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Annals of Allergy, asthma & immunology

(March 2006)

The Nebraska Rule 59 Emergency Response to Life-Threatening Asthma or Systemic Allergic Reactions (Anaphylaxis) protocol is seen as a national model for other school-based program for students with asthma and anaphylaxis.

A delay in treating worsening asthma and anaphylaxis has been identified as one of the most important aspects in patient outcomes.  Most concerning is that children are at greater risk of severe anaphylaxis at school than at home or another setting. 


Characteristics of Individuals and Protocol Use in Nebraska Schools

Data is voluntarily reported to AIRE Nebraska regarding incidents of the use of the Emergency Response to Life-Threatening Asthma or Systemic Allergic Reaction (Anaphylaxis). Schools submit data using a standardized form.

the Rule 59 protocol:
Emergency Response to Life-threatening Asthma or Systemic Allergic Reactions (Anaphylaxis)

Saving the lives of Nebraska's children

All schools in Nebraska - public, parochial and private - are to be prepared to respond to life-threatening asthma and anaphylaxis emergencies.  The protocol directs school staff to identify signs and symptoms of a breathing emergency and respond by calling 911, administering an EpiPen and following with nebulized albuterol. 

In partnership with the Nebraska Department of Education, AIRE Nebraska is the non-profit organization assisting schools with education and training related to this protocol.

The school's stock EpiPen and albuterol DO NOT replace a child's own prescribed medications for asthma or allergy management at school. 

Parents are expected to ensure their children continue to have school-day access to emergency medications; auto-injectable epinephrine, metered-dose inhalers (MDIs), albuterol for nebulizing (to include neb cup & tubing) AND to have an asthma/allergy action plan on file with the school

No one should die from an asthma attack or severe allergic reaction.