5.1 Responding to Anaphylaxis and Documenting the Incident

Treat Anaphylaxis as an Emergency

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Food-service employees do not need to identify the exact food or make a medical diagnosis before activating the operation's emergency plan. They need to recognize danger signs and act within their training.

Warning signs include:

• Trouble breathing, wheezing, persistent cough, or noisy breathing.
• Throat tightness, trouble swallowing, hoarse voice, or tongue swelling.
• Faintness, confusion, pale or bluish color, weak pulse, or collapse.
• Rapid symptoms in more than one body system, such as hives plus repetitive vomiting or dizziness.
• A known allergen exposure followed by serious symptoms.

Hives may be absent. Do not wait for a rash when airway or circulation symptoms are present.

Immediate response sequence

Operations should have a written, practiced plan that assigns roles. A safe general sequence is:

1. Recognize and alert. Stay with the guest and immediately alert the person in charge and nearby trained staff.
2. Use epinephrine promptly within the plan. Epinephrine is the first-line treatment for anaphylaxis. Help the guest use their prescribed device, or use authorized stock epinephrine, only as permitted by local law, training, and operation policy. Follow the device's current instructions.
3. Activate EMS. Call 911 or the local emergency number. Give the exact address, location inside the facility, observed symptoms, known allergen if available, and whether epinephrine was used.
4. Position and monitor. Help the person remain lying down with legs elevated when tolerated. If breathing is difficult, a position that supports breathing may be necessary. Do not allow sudden standing or walking. Follow first-aid training and dispatcher instructions when positioning an unconscious or pregnant person.
5. Prepare for further care. Have someone meet responders, bring the second prescribed device if available, and retrieve an automated external defibrillator and first-aid equipment. Begin CPR and use the AED if the person becomes unresponsive and is not breathing normally, according to training.
6. Transfer information. Tell EMS what was eaten, the symptom timeline, the time and type of epinephrine used, and any change in condition.

If enough staff are present, epinephrine assistance and the emergency call can happen at the same time. Do not leave the guest alone to search for a manager.

Epinephrine principles

National Institute of Allergy and Infectious Diseases guidance identifies intramuscular epinephrine as first-line treatment for food-induced anaphylaxis. A prescribed auto-injector is generally used on the outer middle thigh and can usually be given through clothing, but brands and devices differ. Follow the label, voice prompt, or emergency plan rather than memorizing one brand's cap color or hold time.

A further dose may be needed when symptoms persist or worsen. NIAID guidance allows repeat dosing every 5 to 15 minutes. In a restaurant, follow the person's emergency action plan, the device directions, dispatcher or EMS instructions, and staff authorization. Use a new device for a repeat dose; never attempt to refill or reuse an auto-injector.

There is no absolute contraindication to epinephrine in life-threatening anaphylaxis under clinical guidance. For food-service staff, that medical principle supports prompt use within the authorized emergency plan; it does not authorize untrained practice outside local law.

What not to substitute

Antihistamines may reduce itching or hives, and an asthma inhaler may help bronchospasm, but neither treats all life-threatening features of anaphylaxis. They must not delay epinephrine or the emergency response. Do not give food, drink, or oral medicine to a person with throat or consciousness symptoms. Do not induce vomiting. Do not ask the person to walk to a restroom or drive away.

Symptoms can return after initial improvement. A guest who feels better after epinephrine still needs the emergency plan and evaluation directed by EMS. Food-service staff should not declare the event over or set a universal hospital observation time; clinicians determine monitoring based on the reaction and current guidance.

A clear 911 report

The caller should use plain facts:

• Location: restaurant name, street address, entrance, floor, and table or room.
• Problem: suspected anaphylaxis after food exposure.
• Condition: breathing, consciousness, and major observed symptoms.
• Treatment: epinephrine device and time used, if any.
• Access: who will meet responders and how to enter.

Stay on the line and follow dispatcher instructions. Send an employee to direct responders while another remains with the guest.

After EMS takes over

Emergency care comes first. Once responders have assumed care and immediate hazards are controlled, the person in charge should document objective facts:

• Guest and contact information if voluntarily provided.
• Order, table, server, preparer, and time sequence.
• Guest-reported allergen and observed symptoms.
• Recipe, ingredient packages, labels, lot information, and supplier substitutions relevant to the order.
• Preparation equipment, work area, handoffs, garnishes, and delivery path.
• Time of the emergency call, epinephrine use as reported or observed, and EMS arrival.
• Staff statements recorded separately and factually.

Preserve relevant labels, recipes, tickets, and food according to operation policy and regulator or insurer instructions. Protect personal and medical information. Do not speculate about blame in the incident report.

Then conduct a corrective review. Trace the order from request to delivery, identify the first failed control, correct recipes or systems, clean affected areas, retrain staff, and verify the change. Examples include an unreviewed supplier substitution, a shared scoop, a missed point-of-sale flag, or an unverified garnish.

Scenario

A guest develops a hoarse voice, wheezing, and dizziness minutes after eating. A companion has the guest's prescribed auto-injector. Staff should activate the emergency plan, assist with epinephrine within their training and authorization, call 911, keep the guest safely positioned and observed, prepare for further care, and give EMS the timeline. They should not start by searching the kitchen for the exact ingredient or offering an antihistamine.

Exam rule

Choose recognize, epinephrine, EMS, monitor, support, hand off, document. Reject delay, walking, food or drink, antihistamine-only care, and blame-focused investigation during the emergency.