. Paediatric Allergy Action Plans – BSACI
The school’s spare emergency AAIs can be given to the following pupils:
- Pupils with prescribed AAIs whose own devices aren’t available (broken, expired, inaccessible, or misfired) – provided they have an Allergy Action Plan with medical authorisation and written parental consent.
- Lower-risk pupils with diagnosed food allergies who haven’t been prescribed their own AAIs – again, medical authorisation and parental consent must be in place, typically through an Allergy Action Plan signed by their healthcare professional.
Using “spare” AAIs in an emergency situation without prior consent
The MHRA has clarified that a legal exemption under Regulation 238 of the Human Medicines (Amendment) Regulations 2017 permits a school’s spare AAIs to be used to save a life for a pupil or other person not known by the school to be at risk of anaphylaxis.
This might be a child presenting for the first time with anaphylaxis due to an unrecognised allergy, or an adult visitor to the school premises. This provision should be reserved for exceptional circumstances only, and if anaphylaxis is suspected, the device should be used immediately.
Step 5: Write your allergy policy
Schools should clearly outline the use of spare AAIs within their allergy policy.
Your policy should include:
- When and how spare AAIs may be used.
- Where devices are stored.
- How expiry dates will be monitored.
- Procedures for replacing used or expired devices.
- Record-keeping and incident reporting arrangements.
- Staff training arrangements.
Staff should also know:
- Where spare AAIs are stored.
- How to access them quickly.
- How to use them safely.
The Department of Health and Social Care (DHSC) is expected to publish a template allergy policy alongside the final statutory guidance, which schools will be able to adapt for their own setting.
Step 6: Purchase your spare AAI devices
Schools can purchase spare AAIs directly from a pharmacy without a prescription.
Pharmacies will usually require:
- A signed request from the head teacher or principal.
- The request to be on headed paper.
- Confirmation of the number of devices required and their intended use.
Schools will need to pay the retail cost of the devices and may need to pre-order them, as pharmacies do not always keep stock available. Prices can vary significantly, so it is worth comparing suppliers before purchasing.
AAIs typically have a shelf life of around 18–24 months from the date of manufacture, depending on the brand. Schools should always check expiry dates before purchasing and ideally obtain devices with at least 12 months remaining before expiry.
When devices arrive:
- Label and store them immediately.
- Record purchase and expiry dates on your log sheet.
- Begin your audit trail straight away.
Step 7: Maintain and Review
All schools should appoint a Designated Allergy Lead responsible for overseeing allergy management within the school, including the maintenance of spare emergency AAIs.
Responsibilities should include:
- Checking expiry dates regularly.
- Recording checks on log sheets.
- Re-ordering replacement devices before expiry.
- Returning used or expired devices to the pharmacy for safe disposal.
All checks, replacements, and disposals should be documented as part of the school’s audit process.
Step 8 Book staff training
All staff must receive annual Anaphylaxis and Allergy Awareness Training so they can recognise the signs and symptoms of anaphylaxis & administer an AAI safely and confidently.
This training should not only be provided to teaching staff, but to any adult who may come into contact with pupils during the school day or extended school activities. This includes office and administration staff, lunchtime supervisors, site managers, breakfast and after-school club staff, sports coaches, catering teams, transport escorts, volunteers, and senior leadership staff.
A whole-school approach helps ensure that all staff are able to recognise a potential anaphylactic reaction quickly and respond appropriately in an emergency.
In Summary
The updated guidance marks an important step forward in improving allergy safety within schools.
By introducing spare AAIs, training staff, improving policies, and creating clear emergency procedures, schools can build a safer environment for children and young people living with allergies.
Preparing now will help schools stay ahead of the guidance, and most importantly, help save lives.
How Teach Health can help
If your school is looking for allergy awareness or medical conditions training, it helps to choose sessions that are practical, clear, and suitable for all staff roles.
At Teach Health, we provide live training designed for school teams, helping staff build confidence and understand their responsibilities in a real‑world setting. Our training supports whole‑school approaches to allergy safety and medical conditions and is aligned with current best practice.
For further details, please visit www.teachhealth.co.uk, contact us via email at info@teachhealth.co.uk, or call us at 020 87206635.
About the author
This article was written by the clinical team at Teach Health, specialists in training schools to manage pupils with medical conditions and allergies.
While every effort has been made to ensure the accuracy of the information in this article, the author does not accept liability for any inaccuracies or for actions taken based on this information.
