The Ed Visits Buzz
Allergies unpacked
Welcome to the Ed Visits Buzz. This podcast engages with teachers, educational visits, coordinators, service providers and parents to explore the joys and complexities of organising educational visits. - My name is Andy Smith. I am the Educational Visits Advisory Services Manager Evolved Advice. And I'm really pleased to be joined today by Sarah Knight from the allergy team. Sarah, can you tell us a little bit about yourselves and your family and the allergy team, please? - Yeah, so I'm Sarah Knight. I run the allergy team with my two co-founders, Jen and Catherine. And we support schools and families and businesses to manage allergies. This comes from a personal point of view. I have two children who both have serious allergies. My eldest who is 11 and has just started secondary school. And my younger one who is Freddie and he's eight. They both have allergies and it was there. It was living with this that made us, triggered us to start up the allergy team. I was frustrated by the kind of poor advice out there, the lack of advice. And I really wanted to give places practical tools to support people living with allergy. We help families directly and then we also help schools. - The statistics tell us that around five to eight percent of children in the UK will be living with a food allergy. So most classrooms will have one to two pupils within them. And indeed 20 percent of serious allergic reactions to food happen to a child whilst they're at school. And I know when we were chatting earlier and you've got some really interesting additional statistics on that in terms of the school environment. - Yeah, so 20 percent of allergic reactions in school aged children happen in school, which is more than any other setting outside of the home. And also interestingly, 79 percent of those allergic reactions actually happen outside of the kind of catering environment, outside of the dining hall. So that might be in the classroom in other aspects of school life, on school transport, on school trips. We don't quite know why that is. We wonder if it's because the kind of catering environment is pretty well trained, but also, and there's a sort of real vigilance about food at lunchtime, but then it's thinking about other ways that allergens can come into the environment. That's also not to be complacent though, about catering either, you know, they still very much do happen there. - Yeah, we're talking about educational visits today. So I suppose there's a complexity around educational visits in terms of going beyond the well controlled school environment and out the community and all of the challenges that that compose. And sometimes we're traveling overseas. Sometimes we are traveling overseas and it's well developed countries and language issues could be a problem. So there's a range of complexities there, whether we're doing educational visits within the UK or whether we're overseas, that we're gonna go on to talk about today. Let's initially start about the sort of the law inclusion. What does the law say about this side of things? You know, there are three main legal frameworks that we could and should consider when we're talking about allergy. The first one being the Equality Act 2010, which can, depending on the severity, define a food allergy as a protected characteristic of disability if it's severe and/or life threatening. And that says that you must take reasonable adjustments, is what they're referred to. So you must reasonable adjustments for including that young person on a financial visit. So one aspect, the Children of Families Act 2014 would define allergies as a medical condition. Again, that we must consider how we get to manage that medical condition. And then the help of safety at work out says that we need to make really really practical steps to manage risk for those that are exposed to risks in connection with our operation, that undertaking so for a school, that would be sad. It would be parent helpers and it would be purely on people that attend. The law is really clear that we need to consider how we can manage allergies and other disabilities. And we need to take those reasonable adjustments and take reasonably practical measures to manage that risk. There's a legal aspect that we need to consider and in hand with that is potentially a financial aspect. If we are on the wrong side of the law, we can expose ourselves to both the criminal and civil proceedings, which are obviously potentially damaging and financially they have implications for us. But more so than all of that is the moral aspect. It's the right thing to do from an inclusion perspective to ensure that all children or people get access to these sorts of amazing opportunities. And educational visits are one of those things that are all memorable, they have real impact, they help bring context to our learning, they're amazing from a personal development perspective in terms of teamwork, taking responsibility, being resilient. We could go on for sort of the whole of this webinar and a boy, educational visits are all so good for children and people. And those with allergies should have that same level of benefits as well, Sarah. - Yes, definitely. And we do hear unfortunately of circumstances where they don't. And we just know, you've mentioned how valuable they are and they're so valuable. And to say to a child with feed allergies, oh, you can't do this because of your allergies, it's hard to think about how that can affect them going forward, what that means. They can't do certain things because of their allergies, what else is close to them at a time when you're trying to build that confidence, that sense of independence. School trips are so amazing for that. They're also amazing because they really help because they're out of the school environment, because they're away from their parents. This is a moment where they feel much more independent, much more in control of themselves and much more responsible. So it really helps build their confidence in managing their allergies outside of the normal environment. And then can give them confidence to do more, yet they're still under their safety net and brother of the school. And so it's just such a great opportunity. - I suppose it needs to be a team approach between the school and the family because my perspective is on this that you as a parent, you must have to become an ex really quickly at managing allergies because you now got this little person at whatever point they become diagnosed and you realize, have allergies, that you then need to take care of in the wider world. So I guess you can really help schools and it should ideally be a real two-way processor of back-of-the-fours communication to ensure that that young person could be included. And can you give me your opportunity? - Can you add us? - As the children in school as to how well that works, what the pitfalls might be and what works really well for you. - Talking very much from my personal experience, my son had his first sort of five-day residential at the end of year six a few months ago. And I really remember when I went to look around the school right at the beginning, the head teacher said, "Oh, and in year six, they go away "for this five-day residential," and I just was horrified. The idea that when I had a five-year-old that this was ever gonna happen, but you get there and he was desperate to go super excited, but I was struggling a bit on some of the communication, not so much with the school, but kind of understanding from the provider about what kind of meals they'd get. Anyway, so what worked really well is I went in, obviously I've got a background in supporting schools, so it was slightly different in the sense that I could go in and hold a kind of staff session with all of the staff that were going on. I refreshed adrenaline pin training, the crucially also spoke about reducing risk, 'cause ideally you don't want to get to the point where someone's having an allergic reaction, you need to be treating it, you want to prevent it in the first place. So I talked to them about the spidey sense that I and many other allergy parents and indeed school staff now have about allergies and it's that sort of hunch, it's that thing that if you feel something's not quite right, if that, I don't know, someone brings out some chocolates, they weren't on the menu plan, have they definitely been vetted for allergies? It's when, you know, if you're delayed somewhere and it's like, okay, we're going to stop at a service station, we're going to pick up some extra snacks, it's those moments that lots of things are really well thought through, but it's thinking through as well when things go differently. And so we had a big chat about spidey sense, which actually then, after the school trip, one of the teachers came up to me afterwards and not with my child's allergies, but with another child who had assessed me allergy, they did realize that they did have to get in between some donuts that were being handed out because they may have contained sense to me, but it was their spidey sense that picked up. So it's that communication, it's feeling like the school staff really know your child, really understand your child, really know what to look out for, and then making sure that everyone's trained, and I know we're going to come on to staff competency later, but it's that communication, it really is that communication. I had huge confidence in the school taking my son, and it meant my week was great, and I could wave well off with a big smile, I mean, the other emotions, but the other emotions are saying goodbye to your child for five days rather than being overshadowed by anxiety, and that was huge, and that was so much due to a really proactive, both by the school and by me, and all the parties involved, and that's great. - It's a really good example of the school taking those steps to make reasonable adjustments. The reason adjustments usually are not hugely complex. What they are doing is the time to put in place, and this is something that quite frequently comes up in terms of where schools are struggling with inclusion, be it around allergies or other aspects. Often they find themselves running out of time to put those things in place, and as I said, those things are often not particularly complex, but they might take a bit of time to think about, to put in place, to agree on, to communicate. So starting this process early is really, really key, and it leads us really nicely into the risk assessment process. Ideally, we should identify these hazards, a food allergy being a hazard, and decide on the level of risk, and it's highly likely that it's severe because we're going away from a well-controlled environment that the likelihood of an allergic reaction is going to go quite significantly. So it's putting us into the zone of needing to do something about it, and if we can identify that risk really early, and then take specific steps, well, that young person on this visit and record those, then we're in a really good place to manage that. It shouldn't be a barrier, and it shouldn't be something that we're struggling with inclusion, as long as we start the process early and we take a careful approach to it, that involves those people that need to be involved in terms of parents and potentially medical practitioners and the key people in school as well that need to know and need to be aware of and need to have an input into it. So top tips around risk assessment from me would be consider the prevention as well as the response. We often see, and I'll give you an example, that the information recorded in the risk assessment for how to deal with an allergy is quite sparse, so it will be something along the lines of, make sure that this child has erected them with them all the time, and it probably doesn't go much further than that. It might say something along the lines of, make sure that we tell the provider, or we've told the provider, but from a prevention point of view, that there's plenty of other aspects that need to be considered as well as those things. So for example, considering, as Sarah said, those stops that you might have at service stations, communication with other parents to make sure that they're not sending them, there's such a big stuff, everybody sending them with a combination of what have they got, what are they containing? And other aspects such as, really making sure you provide a, does understand the severity, common foods that bithallogen could be within, and then checking that understanding when you arrive, and checking on a meal by meal basis to ensure that there's not been a mistake and a change of staff or something that they miss, those are a few examples. Sarah, do you have some other examples, maybe in relation to your experience? - Not just my experience, but others as well as things like making sure that when you're traveling on transport, lots of people talk about the risk of airborne nut allergies, for example, now studies suggest that the chances of an airborne nut allergy reaction is incredibly low, the particles don't tend, according to the studies, do travel by air. But what is the risk is, for example, if you sit in a seat where someone's been eating a bag of peanuts or a grated cheese sandwich or something, so just having a once over of transport seats, whether that's on a bus, a train or the plane, because if there's lots of food residue, likewise picnic benches if you're having a picnic outside. So it's just being mindful of those and sort of having that understanding that it's not just the food that is prepared and given to them, then it's also making sure, how do you know that the right sandwich bag has gone to the right child? Is it labeled with their name? Is it have the allergens on? If that's eaten by someone else by accident, is there a backup plan? Just thinking, you know, obviously things happen, but if you have that really good awareness in the first place, then the chances are if you need to mitigate it, you'll do it safely because you're thinking of that in mind. And so it's having a brainstorm before when you're writing the risk assessment of where this can come up. It's also often the simpler trips as well that kind of catch people out of it more, like there was one trip where a group of primary school children were going to a local secondary school to a science experiment and they were doing something where they were dropping eggs to demonstrate gravity. One of the kids had an egg allergy and that wasn't risk assessed. So it's not just the big complex trips, it's also sometimes just those simple things. I mean, that goes to the same way as risk assessing in a classroom activity as well as on a visit, but just thinking those things through. - We've talked about those also really, really key things. Thinking through your itinerary and sort of buy a step and then round tabling that as an established team, and people may be so familiar with it. So parent helpers as well, and ensuring that we kind of have walked ourselves through this hypothetically from both a prevention and a response perspective. And for that to take place, we're going to need a degree of staff competent. So experience understanding potentially relevant training. So again, if we joke to the obvious, that would be having a fixated that knows how to deal with anaphylaxis and an epipenal or an AIA as it's sort of formally referred to. But there's more to it than that, and I know that your team deliver lots of training on the awareness, the prevention sides of things with regards of paying that level of staff competence. - Yeah, definitely. So we've just finished refreshing our training programme for all school staff and it's for all school staff and everyone. And it really helped walk through that, thinking about how to be allergy aware. So you are thinking about it in every aspect in that prevention and then response. Really sadly earlier this year, a ballet dancer called Ola Baxondale died in New York. She was 25 and she ate a mislabeled cookie. And the reason I'm mentioning her is she, she carried her adrenaline pens, she checked the labels, she did everything right. And really sadly the adrenaline pens weren't enough and she died. You really don't want to get to the point where you are, where a child on your watch is accidentally ingesting their antigen. Now they might, it is not possible to prevent that completely. Having that sense of prevention, by being allergy aware, by having developed that spidey sense, which from good training, but also sharing that responsibility among all staff. So that if we've been contacted by school staff who've been taking trips, and they've been the only member of staff with any allergy training on a large school trip and felt the burden of responsibility on them just completely overwhelming. So it's really important that all staff on the trip, not just one person are trained because they can help each other. They can share that responsibility also. If something comes up, say something happens with another student, you're not sending the first aid her off with them, and then leaving the rest of the party vulnerable. So making sure there are enough staff. - There's a really important message there. If I go back to one of the statistics that you were saying earlier about how many of those reactions occur in places other than the dining hall, and if we can increase that level of allergy awareness at a foundation level in our staff team, then we're more likely to catch those scenarios because we'd expect that the catering team have got a fair degree of allergy training, but maybe everybody else in school. There's the real cross benefit there for the school life in general, not for just for educational visits. - Totally, and also it really builds that confidence. I think we go into a lot of schools where also, not only is some schools where the awareness isn't great, but on the flip side where there's a huge fear, and I think people can find that fear really paralyzing. So trying to kind of bolster that confidence across the whole staff body. I mean, I get the fear, I totally get it. I live with it a lot. But equally, I also know that that's when it's things out of my control, I'm less likely to be able to plan stuff. So it's trying to kind of ingrained that confidence. Like any other aspect, like road safety or safeguarding where you've got that whole school approach, and it's really embedded into the culture of the school. - Yeah, and that fear is an important one to deal with because that's the sort of thing that's in the pitch of estimate that might make us make a decision not to include a child because we feel like we can't manage it, whereas in the vascularity of cases with most inclusion issues, they can be managed with enough time and with the right staff and the right levels of teamwork and cooperation with families and with children themselves as well. - On that exclusion point, the damage to the child on the kind of mental health side and stuff like that is not to be underestimated to feel. Children with allergies often feel excluded. Every birthday party they've been to, they probably can't have the cake. They're probably used to having sandwiches when other people are having really nice restaurant lunches, they're exposing it. When you approach every kind of social environment that's got food with a level of anxiety, it's a lot. The more that schools can do to kind of break down those barriers, say, yes, no problem, this is great. We went to, this is not a school trip, but we went to a restaurant in the summer and the chef came out and said, I love catering for people with allergies. It's like, wow, this is amazing. And just that sense of inclusion is so important as well to their sort of wellbeing. - That lead us so nicely on to providers where we begin to share our duty of care. We will still retain the pastoral duty of care, but we're often using a provider to help us deliver activities or provide food in the context of what we're talking about today or to organize, travel and subcontract out various aspects such as accommodation and guiding, potentially meals out in mountain restaurants if you're on a ski visit, et cetera, et cetera. So working with your providers, really, really important to make sure that they are up to speed with the things that you know from a pastoral perspective. You will retain that responsibility pastoralally, double checking that they've got it right because they are only human and you know that the server might be a different server to last night in your residential accommodation that the chef might be different. Something might have gone wrong in the background and it's hypothetically spinning the blades to try and keep the show on the road for you and something gets missed. So don't feel a little comfortable, double triple checking when you arrive to check understanding and each day and when the mean arrives. So there are areas like that so we need to be done like me and I wanted to ask you about lots of providers use allergy response to identify the child. And I suppose that's having it in a different color. So they don't have to ask and talk about it from everybody else and can just glance and know who they are delivering the food to. What's your perspective on all that side of things as a parent, it's interesting more. - It is a really interesting one and you know within our work we go into not just educational visit providers but scope providers where a different dining hall might have a lanyard, they might have wristbands, they might have badges. They might have all sorts of ways to identify the children at a different colored tray, different ways to identify the children with allergies. - It's not ideal to have wristbands and stuff equally though. You've got to make sure it's safe. And so if you do have procedures like this which many, many schools do and we always recommend there's two methods of identification in the dining hall to make sure it's safe. Then it's working with the family and working with the child to make this more of a positive thing rather than a sense of difference. So for example, if you're turning up on day one and having a wristband on a child and they don't know anything about it, that's possibly not the right way to go about it but having a chat with them before and this is what we're gonna do so that we make sure that you get a safe meal. The chances are the child might have a level of anxiety as well about their food that they're eating. So if they can see the stuff that's going on behind the scenes then that can really help them feel confident. So it's all about the kind of messaging and trying to bring the child along with you on this. If they feel really uncomfortable about it then trying to look at whether you need to find another solution but I think it's not landing it as a sort of fade of complete on the child's five minutes before lunch. Also remembering that wristbands can get covered up, they can be swapped, they can be dropped. So what is your second method to make sure that if something goes wrong with the wristband that you're making sure that the right meal goes to the right child? So it's mixed. I don't love it but I can totally see why it happens and in some circumstances it's really good and just how it is approached. - So we often use providers for overseas travel and typically a tour operator and we're gonna give you a hypothetical scenario now to explore some of the challenges that we might have. And so the idea of the dual scenario is that we're going on at the visit to France and we're staying in a hotel and we're working with a provider that's reputable and we've told them about the allergy. On some of the evenings we're gonna be out doing activities so we might be going bowling or ice skating or whatever it might be. One of the evenings is a dinner in a local mountain restaurant where you get the channel at night and it's all flood lit and you have dinner in a mountain restaurant and it's a really local cuisine. And I just wanted to explore some of the challenges there around and language barriers potentially and information not getting passed on from the provider to the subcontractors that they're using. So the mountain restaurant and the ice skating ring might have a restaurant in that you're eating in after your ice skating that evening and how things can potentially get missed, for example, out there there are translated local language cards aren't they in relation to some allergies? - Yeah, I would say that a restaurant upper chairlift and if that's the only way and without direct communication would be high risk. I would definitely feel quite anxious about that. I'd feel anxious about that if I was going with a child 'cause if you didn't need medical help it would be difficult to access that potentially as well. So I'd want to be really confident in the restaurant. So for example, do you have a native speaker in your school that can have a really good conversation with them directly as well as through the overseas travel provider? So there is no language kind of gaps. Allergy translation cards are brilliant as our translation apps where you can hold an app over, you can hold your phone over the ingredients labels and it automatically translates it. But there's nothing quite like the sort of face-to-face or the direct conversation and especially from a native speaker. - And you raised a really important point there that if you're halfway up the mountain and it's nighttime and potentially you're not gonna have the regular sea patrol on duty. So thinking ahead to, you know, we talked about prevention earlier, the response side of things, if something does go wrong, how quickly can we get medical care? How will we access that? Or what will the standard of it be like? And I guess that moves us now CEO to countries that don't have the same levels of medical care as we'd expect in the UK and other developed countries. From your experience and understanding in the more developing world, what's the level of awareness around allergies and care for a degree actions broadly speaking? - It's hugely mixed, but I wouldn't say that's just a developed countries as well. I would say that as well in Europe as well. Like there's just such a difference between different countries, different people. It's so down to the individual. For example, if they're really used to all odds of school children from the UK coming, the chances are they might have really developed understanding and they might be quite unique in there. Whereas other places, it's such a case-per-case basis. I personally have had terrible experiences in some countries. And I don't know if that the country thing or our particular experience, but it's really worth thinking about and thinking about how to navigate. One of the advantages often is a lot more home cooking is done. It's cooked in the kitchen. There's a real understanding of what ingredients are used. Some of the allergens aren't used as much. For example, if you've got an egg allergy, street food in Thailand is likely to be incredibly risky. And so it's thinking about the local cuisine, how prevalent the allergens that your cohort has and how much they're in it, and then looking at the individual understanding. - It's definitely worth everybody being aware of the foreign cold wealth and development office, foreign travel advice and the section in their relation to medical care. What broadly speaking, tell you about the quality of medical care, how it's accessed, how you pay for it, whether it's accessible via a meek or a meek card or whether you're going to be having to pay there. And then, or whether it's like your insurance company is going to be able to be involved at that point in time. If you've got a child with a severe allergy, that's worth exploring in terms of making sure that you've checked the state of local medical care and you've got a plan around that. And sometimes, depending on the severity, you need to be talking to that young person's medical practitioner as to exactly what is the level of risk here and would they advise that they travel or don't travel and have that sort of conversation if you're going to a country where you really see or that the medical care levels are substandard. - And back to your France trip as well, the idea of the sort of up the chairlift in the middle of the night with no one, no one else is sending me a sign language. Like also, don't be frightened to kind of go, we're going to go up the chairlift and we're going to have a drink at the top. And then, we're going to go and get a restaurant meal at the hotel, you know, and adapting things so everyone can have the same experience, but it's just a reasonable adjustment to accommodate the needs of the children. - You mentioned Hope Cookie, which led me mentally down the path of exchange visits. So foreign exchange visits, where your child is going to live with a family overseas for a period of time and just talk to me a little bit around that side of things, do you have any experience of it yet or are your child not out enough, potentially for that to have been on the agenda? - Not personally, but I have spoken to schools who've sent children on these exchange visits and I've heard of good experience, really good experiences and not such a good experience, one of which where the student turned up and very quickly, despite the fact there had been many calls between the school and the family, from native speakers, from, you know, really sort of drilling down on that understanding of the allergen thought it was, you know, the allergies, thought it was all set. And then when the student got there, they felt deeply uncomfortable about it and actually the school had to, within 24 hours, find another solution. And they responded really well and they did it and they, you know, the student felt really uncomfortable about it. So I think it's also making sure that you've got a plan if things aren't going well and it's not just, it's not just the physical safety, it's also how they feel about it. For example, if they've got a nut allergy or fish allergy and that's been cooked a lot in the house, that's going to make them feel really uncomfortable. So it needs a lot of planning those and, but amazing experience to do, but yeah, a lot of planning and making sure that the host family is trained as well, like how can you support them with training? - Super. The you at the LG team offer training that could be accessed by an overseas family. - Currently, all of our training is in English, which isn't particularly helpful. So the short answer is no, we do have this thing called mama, which is me and my allergy, where families can upload a photograph of their child, say what their allergies are, and whether they carry an EpiPen or a JexPen or no adrenaline pen, what their dose of antihistamine is. And it will, through tech, we want a government innovate award to do this. It will turn out a seven minute video and go straight to your inbox so that then you can share that with other potential parents. So it's perfect for like educational visits. If you want to send it ahead to a provider or to like an activity leader who's taking the kids, and it's a really short training video, but it does do the sort of key points about prevention and then how to recognize and respond if there is an allergic reaction. So that's a really useful tool that people can access to help brief a provider. It's also really good for occasional sport coaches, for someone standing in at the last minute. I've certainly used it a lot with my children, with the fact I sent it earlier today, but what looks for an after-school club to help them? - That sounds really good. And I suppose that's something that you could send to the contact in the host school who could then watch it and then brief the parents on it to make sure that the parents are fully up to speed if they, and speak sufficient English to be able to watch it and follow it themselves. - Yeah, but I've got an additional question that I wanted to ask each error, which is how would you feel as a parent if school said to you that your child could only go on the residential if you went along as well? How would you feel or what? And do you feel your child will miss out on if school asks you to do that? - So the schools have asked me the need to do that. I would feel quite disappointed back to that point that we made at the beginning of the session. The school trips are so vital for children, especially those with allergies, to start taking on responsibility with their allergies themselves, that it's really great for them to step away from their parent and to start trying to take some of that ownership. For example, carrying their adrenaline pens themselves, checking labels, trying to navigate allergen matrices in dining halls, that kind of thing. When you've got the staff around who are also double checking behind the child, but it feels less than their parent. - I suppose a really, really important point is to, to think about why are you running this educational visit? And are you going to be compromising that by those sorts of expectations on parents? And often we run a residential for reasons of a group cohesion and taking responsibility, being more independent, being resilient and having mum and dad there with you is going to whip into that a little bit. And that's the sort of thing from an inclusion perspective that we really need to consider before we make those expectations on parents. - Ideally, let's plan as a school to manage it ourselves. - Why it's so important to be parent. - So I also might mean encouraging parents that actually it's okay, we've got this, we're going to work with you and take a board what you're saying and we're going to get ourselves to the point where we can help you to be comfortable that we can take your child or your own person away and you can rest easy, they can have a great time with their friends and get that sense of independence and build those skills that they're going to need when they're older, when they're having to manage this all on their own in the world. - If the system in a school was it's the children to wear their lanyards, but they don't wear them, what would be the best thing for school to do in the institute of that? - Well, it depends on the age of the pupils, the size of the school, how the dining room is managed, but for example, we see things working really well where there's a member of staff who's checking which students, so for example, the class teacher who knows the students really well is there just checking that they've got the right meal at the same time, the catering team knows who the staff is and their pictures behind the surgery of the student, that is often the most discreet way to do it. If it's a case that you really want them to be wearing their lanyards and that the system's not working if they're not wearing it. So talk to the kids, find out why they're not wearing it, are they embarrassed about it, do they feel like they stand out? Is it hard for them? Sometimes we hear of kids being given lanyards and then they have to go and give it back and then they miss out going out to playtime, is there a way to make it easier? If it's a point of difference that they're reluctant about, can you think about introducing other lanyards in the school? For example, do you have a sustainability committee where they've got a green lanyard and then the kids with allergies have a yellow lanyards and then the kids who are vegetarian, without making it too complex as well for the catering stock? And then other schools, I've been to have somehow made the lanyard like the hero thing that the other kids now also want to wear. So like, is there something about the messaging of the lanyards? But I would be looking at the whole thing and it might be that lanyards in this instance isn't the right way to go and there's a better way to do it. - Is there a that you recommend for translating ingredients? - Just Google Translate or Microsoft Translate where you use the camera to use it, work well. Just try it out a little bit sometimes, particularly stuff like tree nuts and nuts can be tricky to navigate and it's not completely fail safe, but it's a really, really great start. It always helps me and then I double check it by also looking out for the words in the local language. - Is there another use to mean that you recommend we generally take on a fit or ones we shouldn't? - So I'm obviously not a doctor, but the allergy conditions we work with are very clear on this. They recommend the second generation antihistamines, which are things like satirism and leredidine, which don't have the drowsiness element that peritone do if a child is over two. For infants, it should be a peritone because that's been more tested on them. But for any older children, then satirism is a really good one. - Thanks for your words. How far can an empty pen take you? - Essentially, his hospital access over an hour away, not something that could be accommodated, if the only options you would have would be a pens until you get to that medical facility over an hour away. - This is really hard, a pen worked brilliantly and a child silly recovers just from one a pen. Sometimes two a pens are childfully recovered. Sometimes they need extra support, like either more adrenaline or other kind of intervention. If it's a really, really serious anaphylaxis, then it can be quite short that you really need intervention, but that's going to depend on the severity of the allergic reaction. And just because a child is reacted in one way in the past doesn't mean they're going to react in another way in the future. I've certainly traveled more than an hour away from a hospital, it doesn't make me feel great. I just take extra care. So I think this is something to really work through with the family, with their medical practitioner. For example, should you be taking other things on the trip to help with that? That would come down to a very individual case and I would really look at that. Also, is there anything between you in the hospital, like some kind of a field of hospital? Is there an ambulance service that will meet you because actually the ambulance service also has an awful lot of stuff often in the ambulance, even if you're abroad, depending on where you are. So that needs to be a successful individual basis. - Yeah, super, and I suppose also the, in terms of help coming to you, where you are, what the roads are like, in terms of access to you, how remote it is. You know, that could be your uphill the hills and mountains and whales, or you could be somewhere in the middle of the den, somewhere in what activity and the tradition you're doing, getting help to you. How reliable is the ambulance service? In terms of waiting times, we can consider that from a UK perspective, but also in some developed countries, they have a very sparsely delivered ambulance service, so they just cover the area you're in, and therefore it's a matter of getting in the car or traveling, and therefore that needs to be considered. There's a range of complexity there, and I think the key takeaway from this is that, that specific risk assessment for the young person in question and the location you're going to, in terms of travel times, the distance. - There's also other things to take into consideration. For example, we were talking to one school who was organizing a really grim trip, and it was a kind of canoeing, camping kind of trip, so they discussed, they had a child with particularly complex allergies, quite a long list, but they decided to just not have any of their allergens on the trip, and actually even with a child with complex allergens, there's an awful lot of food they can have, and so for the whole group, they just decided to eliminate the allergens, to make it as lower risk as possible. So there's other ways to look at it as well and to approach it. We also, in really remote areas, especially when it's pupil led like a D of E trip or a CCF trip, thinking about training the other students as well so that they can support their peer if they're in a remote area, and they need to call for help. - That needs to be really nice to do, and part of Julie's short story that she shared, and Julie's son has an allergy to shellfish since he was a fall. Well, she started senior school, but the school nurse trained the teachers, and had to use his MPP pen, but also his friends as well, and he always carries his MPP pen. He has a very severe allergies. Julie's really reassured that his friends can help doing it in an emergency as well, and that becomes increasingly important as your people become more dependent, and are less dependent on us, and are taking more responsibility themselves, and are potentially out quite a lot with their friends doing various things, and knowing they've got that support around is reassuring for Julie and, I guess, as your children, girl Sarah, that's gonna be the same for you as well. - Yeah, and also tying other kids into other aspects of allergy awareness. So, for example, we heard a CCF trip where they had nuts in the ration packs, so it was part of the activity before they went. The students took the nuts out of the ration packs and replaced them with something else, and so not only being trained on the emergency response, but on the awareness in the first place, and lots of peers, the peers will be the kids' biggest supporters often, like helping them to make good choices, helping them to have, you know, being considerate on the plane or on the travel and not eating their allergens near them, especially if it makes them feel uncomfortable, or helping them navigate the restaurant menu as well. So, not, again, just the sort of emergency response, but trying to help their friends stay safe in the first place. - What if a young person would like to decipher in Duke of Edinburgh Award exhibition, where the students are likely going to be left on their own for a large part of it with no direct adult supervision, so they'll be remotely supervised by the staff team, should the school adjust their plan by ensuring an adult is nearer than originally planned? - Yeah, we hear of lots of students taking part in D.A.V. really successfully, and it's just, as you said, planning it before thinking about trying to eliminate someone, perhaps the allergens, well, eliminating the allergens before they go, so making sure that everything's being double checked, training the students, also thinking about if they don't have any mobile phone reception where they're going, how can they get communication out there? Do they need some of the kind of form of communication to get help if needed? - It can sound overwhelming and a lot, but actually when you break it down, it often isn't. It's like, oh, okay, like so many foods are safe for even people with the most lengthy complex list of allergens, and no one has to miss out. Like, you can go, oh, but, you know, it's not fair if the other kids don't have milk. For a couple of days, everyone can have a really great few meals without missing a certain thing, so it's just taking a different approach. - My final question is, and it's a question from me about the minimum age that appear can give their friend an auto and pen injection linked into that. How okay is it to, I suppose it's linked to the DV analogy we just talked about as well, how okay is it to extend a young person to take full responsibility for their allergy? Or where does that responsibility line in relation to school? - Really depends on the individual, and it's so age appropriate. I know from our allergy conditions that we work with that they have seen children as young as six administer their own adrenaline pen successfully, but it's a lot, and it's a lot if you're feeling really rubbish as well. People often say to me when I hand over my toads like an off to school club or something, oh, are they all right? Can they inject their adrenaline themselves? And it's like they're eight and 11. And I think, well, technically yes, they have been trained, they know how to do it, but if they're experiencing anaphylaxis, they may feel really rubbish, they may be very, very scared. Just because they're trained doesn't mean they can. And so to have adult support is, especially with the younger students, is really important. But when they start to be navigating life on their own, traveling to and from school on their own, going out with their friends, they do need to be able to do that. And it is straightforward and simple to do, but having their peers with them who also know, even if they do it, but they know they've got back up, can really help. So I mean, it's so down to the individual age of the student, it's down to how the students feel about it, how the parents feel about it. And so it's very much a lot of conversations there. - Yeah, and fundamentally was it's so, so important that we prepare children and young people for managing their allergy themselves. And we support them to do that. We educate them to do that. Fundamentally, the legal application is on the school to have plans to manage avoiding contact with those allergens. And then if it does happen, how we respond to it. And so, you know, it's about having that, supporting them, but also it's about understanding what our responsibilities are, having a good plan in place and thinking things through in advance at all of those things that we've talked about. - You've been listening to the ED visits buzz. 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