Spare Adrenaline Auto-Injectors in Schools

Schools in England may hold spare AAIs, but it is not compulsory and there are conditions. Who the spare can be used on, what the policy must cover, and how to recognise anaphylaxis.

Updated 15 September 2026 7 min read By The Training Co.

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Quick answer

Since 1 October 2017, schools in England have been allowed to buy spare adrenaline auto-injectors (AAIs) without a prescription, for emergency use on a pupil at risk of anaphylaxis whose own device is unavailable, out of date or fails. It is not compulsory. A school that chooses to hold spare AAIs needs a written policy covering when the spare may be used, staff training, and parental consent. Adrenaline is the first-line treatment for anaphylaxis, and after it is given you must call 999 and say “anaphylaxis”.

This change is now long settled, but the questions we get asked about it have not gone away: is it compulsory, who is allowed to use the spare, and who needs training. Here are the answers.

What the rules allow, and what they do not

	Allowed	Not allowed / not the case
Buying	Schools in England may purchase spare AAIs without a prescription	Not compulsory — no school is required to hold one
Who it can be used on	A pupil already known to be at risk, with medical authorisation and parental consent	Not a general-purpose device for any child who collapses
When	Their own device is unavailable, out of date, or has failed	Not a replacement for the pupil’s own prescribed AAIs
Who administers	Trained staff, under the school’s policy	Not restricted to a qualified first aider, but training is expected

Before October 2017, a school could only hold an AAI prescribed to a named pupil. If that pupil’s device was at home, out of date, or misfired, there was nothing else on site and staff could only wait for the ambulance.

The Department of Health and Social Care published guidance on using emergency adrenaline auto-injectors in schools to help schools that choose to keep one write a policy for using it.

Recognising anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction. It can develop within minutes of exposure, and the airway, breathing and circulation signs are what make it an emergency rather than a bad rash.

System	Signs	Significance
Airway	Swelling of the throat, tongue or mouth; difficulty swallowing or speaking; hoarse voice	Anaphylaxis — give adrenaline
Breathing	Wheeze, persistent cough, difficulty breathing, severe asthma-like symptoms	Anaphylaxis — give adrenaline
Circulation	Pale or clammy skin, dizziness, collapse, unconsciousness	Anaphylaxis — give adrenaline
Skin / gut only	Rash, flushing, itching, abdominal pain, nausea or vomiting	A reaction, but not by itself anaphylaxis — watch closely

The rule that keeps this simple: a rash on its own is not anaphylaxis; any airway, breathing or circulation sign is. And a sense of impending doom, which sounds vague, is a genuinely recognised feature — take it seriously.

What to do

Give adrenaline without delay using the auto-injector, into the outer mid-thigh — through clothing if necessary. Adrenaline is the first-line treatment and delay is the single biggest risk factor for a poor outcome.
Call 999 and say “anaphylaxis” (pronounced ana-fill-ax-is) so the call is prioritised correctly.
Lie them flat with their legs raised. If breathing is difficult they can sit up, but they should not stand or walk — standing suddenly can cause a dangerous drop in blood pressure. If they are unresponsive but breathing, put them in the recovery position.
If there is no improvement after 5 minutes, give a second dose from a second device.
Stay with them until the ambulance arrives. Everyone who has had anaphylaxis needs hospital assessment, even if they seem to recover completely, because symptoms can return.
Note the time each dose was given and hand the used devices to the ambulance crew.

The point that causes the most hesitation: if you are not sure whether it is anaphylaxis, give the adrenaline. Withholding it from someone who needed it is far more dangerous than giving it to someone who did not.

Training staff

A device in a cupboard that nobody is confident using is not a control measure. Schools holding spare AAIs need staff who can recognise anaphylaxis and use the device without hesitating — and the different brands work differently, so training should cover whichever device the school actually holds.

Our view, and it is a practical one rather than a legal requirement: train more staff than you think you need. Anaphylaxis does not wait for the trained person to be on the right corridor. Consider:

Class teachers and teaching assistants
Lunchtime supervisors — food is the commonest trigger, and lunch is when it happens
Office and reception staff
Site and caretaking staff
PE staff and anyone supervising trips
Catering staff — who also need allergen training as a separate matter

We deliver anaphylaxis and AAI training at schools alongside Paediatric First Aid, which covers the wider set of emergencies school staff actually encounter.

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Getting the policy right

A workable school AAI policy covers:

Element	What to specify
Who it may be used on	The register of pupils with both medical authorisation and written parental consent
Where devices are kept	Accessible, not locked away, known to all staff; consider more than one location on a spread-out site
Checking and replacing	Expiry dates, a named person responsible, and a checking interval
Who is trained	The list, and when refresher training happens
After use	Recording, informing parents, replacing the device, reviewing what happened
Off site	Trips, sports fixtures and residentials — who carries what

The things that go wrong

The device is locked in the office. Accessibility beats security here.
Expiry dates pass unnoticed. AAIs expire, and nothing announces it.
Only one person is trained, and they teach Year 4 at the other end of the site.
The consent list is out of date after pupils join or leave.
Nobody thought about school trips, where the risk is arguably higher and the ambulance further away.
Supply and agency staff are not briefed on which children are at risk.

Wider allergy management

Holding a spare AAI is one part of it. The rest is prevention: knowing which pupils are affected and by what, managing food in the classroom and at lunch, thinking about baking activities and food-based rewards, briefing supply staff, and planning for trips. Catering staff need allergen training in its own right, which is a separate duty under food information law.

Frequently asked questions

Are schools required to hold spare adrenaline auto-injectors?

No. Schools in England have been allowed to buy spare AAIs without a prescription since 1 October 2017, but it is not compulsory — it is each school’s decision whether to hold one.

Who can the school's spare AAI be used on?

A pupil already known to be at risk of anaphylaxis, who has both medical authorisation and written parental consent for the spare to be used, and whose own device is unavailable, out of date or has failed.

Does a spare AAI replace the pupil's own device?

No. Children at risk of anaphylaxis should still have their own prescribed auto-injectors at school. The spare is a backup for when the pupil’s own device is not available or does not work.

Where should an adrenaline auto-injector be injected?

Into the outer mid-thigh, through clothing if necessary. Follow the instructions for the specific device you hold, as brands differ.

What do you do after giving adrenaline?

Call 999 and say “anaphylaxis”. Lie the person flat with their legs raised, or sitting up if breathing is difficult, and do not let them stand or walk. If there is no improvement after five minutes, give a second dose. Everyone who has had anaphylaxis needs hospital assessment.

How many staff should be trained?

There is no set number. In practice we suggest training well beyond the minimum, because anaphylaxis can happen anywhere on site and the nearest adult is often a lunchtime supervisor or site staff member rather than a designated first aider.

Can a rash alone be anaphylaxis?

A rash on its own is not anaphylaxis. What makes a reaction anaphylaxis is involvement of the airway, breathing or circulation — throat or tongue swelling, difficulty breathing, dizziness or collapse.

What if we are not sure whether it is anaphylaxis?

Give the adrenaline. Withholding it from someone who needed it is considerably more dangerous than giving it to someone who did not, and delay is the biggest risk factor for a poor outcome.

Do adrenaline auto-injectors expire?

Yes, and nothing announces it. Expiry checking needs to be somebody’s named responsibility on a set interval, along with replacing any device that has been used.

What about school trips and residentials?

Plan them explicitly in the policy — who carries the pupil’s own device and any spare, who on the trip is trained, and how 999 would be called from wherever you are going. Risk is arguably higher off site, not lower.

Arrange training for your school

We deliver anaphylaxis, AAI and paediatric first aid training at schools across Greater Manchester and the North West, on dates that fit the school calendar. Call 0845 838 4643 or use the enquiry form on this page.

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