Empowering High School Staff to Respond to Emergencies: A Pilot Training Program for Intranasal Naloxone and Epinephrine Administration

Empowering High School Staff to Respond to Emergencies: A Pilot Training Program for Intranasal Naloxone and Epinephrine Administration | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Empowering High School Staff to Respond to Emergencies: A Pilot Training Program for Intranasal Naloxone and Epinephrine Administration Wesley P. Jameson, Molly Cook, Bailey Lupo, Andrew Schwartz, Emile Legendre, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6977727/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To evaluate the effectiveness and feasibility of a bimodal educational program designed to improve high school staff members’ knowledge and confidence in recognizing and managing opioid overdoses and anaphylactic reactions. Methods Twenty high school teachers and staff participated in a structured educational intervention consisting of a 30-minute didactic presentation covering opioid overdose and anaphylaxis recognition and management. Following the presentation, instructors led a 15-minute hands-on practical exercise using intranasal naloxone and epinephrine auto-injector training devices. A survey assessing knowledge and self-reported confidence was administered immediately before and after the training to measure the impact of the educational intervention. Results Participants’ post-training scores demonstrated significant improvement. Knowledge assessment scores increased from 62.5–87.5% (p ≤ 0.05). The most substantial knowledge increase was seen in identification of the proper method of intranasal naloxone administration (67% increase in correct responses). Additionally, participants expressed increased confidence in recognition and management of both emergencies following the training session, indicated by a 2.1-point increase on a 5-point Likert scale. Conclusion This pilot study demonstrates that our educational program has the potential to significantly improve the ability of school personnel to recognize and manage opioid overdose and anaphylaxis. Our results indicate that scaling the program to multiple campuses is feasible, financially sustainable, and should be considered as a proactive measure to improve safety and potentially save lives during student medical emergencies. Opioid overdose anaphylaxis school-based emergency response pilot training program Figures Figure 1 Figure 2 1 Background High school teachers and staff confront life-threatening medical emergencies affecting their students that demand immediate recognition and medical intervention 1–8 . Training school personnel to recognize and respond to these emergencies is critical to bridging the gap between the onset of illness and arrival of emergency medical services 9 , 10 . This pilot study focuses on two of these emergencies, opioid overdose and anaphylaxis. Opioids, both natural and synthetic, are a class of drug primarily used for pain management in the setting of acute and terminal illness 11 , 12 . Although they have been shown to be extremely efficacious when used properly, they also carry serious risks. In high doses or when misused, opioids can cause sedation, dependence, and importantly, profound respiratory depression leading to death 12 . Over the past decade, the opioid misuse patterns among youth have undergone a radical transformation. In 2015, prescription opioid consumption per capita was declining, but still responsible for more overdose related fatalities than any other illicit drugs 13 , 14 . Recent data from the High School Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention (CDC) reported that 16,858 high school students have used prescription pain medication without a doctor’s supervision or differently than how a doctor told them to use it 15 . Efforts to curb the epidemic, such as increased awareness and more restrictive prescribing criteria, have resulted in reducing the number of opioid prescriptions to a rate of 37.5 per 100 persons by 2023, and a drop in illicit drug use among 12th graders from 21–8% 16,17 . Paradoxically, adolescent injury and fatalities related to drug overdose occur at an unacceptably high rate. National surveillance data indicates fatalities among adolescents has more than doubled between 2019 and 2021 alone, with an average of 22 adolescent opioid overdose fatalities occurring every week in the United States 17 . Although drug overdoses have the potential to occur in any environment, school districts across the United States have reported administration of naloxone in their school or at a school sponsored event 1, 3 , 8 – 10 . Fentanyl, a synthetic opioid 50–100 times more potent than morphine, is the major contributor to the high rate of fatality and is involved in at least 75% of adolescent overdose deaths 6 , 7 , 14 , 17 , 18 . It is often illegally manufactured and pressed into counterfeit pills or mixed with other illicit drugs resulting in over 115 million pills containing illicit fentanyl being seized by law enforcement in 2023 alone 19 . The deceitful and unforgiving nature of fentanyl makes it a hidden threat to the unsuspecting adolescent population. Naloxone is an opioid overdose antidote approved by the Food and Drug Administration (FDA) in 1971 20 . It can rapidly reverse life-threatening effects and “does not cause harm if administered to a person who does not have opioids in their system”, making it the cornerstone treatment indicated for opioid overdose 21 , 22 . Access to naloxone was initially restricted to licensed medical personnel, but it is now accessible to the public as an over-the-counter intranasal spray 20 , 22 . This change inspired community training programs which have shown efficacy in improving participants’ ability to respond effectively to opioid overdoses 23 , 24 . However, literature has shown no implementation of opioid misuse education programs in schools 25 . Given that two-thirds of adolescent overdose deaths occur in the presence of a potential bystander, it is concerning that most educators have never received formal instruction in overdose recognition or naloxone administration 26 . Opioid overdose is not the only medical emergency seeing an increase in incidence among adolescents. Additionally, anaphylaxis is a rapid-onset, severe allergic reaction that can be fatal if not treated immediately. Common triggers in adolescents include certain foods, medications, or insect stings, and occurrence in schools is not uncommon 27 . Specifically, 16–18% of serious allergic reactions in children happened at school, most frequently at the high school level 28 . In the absence of trained medical personnel, the first-line treatment for anaphylaxis is an intramuscular epinephrine auto-injector (EAI) administration, which can alleviate or prevent the progression of anaphylactic symptoms 29 . However, the rate of adolescents carrying EAIs is inconsistent 30 . Additionally, for every four students experiencing a severe allergic reaction at school, one of them will be experiencing their first 31 . In an effort to further prepare schools, the federal government developed the School Access to Emergency Epinephrine Act allowing stock or undesignated epinephrine to be prescribed to an entity for use during an anaphylactic emergency regardless of their previous allergy history 31 . Since its approval, nearly every state in the United States, except for Hawaii, have passed laws authorizing stock epinephrine in schools 32 . Recent data has indicated that 47.5% of student anaphylactic reactions were treated with the school’s undesignated epinephrine auto-injectors 33 . However, many states do not require staff training in anaphylaxis recognition or proper administration of epinephrine 34 . School staff members’ inconsistent, limited, or lack of epinephrine auto-injector training is compounded by students not carrying their epinephrine injectors. Students report factors such as lack of knowledge regarding proper usage, perceived lack of necessity, and social stigma contributing to the lack of carrying EAIs 31 . Recently, public health organizations have called for mandatory naloxone and epinephrine policies and education in U.S. schools 32 , 35 . Recognizing that trained educators can bridge the critical time period between the onset of illness and arrival of emergency medical services, we developed a pilot training program for high school staff that targeted the recognition and prehospital management of opioid overdoses and anaphylaxis. This study aimed to assess the feasibility and efficacy of an integrated, bimodal training intervention composed of didactic presentations coupled with practical hands-on exercises. We evaluated the program’s impact by comparing participants’ knowledge and self-confidence before and after the training. 2 Methods 2.1 Participants and Study Design Faculty and student members of this academic institution’s Emergency Medicine Interest Group (EMIG) conducted this pilot study. We recruited twenty high school teachers and staff from a private high school in Northwest Louisiana to participate. The study involved a single educational session with pre- and post-training evaluations. All participants provided informed consent, and the Institutional Review Board of Louisiana State University Health Sciences approved the study protocol on 10/14/2024 (IRB# STUDY00002851). 2.2 Training Intervention Participants attended a 30-minute didactic presentation followed by 15-minute hands-on practical exercises with trainer devices. The training curriculum was developed using current literature and was vetted by emergency medicine and critical care faculty to ensure accuracy. The lecture was delivered in two parts, opioid overdose and anaphylaxis, each followed by a brief open discussion segment. The content covered in the presentations included definitions and current statistics on adolescent opioid overdoses and anaphylaxis, signs and symptoms of these medical emergencies, appropriate immediate response steps, and proper administration techniques for intranasal naloxone and epinephrine auto-injectors. In order to reinforce the emergency medical skills taught during the presentation, EMIG facilitators provided guidance to participants during the hands-on practical exercise. Training devices were acquired from this institution’s emergency department pharmacy. 2.3 Assessments Participants completed identical written surveys (Additional file 1) immediately before and after the training, with the exception of demographic information and prior education experiences, which was collected during the pre-training survey. The survey evaluated participants’ confidence and comfort in recognition of the medical emergencies and administration of the appropriate medication utilizing four Likert-scale items (1 = Not confident/comfortable at all; 5 = Very confident/comfortable). Additionally, the survey included eight multiple-choice questions covering the prevalence, symptom recognition, and appropriate management of each medical emergency. Each knowledge question was worth one point if answered correctly and no points were awarded for incorrect or incomplete answers. 2.4 Statistical Analysis Survey results were analyzed using Microsoft Excel Version 2502. Post-training knowledge scores were compared to baseline results using the Wilcoxon signed-rank test (α ≤ 0.05). Changes in Likert-scale responses were evaluated by comparing the mean pre-training and post-training score for each item. 3 Results Participants who met the inclusion criteria were present throughout the duration of the presentations and participated in both surveys (n = 18). Two participants did not complete the post-test and were excluded from analysis. The participants were predominantly over 40 years of age and had ≤ 10 years of teaching experience. Although some of the participants had prior exposure to epinephrine auto-injector training (n = 6), none of the participants had prior naloxone training. Demographic data has been represented in Table 1 . Table 1 Demographic data of high school teachers. This table shows a stratification of participants based on age and length of teaching career and how many from each category have prior training with intranasal naloxone and epinephrine auto-injector training. Age Participants Prior Naloxone Training Prior * EAI Training 20–29 2 0 1 30–39 4 0 0 ≥ 40 12 0 5 Length of Teaching Career, in years 0–9 11 0 5 10–19 3 0 0 20–29 2 0 1 ≥ 30 2 0 0 * EAI: Epinephrine Auto Injector Values represent the number of participant responses 3.1 Changes in Confidence Before the training, participants’ self-rated confidence was highest for administering an epinephrine auto-injector and lowest for recognizing an opioid overdose. After the intervention, confidence levels increased substantially across all measured areas. On the 5-point Likert scale, the average rating for the four critical competencies (recognizing overdose, recognizing anaphylaxis, administering naloxone, administering epinephrine) rose by approximately 2.1 points from pre- to post-training. Post-training, mean confidence ratings ranged from 4.1 to 4.6 out of 5, indicating most participants felt very confident. The largest gain was in confidence about identifying an opioid overdose (score increase = 2.3). Figure 1 illustrates a comparison of participants average response following the intervention. 3.2 Changes in Knowledge In the pre-test, participants answered an average of 5 out of 8 knowledge questions correctly (62.5% correct). This average increased to 7 out of 8 (87.5% correct) in the post-test. Overall knowledge score showed a 25% improvement (p ≤ 0.05). Notably, Question 5 assessed the proper method of intranasal naloxone administration and showed the greatest improvement. Approximately one-third (n = 6) of participants answered Question 5 correctly before training, compared to all participants (n = 18) correctly responding after training, resulting in a 67% increase in correct responses. Figure 2 demonstrates the increase in correct responses following intervention. 4 Discussion This pilot training program produced significant improvement in participants’ knowledge and confidence in medical emergency response. Mean knowledge increased by 25 percentage points, while confidence showed a 2-point increase across all critical tasks. These improvements were achieved following a single, 45-minute training session using low-cost trainer devices and freely available presentation software. The outcome of this study suggests that imparting high school educators with critical, life-saving skills may be accomplished without extensive financial burden or classroom time. Prior to educational interventions, study participants reported the highest confidence in administering EAIs and the lowest confidence in identifying opioid overdose. These findings are consistent with participants (n = 6) reporting having prior EAI training only. The greatest confidence increase was participants’ ability to properly identify an opioid overdose. Similarly, knowledge gains were observed across nearly all topics, reflecting a better understanding of both the frequency and identification of these emergencies in adolescents and the steps for effective emergency management. Intranasal naloxone administration showed the greatest knowledge increase, in which all participants provided correct responses following training. These findings highlight the effectiveness of our educational approach in emergency recognition and management for non-medically licensed community members. The results from our pilot training program align with knowledge and confidence gains seen in previous studies evaluating community-based naloxone and epinephrine auto-injector training programs 36 – 38 . Contrary to previous studies which solely target opioid overdose or anaphylaxis, our training program integrates both medical emergencies into one training session. This integration leverages a synergistic approach while preserving outcomes. Integration of both emergencies, minimal time requirement, and high participant engagement without adverse events may lead to enhanced information distribution and cost-effectiveness for school districts with limited resources. All course materials other than trainer devices were developed or acquired at no cost by members of this institutions EMIG. Additionally, naloxone ( $ 20.50 / 5 pc.) and EAI ( $ 26.00 / 4 pc.) trainers are available at discounted or no cost to schools through multiple vendors 39 , 40 . Active medication administration devices are now being distributed to qualifying schools at no cost through programs such as EPIPENS4SCHOOLS and implementation of the HERO Act, a federally funded grant for purchasing opioid reversal medications and development and implementation of opioid educational programs 41 – 43 . One encouraging outcome of this pilot study was the school administration utilized these sources provided during the training to obtain naloxone and epinephrine auto-injector kits for the campus at no cost. This immediate improvement in the school’s emergency preparedness underscores how education, coupled with guidance on resources, can have a tangible impact beyond the classroom training itself. As a pilot program, there are inherent limitations to our study. Our single-site sample size was limited and reduced the generalizability of the results. Outcomes were only assessed immediately after the training, preventing analysis of long-term knowledge retention and utilization of the learned skills in real-world scenarios. Future studies should evaluate larger and more diverse school populations utilizing multiple follow-up assessments and examine real-life emergency events at these schools to determine if this format of training translates into effective action and improved outcomes. Given its brevity, negligible financial burden, and alignment with existing best practices, our training program appears readily scalable. School districts could embed our program within annual professional-development calendars and utilize standing local partnerships with medical institutions to ensure compliance with current medical guidelines. At the policy level, mandating both stock medications and annual staff training would increase overdose and anaphylaxis school readiness, and may save a child’s life. 5 Conclusion This pilot study demonstrates that our educational program has the potential to significantly improve the preparedness of school personnel to recognize and manage opioid overdose and anaphylaxis. The school’s proactive acquisition of emergency medications as well as the results of this study support a proactive approach to public health organizations concerns for mandatory naloxone and epinephrine policies and education in US schools. Our intervention required only two hours of participants’ time and materials were obtained at no cost. The requirements for implementation of our training program are limited to the acquisition of trainer devices and a single facilitator. This supports the ability to embed this education into routine in-service days or after school professional development sessions with minimal disruption to normal school activities. Additionally, pre-recorded lectures are currently under development by this institution to increase information distribution. In summary, our pilot study results indicate that scaling the program to multiple campuses is feasible, financially sustainable, and should be considered as a proactive measure to improve safety and potentially save lives during student medical emergencies. Abbreviations FDA Food and Drug Association CDC Centers for Disease Control and Prevention EAI Epinephrine Auto-Injector EMIG Emergency Medicine Interest Group HERO Act Helping Educators Respond to Overdoses Act Declarations Ethics Approval Surveys for this study were completed anonymously without any identifying information. All participants provided informed consent, and the Institutional Review Board of Louisiana State University Health Sciences approved the study protocol on 10/14/2024 (IRB# STUDY00002851). Consent for Publication Not applicable. Availability of Data and Materials The datasets supporting the conclusions of this article are included within the article and supplementary files. Data may also be provided by the authors upon reasonable request. Competing Interests The authors declare no competing interests. Funding No funding was received to assist with the preparation of this manuscript. Author Contributions W.P.J. contributed to conceptualization, investigation, resources, methodology, data curation, writing—original draft preparation, and writing—review and editing. B.L., C.Q., and A.S., contributed to data curation and writing—review and editing. M.C., E.L., and K.A. contributed to investigation, data curation, and writing—original draft preparation. K.H. was involved in supervision and project administration. E.B. contributed to conceptualization, methodology, supervision, and project administration. All authors have read and agreed to the published version of the manuscript. Acknowledgments The authors would like to thank the administration and staff at Loyola College Preparatory School for their participation and support. Additionally, we would like to extend a thank you to Mr. Michael Greene, the assistant principal, as his support and encouragement throughout this project have been instrumental in its success. We also acknowledge the LSU Health Shreveport EMIG members who helped facilitate the training. References facing charges in connection with suspected fentanyl overdoses at Wakefield High School. WTOP News. October 4, 2023. Accessed May 19, 2025. https://wtop.com/arlington/2023/10/2-facing-charges-in-connection-with-suspected-fentanyl-overdoses-at-wakefield-high-school/ Staff 7News. 2 suspected overdoses reported at Park View High School, Loudoun Co. officials say. WJLA. March 20, 2025. Accessed May 19, 2025. https://wjla.com/news/local/loudoun-county-public-schools-park-view-high-school-sterling-virginia-overdoses-privacy-health-nalaxone-families-naloxone-training-clinic-police-health Every NYC school building now carries Naloxone. Is it enough? Chalkbeat. August 19, 2024. Accessed May 19, 2025. https://www.chalkbeat.org/newyork/2024/08/19/naloxone-training-school-staff-expands-prevent-student-overdoses/ Fentanyl caused death of 15-year-old Dunwoody High School student, ME says | FOX 5 Atlanta. Accessed May 19, 2025. https://www.fox5atlanta.com/news/fentanyl-caused-death-15-year-old-dunwoody-high-school-student-me-says Police Investigate Apparent Drug Overdose at Wakefield High School. Accessed May 19, 2025. https://www.arlingtonva.us/About-Arlington/Newsroom/Articles/2023/Police-Investigate-Apparent-Drug-Overdose-at-Wakefield-High-School Weber C. Police: Arrest after teen ODs and dies in school bathroom. AP News. September 15, 2022. Accessed May 19, 2025. https://apnews.com/article/health-arrests-los-angeles-hollywood-d92c445a8f43f17de6983dcc5c8d0223 Lambert BB. Police: Student, 16, suffers apparent fentanyl overdose at Bloomfield school. Darien Times. February 7, 2022. Accessed May 19, 2025. https://www.darientimes.com/news/article/Police-Student-16-suffers-apparent-fentanyl-16839351.php McDonald CC, Pinto-Martin J, Compton P, Parikh M, Meisel ZF. School nurse reported supply and administration of naloxone in schools. Public Health Nurs Boston Mass . 2020;37(3):347-352. doi:10.1111/phn.12715 Reporter RS KOMO News. Highline High School educators use Narcan to save student overdosing on campus. KOMO. May 24, 2024. Accessed May 19, 2025. https://komonews.com/news/local/highline-high-school-burien-washington-seattle-teen-student-overdose-fentanyl-opioid-crisis-save-life-lifesaving-public-schools-washington-law-narcan-naloxone-overdosing-educators-teachers-staff-revived-hartford-department-health-pills-marijuana-laced Dial S. Narcan used to revive Carrollton middle school student. FOX 4. April 6, 2023. Accessed May 19, 2025. https://www.fox4news.com/news/narcan-used-to-revive-carrollton-middle-school-student Abuse NI on D. Prescription Opioids DrugFacts | National Institute on Drug Abuse (NIDA). June 1, 2021. Accessed June 11, 2025. https://nida.nih.gov/publications/drugfacts/prescription-opioids Pain Physician. Accessed March 25, 2025. https://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=11&page=S105 A Brief History of Opioids in the U.S. | Hopkins Bloomberg Public Health Magazine. Accessed April 8, 2025. https://magazine.publichealth.jhu.edu/2023/brief-history-opioids-us Abuse NI on D. Drug Overdose Deaths: Facts and Figures | National Institute on Drug Abuse (NIDA). August 21, 2024. Accessed June 2, 2025. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates Youth Online: High School YRBS - 2021 Results | DASH | CDC. Accessed April 8, 2025. https://nccd.cdc.gov/Youthonline/App/Results.aspx?TT=B&OUT=0&SID=HS&QID=H49&LID=LL&YID=RY&LID2=&YID2=&COL=&ROW1=&ROW2=&HT=&LCT=&FS=&FR=&FG =&FA=&FI=&FP=&FSL=&FRL=&FGL=&FAL=&FIL=&FPL=&PV=&TST=&C1=&C2=&QP=G&DP=&VA =CI&CS=Y&SYID=&EYID=&SC=&SO= CDC. Opioid Dispensing Rate Maps. Overdose Prevention. November 7, 2024. Accessed April 8, 2025. https://www.cdc.gov/overdose-prevention/data-research/facts-stats/opioid-dispensing-rate-maps.html Friedman Joseph, Hadland Scott E. The Overdose Crisis among U.S. Adolescents. N Engl J Med . 2024;390(2):97-100. doi:10.1056/NEJMp2312084 Kuehn BM. Fentanyl Drives Startling Increases in Adolescent Overdose Deaths. JAMA . 2023;329(4):280-281. doi:10.1001/jama.2022.23563 Abuse NI on D. Number of Pills Containing Fentanyl Seized by Law Enforcement in the United States, 2017-2023 | National Institute on Drug Abuse (NIDA). May 13, 2024. Accessed May 19, 2025. https://nida.nih.gov/research-topics/trends-statistics/infographics/number-of-pills-containing-fentanyl-seized-by-law-enforcement-in-the-united-states-2017-2023 History. Remedy Alliance / For The People. Accessed March 25, 2025. https://remedyallianceftp.org/pages/history Opioid Overdose: Symptoms, Treatment & Prevention. Cleveland Clinic. Accessed February 17, 2025. https://my.clevelandclinic.org/health/diseases/24583-opioid-overdose Commissioner O of the. Access to Naloxone Can Save a Life During an Opioid Overdose. FDA . Published online March 29, 2023. Accessed June 12, 2025. https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose Beauchamp GA, Cuadrado HM, Campbell S, et al. A Study on the Efficacy of a Naloxone Training Program. Cureus . 2021;13(11):e19831. doi:10.7759/cureus.19831 Jones JD, Roux P, Stancliff S, Matthews W, Comer SD. Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users. Int J Drug Policy . 2014;25(1):166-170. doi:10.1016/j.drugpo.2013.05.006 Harrod SB, Harrison SE, McQuillin SD, Weist MD. United States Schools and the Opioid Crisis: Charting New Directions. Am J Health Educ . 2024;55(3):156-168. doi:10.1080/19325037.2023.2295558 Tanz LJ. Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. MMWR Morb Mortal Wkly Rep . 2022;71. doi:10.15585/mmwr.mm7150a2 White MV, Hogue SL, Odom D, et al. Anaphylaxis in Schools: Results of the EPIPEN4SCHOOLS Survey Combined Analysis. Pediatr Allergy Immunol Pulmonol . 2016;29(3):149. doi:10.1089/ped.2016.0675 Food Allergy Knowledge, Attitudes, and Beliefs Among Kindergarten Through Fourth-Grade Teachers – School Nutrition Association. https://schoolnutrition.org/. Accessed June 12, 2025. https://schoolnutrition.org/journal/fall-2023-food-allergy-knowledge-attitudes-and-beliefs-among-kindergarten-through-fourth-grade-teachers/ Simons FER, Clark S, Camargo CA. Anaphylaxis in the community: Learning from the survivors. J Allergy Clin Immunol . 2009;124(2):301-306. doi:10.1016/j.jaci.2009.03.050 Sampson MA, Muñoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol . 2006;117(6):1440-1445. doi:10.1016/j.jaci.2006.03.009 Tarr Cooke A, Meize-Grochowski R. Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper. SAGE Open Nurs . 2019;5:2377960819845246. doi:10.1177/2377960819845246 Epinephrine in Schools and Public Places. Asthma & Allergy Foundation of America. Accessed May 20, 2025. https://aafa.org/advocacy/key-issues/access-to-medications/epinephrine-stocking-in-schools/ White MV, Goss D, Hollis K, et al. Anaphylaxis Triggers and Treatments by Grade Level and Staff Training: Findings from the EPIPEN4SCHOOLS Pilot Survey. Pediatr Allergy Immunol Pulmonol . 2016;29(2):80-85. doi:10.1089/ped.2015.0614 Tsuang A, Wang J. Childcare and School Management Issues in Food Allergy. Curr Allergy Asthma Rep . 2016;16(12):83. doi:10.1007/s11882-016-0663-0 October 30, 2023- Joint Letter with Director Rahul Gupta of the Office of National Drug Control Policy Director on the fentanyl overdose epidemic | U.S. Department of Education. Accessed June 15, 2025. http://www.ed.gov/laws-and-policy/education-policy/key-policy-letters-signed-by-the-education-secretary-or-deputy-secretary/october-30-2023-joint-letter-with-director-rahul-gupta-of-the-office-of-national-drug-control-policy-director-on-the-fentanyl-overdose-epidemic Ashrafioun L, Gamble S, Herrmann M, Baciewicz G. Evaluation of Knowledge and Confidence following Opioid Overdose Prevention Training: A Comparison of Types of Training Participants and Naloxone Administration Methods. Subst Abuse . 2016;37(1):76-81. doi:10.1080/08897077.2015.1110550 Beauchamp GA, Cuadrado HM, Campbell S, et al. A Study on the Efficacy of a Naloxone Training Program. Cureus . 13(11):e19831. doi:10.7759/cureus.19831 Litarowsky JA. Evaluation of the Effectiveness of an Anaphylaxis Training Program for Unlicensed Assistive Personnel . Master of Science. San Jose State University; 2003. doi:10.31979/etd.vesy-th5n Epinephrine Auto Injector Training Device | Red Cross Store. Accessed June 15, 2025. https://www.redcross.org/store/epinephrine-auto-injector-training-device/765201.html?srsltid=AfmBOor5z-qXFoyNQg_j2nNKG2PCGTyDdgt0a1uhl30_qT2CWQMTh0hb Naloxone Nasal Spray Training Device (5-Pack) | Red Cross Store. Accessed June 15, 2025. https://www.redcross.org/store/naloxone-nasal-spray-training-device-5-pack/765216.html?srsltid=AfmBOor59Xz_MlDst2dMiOQ7f8-pkGtcSg47qFCiLtasJJ7QNZYzkoe- Free NARCAN Nasal Spray for Eligible Schools. National Overdose Prevention Network. Accessed May 3, 2025. https://nopn.org/resources/free-narcan-nasal-spray-for-eligible-schools EPIPEN® (epinephrine injection, USP) and EPIPEN JR® (epinephrine injection, USP) Auto-Injectors. Accessed May 3, 2025. https://www.epipen4schools.com/ Rep. Schiff AB [D C 28. Text - H.R.6251 - 118th Congress (2023-2024): HERO Act. November 10, 2023. Accessed June 15, 2025. https://www.congress.gov/bill/118th-congress/house-bill/6251/text Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.xlsx Additional File 1 (.docx); Example Survey; Full-length, 19-question survey utilized during the pilot study. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6977727","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":514236793,"identity":"7121bb76-623b-4527-a647-28a7c5f121ac","order_by":0,"name":"Wesley P. Jameson","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Wesley","middleName":"P.","lastName":"Jameson","suffix":""},{"id":514236794,"identity":"76b0b7a7-d033-4ce8-b51e-972ad945e6b2","order_by":1,"name":"Molly Cook","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Molly","middleName":"","lastName":"Cook","suffix":""},{"id":514236795,"identity":"66f3398f-dcd8-4d89-925a-1e180ed9a391","order_by":2,"name":"Bailey Lupo","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Bailey","middleName":"","lastName":"Lupo","suffix":""},{"id":514236797,"identity":"f7576b3b-1f8c-49e9-8e9d-bd2720ce9252","order_by":3,"name":"Andrew Schwartz","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Schwartz","suffix":""},{"id":514236798,"identity":"8df91845-3c31-471c-90fc-7b05f513365e","order_by":4,"name":"Emile Legendre","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Emile","middleName":"","lastName":"Legendre","suffix":""},{"id":514236800,"identity":"970d75da-3688-4f3b-ae1e-8b280fc28792","order_by":5,"name":"Kristen Adams","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Kristen","middleName":"","lastName":"Adams","suffix":""},{"id":514236802,"identity":"d8df6efa-6f23-47b0-824e-38e5a15937fd","order_by":6,"name":"Christian Quinones","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Quinones","suffix":""},{"id":514236803,"identity":"aef0013e-d927-4e09-a380-92a8d0aa0257","order_by":7,"name":"Kimberley Hutchinson","email":"","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":false,"prefix":"","firstName":"Kimberley","middleName":"","lastName":"Hutchinson","suffix":""},{"id":514236804,"identity":"749e925c-0d62-462e-a1d7-fa633ea61d1c","order_by":8,"name":"Elaine Brown","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACdgaGA0AqAcz5UMDAYABi8ODTwoykhXGGAZFaGGBamHmI0cLPzPzwcEEFQ555e4/ZYxuDusTt/AcYH7xtw61FspnN4PCMMwzFMmfOmBvnGBxO3DkjgdlwLh4tBoeBiLeNIXGGRO426RyDA4kbbjCwSfPi0WJ/mP3DYd5/UC0WQIdtOH+A/Tc+LQZALx/mbYBqAXITNxxIYGPGp0XiME/BYZ5jEsUSPOe/SfYYHDbecCOxWXLOOdxa+NvbN3/mqbHJk2BvS5P4UVEnu+H84YMf3pTh1gKzDJnD2EBQ/SgYBaNgFIwC/AAAGlhN3q7Do2MAAAAASUVORK5CYII=","orcid":"","institution":"Louisiana State University Health Shreveport, United States","correspondingAuthor":true,"prefix":"","firstName":"Elaine","middleName":"","lastName":"Brown","suffix":""}],"badges":[],"createdAt":"2025-06-25 20:23:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6977727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6977727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91303970,"identity":"b46d5b27-4700-4e2a-b271-8d411d834497","added_by":"auto","created_at":"2025-09-15 06:21:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39437,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant response confidence questions.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6977727/v1/add40f650ba2cd30a1d12546.jpg"},{"id":91303973,"identity":"5902b4bf-4085-422b-97f3-58ddb01f215a","added_by":"auto","created_at":"2025-09-15 06:21:19","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39149,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of correct knowledge question responses.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6977727/v1/171505521a4e5b4bb8e66322.jpg"},{"id":93794587,"identity":"1eea810a-2d6b-4818-8b54-de8921ea8ac3","added_by":"auto","created_at":"2025-10-17 15:39:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":620054,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6977727/v1/00471ee6-dcde-4de1-a8a8-cee727636243.pdf"},{"id":91303976,"identity":"feb4d44b-94c0-42ac-87dc-0bae94146b1b","added_by":"auto","created_at":"2025-09-15 06:21:19","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12561,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional File 1 (.docx); Example Survey; Full-length, 19-question survey utilized during the pilot study.\u003c/p\u003e","description":"","filename":"Additionalfile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6977727/v1/d1f5ab34e6c8aeb867c6c188.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empowering High School Staff to Respond to Emergencies: A Pilot Training Program for Intranasal Naloxone and Epinephrine Administration","fulltext":[{"header":"1 Background","content":"\u003cp\u003eHigh school teachers and staff confront life-threatening medical emergencies affecting their students that demand immediate recognition and medical intervention\u003csup\u003e1\u0026ndash;8\u003c/sup\u003e. Training school personnel to recognize and respond to these emergencies is critical to bridging the gap between the onset of illness and arrival of emergency medical services\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. This pilot study focuses on two of these emergencies, opioid overdose and anaphylaxis.\u003c/p\u003e\u003cp\u003eOpioids, both natural and synthetic, are a class of drug primarily used for pain management in the setting of acute and terminal illness\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Although they have been shown to be extremely efficacious when used properly, they also carry serious risks. In high doses or when misused, opioids can cause sedation, dependence, and importantly, profound respiratory depression leading to death\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Over the past decade, the opioid misuse patterns among youth have undergone a radical transformation. In 2015, prescription opioid consumption per capita was declining, but still responsible for more overdose related fatalities than any other illicit drugs\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Recent data from the High School Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention (CDC) reported that 16,858 high school students have used prescription pain medication without a doctor\u0026rsquo;s supervision or differently than how a doctor told them to use it\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEfforts to curb the epidemic, such as increased awareness and more restrictive prescribing criteria, have resulted in reducing the number of opioid prescriptions to a rate of 37.5 per 100 persons by 2023, and a drop in illicit drug use among 12th graders from 21\u0026ndash;8%\u003csup\u003e16,17\u003c/sup\u003e. Paradoxically, adolescent injury and fatalities related to drug overdose occur at an unacceptably high rate. National surveillance data indicates fatalities among adolescents has more than doubled between 2019 and 2021 alone, with an average of 22 adolescent opioid overdose fatalities occurring every week in the United States\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Although drug overdoses have the potential to occur in any environment, school districts across the United States have reported administration of naloxone in their school or at a school sponsored event\u003csup\u003e1,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Fentanyl, a synthetic opioid 50\u0026ndash;100 times more potent than morphine, is the major contributor to the high rate of fatality and is involved in at least 75% of adolescent overdose deaths\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. It is often illegally manufactured and pressed into counterfeit pills or mixed with other illicit drugs resulting in over 115\u0026nbsp;million pills containing illicit fentanyl being seized by law enforcement in 2023 alone\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The deceitful and unforgiving nature of fentanyl makes it a hidden threat to the unsuspecting adolescent population.\u003c/p\u003e\u003cp\u003eNaloxone is an opioid overdose antidote approved by the Food and Drug Administration (FDA) in 1971\u003csup\u003e20\u003c/sup\u003e. It can rapidly reverse life-threatening effects and \u0026ldquo;does not cause harm if administered to a person who does not have opioids in their system\u0026rdquo;, making it the cornerstone treatment indicated for opioid overdose\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Access to naloxone was initially restricted to licensed medical personnel, but it is now accessible to the public as an over-the-counter intranasal spray\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. This change inspired community training programs which have shown efficacy in improving participants\u0026rsquo; ability to respond effectively to opioid overdoses\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. However, literature has shown no implementation of opioid misuse education programs in schools\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Given that two-thirds of adolescent overdose deaths occur in the presence of a potential bystander, it is concerning that most educators have never received formal instruction in overdose recognition or naloxone administration\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOpioid overdose is not the only medical emergency seeing an increase in incidence among adolescents. Additionally, anaphylaxis is a rapid-onset, severe allergic reaction that can be fatal if not treated immediately. Common triggers in adolescents include certain foods, medications, or insect stings, and occurrence in schools is not uncommon\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Specifically, 16\u0026ndash;18% of serious allergic reactions in children happened at school, most frequently at the high school level\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. In the absence of trained medical personnel, the first-line treatment for anaphylaxis is an intramuscular epinephrine auto-injector (EAI) administration, which can alleviate or prevent the progression of anaphylactic symptoms\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. However, the rate of adolescents carrying EAIs is inconsistent\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Additionally, for every four students experiencing a severe allergic reaction at school, one of them will be experiencing their first\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn an effort to further prepare schools, the federal government developed the School Access to Emergency Epinephrine Act allowing stock or undesignated epinephrine to be prescribed to an entity for use during an anaphylactic emergency regardless of their previous allergy history\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Since its approval, nearly every state in the United States, except for Hawaii, have passed laws authorizing stock epinephrine in schools\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Recent data has indicated that 47.5% of student anaphylactic reactions were treated with the school\u0026rsquo;s undesignated epinephrine auto-injectors\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. However, many states do not require staff training in anaphylaxis recognition or proper administration of epinephrine\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. School staff members\u0026rsquo; inconsistent, limited, or lack of epinephrine auto-injector training is compounded by students not carrying their epinephrine injectors. Students report factors such as lack of knowledge regarding proper usage, perceived lack of necessity, and social stigma contributing to the lack of carrying EAIs\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eRecently, public health organizations have called for mandatory naloxone and epinephrine policies and education in U.S. schools\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Recognizing that trained educators can bridge the critical time period between the onset of illness and arrival of emergency medical services, we developed a pilot training program for high school staff that targeted the recognition and prehospital management of opioid overdoses and anaphylaxis. This study aimed to assess the feasibility and efficacy of an integrated, bimodal training intervention composed of didactic presentations coupled with practical hands-on exercises. We evaluated the program\u0026rsquo;s impact by comparing participants\u0026rsquo; knowledge and self-confidence before and after the training.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants and Study Design\u003c/h2\u003e\u003cp\u003eFaculty and student members of this academic institution\u0026rsquo;s Emergency Medicine Interest Group (EMIG) conducted this pilot study. We recruited twenty high school teachers and staff from a private high school in Northwest Louisiana to participate. The study involved a single educational session with pre- and post-training evaluations. All participants provided informed consent, and the Institutional Review Board of Louisiana State University Health Sciences approved the study protocol on 10/14/2024 (IRB# STUDY00002851).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Training Intervention\u003c/h2\u003e\u003cp\u003eParticipants attended a 30-minute didactic presentation followed by 15-minute hands-on practical exercises with trainer devices. The training curriculum was developed using current literature and was vetted by emergency medicine and critical care faculty to ensure accuracy. The lecture was delivered in two parts, opioid overdose and anaphylaxis, each followed by a brief open discussion segment. The content covered in the presentations included definitions and current statistics on adolescent opioid overdoses and anaphylaxis, signs and symptoms of these medical emergencies, appropriate immediate response steps, and proper administration techniques for intranasal naloxone and epinephrine auto-injectors. In order to reinforce the emergency medical skills taught during the presentation, EMIG facilitators provided guidance to participants during the hands-on practical exercise. Training devices were acquired from this institution\u0026rsquo;s emergency department pharmacy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Assessments\u003c/h2\u003e\u003cp\u003eParticipants completed identical written surveys (Additional file 1) immediately before and after the training, with the exception of demographic information and prior education experiences, which was collected during the pre-training survey. The survey evaluated participants\u0026rsquo; confidence and comfort in recognition of the medical emergencies and administration of the appropriate medication utilizing four Likert-scale items (1\u0026thinsp;=\u0026thinsp;Not confident/comfortable at all; 5\u0026thinsp;=\u0026thinsp;Very confident/comfortable). Additionally, the survey included eight multiple-choice questions covering the prevalence, symptom recognition, and appropriate management of each medical emergency. Each knowledge question was worth one point if answered correctly and no points were awarded for incorrect or incomplete answers.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e\u003cp\u003eSurvey results were analyzed using Microsoft Excel Version 2502. Post-training knowledge scores were compared to baseline results using the Wilcoxon signed-rank test (α\u0026thinsp;\u0026le;\u0026thinsp;0.05). Changes in Likert-scale responses were evaluated by comparing the mean pre-training and post-training score for each item.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eParticipants who met the inclusion criteria were present throughout the duration of the presentations and participated in both surveys (n\u0026thinsp;=\u0026thinsp;18). Two participants did not complete the post-test and were excluded from analysis. The participants were predominantly over 40 years of age and had\u0026thinsp;\u0026le;\u0026thinsp;10 years of teaching experience. Although some of the participants had prior exposure to epinephrine auto-injector training (n\u0026thinsp;=\u0026thinsp;6), none of the participants had prior naloxone training. Demographic data has been represented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic data of high school teachers. This table shows a stratification of participants based on age and length of teaching career and how many from each category have prior training with intranasal naloxone and epinephrine auto-injector training.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePrior Naloxone Training\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrior \u003csup\u003e*\u003c/sup\u003eEAI Training\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of Teaching Career, in years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e0\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eEAI: Epinephrine Auto Injector\u003c/p\u003e\u003cp\u003eValues represent the number of participant responses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Changes in Confidence\u003c/h2\u003e\u003cp\u003eBefore the training, participants\u0026rsquo; self-rated confidence was highest for administering an epinephrine auto-injector and lowest for recognizing an opioid overdose. After the intervention, confidence levels increased substantially across all measured areas. On the 5-point Likert scale, the average rating for the four critical competencies (recognizing overdose, recognizing anaphylaxis, administering naloxone, administering epinephrine) rose by approximately 2.1 points from pre- to post-training. Post-training, mean confidence ratings ranged from 4.1 to 4.6 out of 5, indicating most participants felt very confident. The largest gain was in confidence about identifying an opioid overdose (score increase\u0026thinsp;=\u0026thinsp;2.3). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates a comparison of participants average response following the intervention.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Changes in Knowledge\u003c/h2\u003e\u003cp\u003eIn the pre-test, participants answered an average of 5 out of 8 knowledge questions correctly (62.5% correct). This average increased to 7 out of 8 (87.5% correct) in the post-test. Overall knowledge score showed a 25% improvement (p\u0026thinsp;\u0026le;\u0026thinsp;0.05). Notably, Question 5 assessed the proper method of intranasal naloxone administration and showed the greatest improvement. Approximately one-third (n\u0026thinsp;=\u0026thinsp;6) of participants answered Question 5 correctly before training, compared to all participants (n\u0026thinsp;=\u0026thinsp;18) correctly responding after training, resulting in a 67% increase in correct responses. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates the increase in correct responses following intervention.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis pilot training program produced significant improvement in participants\u0026rsquo; knowledge and confidence in medical emergency response. Mean knowledge increased by 25 percentage points, while confidence showed a 2-point increase across all critical tasks. These improvements were achieved following a single, 45-minute training session using low-cost trainer devices and freely available presentation software. The outcome of this study suggests that imparting high school educators with critical, life-saving skills may be accomplished without extensive financial burden or classroom time.\u003c/p\u003e\u003cp\u003ePrior to educational interventions, study participants reported the highest confidence in administering EAIs and the lowest confidence in identifying opioid overdose. These findings are consistent with participants (n\u0026thinsp;=\u0026thinsp;6) reporting having prior EAI training only. The greatest confidence increase was participants\u0026rsquo; ability to properly identify an opioid overdose. Similarly, knowledge gains were observed across nearly all topics, reflecting a better understanding of both the frequency and identification of these emergencies in adolescents and the steps for effective emergency management. Intranasal naloxone administration showed the greatest knowledge increase, in which all participants provided correct responses following training. These findings highlight the effectiveness of our educational approach in emergency recognition and management for non-medically licensed community members.\u003c/p\u003e\u003cp\u003eThe results from our pilot training program align with knowledge and confidence gains seen in previous studies evaluating community-based naloxone and epinephrine auto-injector training programs\u003csup\u003e\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Contrary to previous studies which solely target opioid overdose or anaphylaxis, our training program integrates both medical emergencies into one training session. This integration leverages a synergistic approach while preserving outcomes. Integration of both emergencies, minimal time requirement, and high participant engagement without adverse events may lead to enhanced information distribution and cost-effectiveness for school districts with limited resources.\u003c/p\u003e\u003cp\u003eAll course materials other than trainer devices were developed or acquired at no cost by members of this institutions EMIG. Additionally, naloxone (\u003cspan\u003e$\u003c/span\u003e20.50 / 5 pc.) and EAI (\u003cspan\u003e$\u003c/span\u003e26.00 / 4 pc.) trainers are available at discounted or no cost to schools through multiple vendors\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Active medication administration devices are now being distributed to qualifying schools at no cost through programs such as EPIPENS4SCHOOLS and implementation of the HERO Act, a federally funded grant for purchasing opioid reversal medications and development and implementation of opioid educational programs\u003csup\u003e\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. One encouraging outcome of this pilot study was the school administration utilized these sources provided during the training to obtain naloxone and epinephrine auto-injector kits for the campus at no cost. This immediate improvement in the school\u0026rsquo;s emergency preparedness underscores how education, coupled with guidance on resources, can have a tangible impact beyond the classroom training itself.\u003c/p\u003e\u003cp\u003eAs a pilot program, there are inherent limitations to our study. Our single-site sample size was limited and reduced the generalizability of the results. Outcomes were only assessed immediately after the training, preventing analysis of long-term knowledge retention and utilization of the learned skills in real-world scenarios. Future studies should evaluate larger and more diverse school populations utilizing multiple follow-up assessments and examine real-life emergency events at these schools to determine if this format of training translates into effective action and improved outcomes.\u003c/p\u003e\u003cp\u003eGiven its brevity, negligible financial burden, and alignment with existing best practices, our training program appears readily scalable. School districts could embed our program within annual professional-development calendars and utilize standing local partnerships with medical institutions to ensure compliance with current medical guidelines. At the policy level, mandating both stock medications and annual staff training would increase overdose and anaphylaxis school readiness, and may save a child\u0026rsquo;s life.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis pilot study demonstrates that our educational program has the potential to significantly improve the preparedness of school personnel to recognize and manage opioid overdose and anaphylaxis. The school\u0026rsquo;s proactive acquisition of emergency medications as well as the results of this study support a proactive approach to public health organizations concerns for mandatory naloxone and epinephrine policies and education in US schools. Our intervention required only two hours of participants\u0026rsquo; time and materials were obtained at no cost. The requirements for implementation of our training program are limited to the acquisition of trainer devices and a single facilitator. This supports the ability to embed this education into routine in-service days or after school professional development sessions with minimal disruption to normal school activities. Additionally, pre-recorded lectures are currently under development by this institution to increase information distribution. In summary, our pilot study results indicate that scaling the program to multiple campuses is feasible, financially sustainable, and should be considered as a proactive measure to improve safety and potentially save lives during student medical emergencies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFDA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFood and Drug Association\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEAI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEpinephrine Auto-Injector\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMIG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medicine Interest Group\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHERO Act\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHelping Educators Respond to Overdoses Act\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval\u003c/p\u003e\n\u003cp\u003eSurveys for this study were completed anonymously without any identifying information. All participants provided informed consent, and the Institutional Review Board of Louisiana State University Health Sciences approved the study protocol on 10/14/2024 (IRB# STUDY00002851).\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are included within the article and supplementary files. Data may also be provided by the authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eW.P.J. contributed to conceptualization, investigation, resources, methodology, data curation, writing\u0026mdash;original draft preparation, and writing\u0026mdash;review and editing. B.L., C.Q., and A.S., contributed to data curation and writing\u0026mdash;review and editing. M.C., E.L., and K.A. contributed to investigation, data curation, and writing\u0026mdash;original draft preparation. K.H. was involved in supervision and project administration. E.B. contributed to conceptualization, methodology, supervision, and project administration. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the administration and staff at Loyola College Preparatory School for their participation and support. Additionally, we would like to extend a thank you to Mr. Michael Greene, the assistant principal, as his support and encouragement throughout this project have been instrumental in its success. We also acknowledge the LSU Health Shreveport EMIG members who helped facilitate the training.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003efacing charges in connection with suspected fentanyl overdoses at Wakefield High School. WTOP News. October 4, 2023. Accessed May 19, 2025. https://wtop.com/arlington/2023/10/2-facing-charges-in-connection-with-suspected-fentanyl-overdoses-at-wakefield-high-school/\u003c/li\u003e\n\u003cli\u003eStaff 7News. 2 suspected overdoses reported at Park View High School, Loudoun Co. officials say. WJLA. March 20, 2025. Accessed May 19, 2025. https://wjla.com/news/local/loudoun-county-public-schools-park-view-high-school-sterling-virginia-overdoses-privacy-health-nalaxone-families-naloxone-training-clinic-police-health\u003c/li\u003e\n\u003cli\u003eEvery NYC school building now carries Naloxone. Is it enough? Chalkbeat. August 19, 2024. Accessed May 19, 2025. https://www.chalkbeat.org/newyork/2024/08/19/naloxone-training-school-staff-expands-prevent-student-overdoses/\u003c/li\u003e\n\u003cli\u003eFentanyl caused death of 15-year-old Dunwoody High School student, ME says | FOX 5 Atlanta. Accessed May 19, 2025. https://www.fox5atlanta.com/news/fentanyl-caused-death-15-year-old-dunwoody-high-school-student-me-says\u003c/li\u003e\n\u003cli\u003ePolice Investigate Apparent Drug Overdose at Wakefield High School. Accessed May 19, 2025. https://www.arlingtonva.us/About-Arlington/Newsroom/Articles/2023/Police-Investigate-Apparent-Drug-Overdose-at-Wakefield-High-School\u003c/li\u003e\n\u003cli\u003eWeber C. Police: Arrest after teen ODs and dies in school bathroom. AP News. September 15, 2022. Accessed May 19, 2025. https://apnews.com/article/health-arrests-los-angeles-hollywood-d92c445a8f43f17de6983dcc5c8d0223\u003c/li\u003e\n\u003cli\u003eLambert BB. Police: Student, 16, suffers apparent fentanyl overdose at Bloomfield school. Darien Times. February 7, 2022. Accessed May 19, 2025. https://www.darientimes.com/news/article/Police-Student-16-suffers-apparent-fentanyl-16839351.php\u003c/li\u003e\n\u003cli\u003eMcDonald CC, Pinto-Martin J, Compton P, Parikh M, Meisel ZF. School nurse reported supply and administration of naloxone in schools. \u003cem\u003ePublic Health Nurs Boston Mass\u003c/em\u003e. 2020;37(3):347-352. doi:10.1111/phn.12715\u003c/li\u003e\n\u003cli\u003eReporter RS KOMO News. Highline High School educators use Narcan to save student overdosing on campus. KOMO. May 24, 2024. Accessed May 19, 2025. https://komonews.com/news/local/highline-high-school-burien-washington-seattle-teen-student-overdose-fentanyl-opioid-crisis-save-life-lifesaving-public-schools-washington-law-narcan-naloxone-overdosing-educators-teachers-staff-revived-hartford-department-health-pills-marijuana-laced\u003c/li\u003e\n\u003cli\u003eDial S. Narcan used to revive Carrollton middle school student. FOX 4. April 6, 2023. Accessed May 19, 2025. https://www.fox4news.com/news/narcan-used-to-revive-carrollton-middle-school-student\u003c/li\u003e\n\u003cli\u003eAbuse NI on D. Prescription Opioids DrugFacts | National Institute on Drug Abuse (NIDA). June 1, 2021. Accessed June 11, 2025. https://nida.nih.gov/publications/drugfacts/prescription-opioids\u003c/li\u003e\n\u003cli\u003ePain Physician. Accessed March 25, 2025. https://www.painphysicianjournal.com/linkout?issn=1533-3159\u0026amp;vol=11\u0026amp;page=S105\u003c/li\u003e\n\u003cli\u003eA Brief History of Opioids in the U.S. | Hopkins Bloomberg Public Health Magazine. Accessed April 8, 2025. https://magazine.publichealth.jhu.edu/2023/brief-history-opioids-us\u003c/li\u003e\n\u003cli\u003eAbuse NI on D. Drug Overdose Deaths: Facts and Figures | National Institute on Drug Abuse (NIDA). August 21, 2024. Accessed June 2, 2025. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates\u003c/li\u003e\n\u003cli\u003eYouth Online: High School YRBS - 2021 Results | DASH | CDC. Accessed April 8, 2025. https://nccd.cdc.gov/Youthonline/App/Results.aspx?TT=B\u0026amp;OUT=0\u0026amp;SID=HS\u0026amp;QID=H49\u0026amp;LID=LL\u0026amp;YID=RY\u0026amp;LID2=\u0026amp;YID2=\u0026amp;COL=\u0026amp;ROW1=\u0026amp;ROW2=\u0026amp;HT=\u0026amp;LCT=\u0026amp;FS=\u0026amp;FR=\u0026amp;FG\u003cbr\u003e=\u0026amp;FA=\u0026amp;FI=\u0026amp;FP=\u0026amp;FSL=\u0026amp;FRL=\u0026amp;FGL=\u0026amp;FAL=\u0026amp;FIL=\u0026amp;FPL=\u0026amp;PV=\u0026amp;TST=\u0026amp;C1=\u0026amp;C2=\u0026amp;QP=G\u0026amp;DP=\u0026amp;VA\u003cbr\u003e=CI\u0026amp;CS=Y\u0026amp;SYID=\u0026amp;EYID=\u0026amp;SC=\u0026amp;SO=\u003c/li\u003e\n\u003cli\u003eCDC. Opioid Dispensing Rate Maps. Overdose Prevention. November 7, 2024. Accessed April 8, 2025. https://www.cdc.gov/overdose-prevention/data-research/facts-stats/opioid-dispensing-rate-maps.html\u003c/li\u003e\n\u003cli\u003eFriedman Joseph, Hadland Scott E. The Overdose Crisis among U.S. Adolescents. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2024;390(2):97-100. doi:10.1056/NEJMp2312084\u003c/li\u003e\n\u003cli\u003eKuehn BM. Fentanyl Drives Startling Increases in Adolescent Overdose Deaths. \u003cem\u003eJAMA\u003c/em\u003e. 2023;329(4):280-281. doi:10.1001/jama.2022.23563\u003c/li\u003e\n\u003cli\u003eAbuse NI on D. Number of Pills Containing Fentanyl Seized by Law Enforcement in the United States, 2017-2023 | National Institute on Drug Abuse (NIDA). May 13, 2024. Accessed May 19, 2025. https://nida.nih.gov/research-topics/trends-statistics/infographics/number-of-pills-containing-fentanyl-seized-by-law-enforcement-in-the-united-states-2017-2023\u003c/li\u003e\n\u003cli\u003eHistory. Remedy Alliance / For The People. Accessed March 25, 2025. https://remedyallianceftp.org/pages/history\u003c/li\u003e\n\u003cli\u003eOpioid Overdose: Symptoms, Treatment \u0026amp; Prevention. Cleveland Clinic. Accessed February 17, 2025. https://my.clevelandclinic.org/health/diseases/24583-opioid-overdose\u003c/li\u003e\n\u003cli\u003eCommissioner O of the. Access to Naloxone Can Save a Life During an Opioid Overdose. \u003cem\u003eFDA\u003c/em\u003e. Published online March 29, 2023. Accessed June 12, 2025. https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose\u003c/li\u003e\n\u003cli\u003eBeauchamp GA, Cuadrado HM, Campbell S, et al. A Study on the Efficacy of a Naloxone Training Program. \u003cem\u003eCureus\u003c/em\u003e. 2021;13(11):e19831. doi:10.7759/cureus.19831\u003c/li\u003e\n\u003cli\u003eJones JD, Roux P, Stancliff S, Matthews W, Comer SD. Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users. \u003cem\u003eInt J Drug Policy\u003c/em\u003e. 2014;25(1):166-170. doi:10.1016/j.drugpo.2013.05.006\u003c/li\u003e\n\u003cli\u003eHarrod SB, Harrison SE, McQuillin SD, Weist MD. United States Schools and the Opioid Crisis: Charting New Directions. \u003cem\u003eAm J Health Educ\u003c/em\u003e. 2024;55(3):156-168. doi:10.1080/19325037.2023.2295558\u003c/li\u003e\n\u003cli\u003eTanz LJ. Drug Overdose Deaths Among Persons Aged 10\u0026ndash;19 Years \u0026mdash; United States, July 2019\u0026ndash;December 2021. \u003cem\u003eMMWR Morb Mortal Wkly Rep\u003c/em\u003e. 2022;71. doi:10.15585/mmwr.mm7150a2\u003c/li\u003e\n\u003cli\u003eWhite MV, Hogue SL, Odom D, et al. Anaphylaxis in Schools: Results of the EPIPEN4SCHOOLS Survey Combined Analysis. \u003cem\u003ePediatr Allergy Immunol Pulmonol\u003c/em\u003e. 2016;29(3):149. doi:10.1089/ped.2016.0675\u003c/li\u003e\n\u003cli\u003eFood Allergy Knowledge, Attitudes, and Beliefs Among Kindergarten Through Fourth-Grade Teachers \u0026ndash; School Nutrition Association. https://schoolnutrition.org/. Accessed June 12, 2025. https://schoolnutrition.org/journal/fall-2023-food-allergy-knowledge-attitudes-and-beliefs-among-kindergarten-through-fourth-grade-teachers/\u003c/li\u003e\n\u003cli\u003eSimons FER, Clark S, Camargo CA. Anaphylaxis in the community: Learning from the survivors. \u003cem\u003eJ Allergy Clin Immunol\u003c/em\u003e. 2009;124(2):301-306. doi:10.1016/j.jaci.2009.03.050\u003c/li\u003e\n\u003cli\u003eSampson MA, Mu\u0026ntilde;oz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. \u003cem\u003eJ Allergy Clin Immunol\u003c/em\u003e. 2006;117(6):1440-1445. doi:10.1016/j.jaci.2006.03.009\u003c/li\u003e\n\u003cli\u003eTarr Cooke A, Meize-Grochowski R. Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper. \u003cem\u003eSAGE Open Nurs\u003c/em\u003e. 2019;5:2377960819845246. doi:10.1177/2377960819845246\u003c/li\u003e\n\u003cli\u003eEpinephrine in Schools and Public Places. Asthma \u0026amp; Allergy Foundation of America. Accessed May 20, 2025. https://aafa.org/advocacy/key-issues/access-to-medications/epinephrine-stocking-in-schools/\u003c/li\u003e\n\u003cli\u003eWhite MV, Goss D, Hollis K, et al. Anaphylaxis Triggers and Treatments by Grade Level and Staff Training: Findings from the EPIPEN4SCHOOLS Pilot Survey. \u003cem\u003ePediatr Allergy Immunol Pulmonol\u003c/em\u003e. 2016;29(2):80-85. doi:10.1089/ped.2015.0614\u003c/li\u003e\n\u003cli\u003eTsuang A, Wang J. Childcare and School Management Issues in Food Allergy. \u003cem\u003eCurr Allergy Asthma Rep\u003c/em\u003e. 2016;16(12):83. doi:10.1007/s11882-016-0663-0\u003c/li\u003e\n\u003cli\u003eOctober 30, 2023- Joint Letter with Director Rahul Gupta of the Office of National Drug Control Policy Director on the fentanyl overdose epidemic | U.S. Department of Education. Accessed June 15, 2025. http://www.ed.gov/laws-and-policy/education-policy/key-policy-letters-signed-by-the-education-secretary-or-deputy-secretary/october-30-2023-joint-letter-with-director-rahul-gupta-of-the-office-of-national-drug-control-policy-director-on-the-fentanyl-overdose-epidemic\u003c/li\u003e\n\u003cli\u003eAshrafioun L, Gamble S, Herrmann M, Baciewicz G. Evaluation of Knowledge and Confidence following Opioid Overdose Prevention Training: A Comparison of Types of Training Participants and Naloxone Administration Methods. \u003cem\u003eSubst Abuse\u003c/em\u003e. 2016;37(1):76-81. doi:10.1080/08897077.2015.1110550\u003c/li\u003e\n\u003cli\u003eBeauchamp GA, Cuadrado HM, Campbell S, et al. A Study on the Efficacy of a Naloxone Training Program. \u003cem\u003eCureus\u003c/em\u003e. 13(11):e19831. doi:10.7759/cureus.19831\u003c/li\u003e\n\u003cli\u003eLitarowsky JA. \u003cem\u003eEvaluation of the Effectiveness of an Anaphylaxis Training Program for Unlicensed Assistive Personnel\u003c/em\u003e. Master of Science. San Jose State University; 2003. doi:10.31979/etd.vesy-th5n\u003c/li\u003e\n\u003cli\u003eEpinephrine Auto Injector Training Device | Red Cross Store. Accessed June 15, 2025. https://www.redcross.org/store/epinephrine-auto-injector-training-device/765201.html?srsltid=AfmBOor5z-qXFoyNQg_j2nNKG2PCGTyDdgt0a1uhl30_qT2CWQMTh0hb\u003c/li\u003e\n\u003cli\u003eNaloxone Nasal Spray Training Device (5-Pack) | Red Cross Store. Accessed June 15, 2025. https://www.redcross.org/store/naloxone-nasal-spray-training-device-5-pack/765216.html?srsltid=AfmBOor59Xz_MlDst2dMiOQ7f8-pkGtcSg47qFCiLtasJJ7QNZYzkoe-\u003c/li\u003e\n\u003cli\u003eFree NARCAN Nasal Spray for Eligible Schools. National Overdose Prevention Network. Accessed May 3, 2025. https://nopn.org/resources/free-narcan-nasal-spray-for-eligible-schools\u003c/li\u003e\n\u003cli\u003eEPIPEN\u0026reg; (epinephrine injection, USP) and EPIPEN JR\u0026reg; (epinephrine injection, USP) Auto-Injectors. Accessed May 3, 2025. https://www.epipen4schools.com/\u003c/li\u003e\n\u003cli\u003eRep. Schiff AB [D C 28. Text - H.R.6251 - 118th Congress (2023-2024): HERO Act. November 10, 2023. Accessed June 15, 2025. https://www.congress.gov/bill/118th-congress/house-bill/6251/text\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Opioid overdose, anaphylaxis, school-based emergency response, pilot training program","lastPublishedDoi":"10.21203/rs.3.rs-6977727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6977727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTo evaluate the effectiveness and feasibility of a bimodal educational program designed to improve high school staff members\u0026rsquo; knowledge and confidence in recognizing and managing opioid overdoses and anaphylactic reactions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eTwenty high school teachers and staff participated in a structured educational intervention consisting of a 30-minute didactic presentation covering opioid overdose and anaphylaxis recognition and management. Following the presentation, instructors led a 15-minute hands-on practical exercise using intranasal naloxone and epinephrine auto-injector training devices. A survey assessing knowledge and self-reported confidence was administered immediately before and after the training to measure the impact of the educational intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eParticipants\u0026rsquo; post-training scores demonstrated significant improvement. Knowledge assessment scores increased from 62.5\u0026ndash;87.5% (p\u0026thinsp;\u0026le;\u0026thinsp;0.05). The most substantial knowledge increase was seen in identification of the proper method of intranasal naloxone administration (67% increase in correct responses). Additionally, participants expressed increased confidence in recognition and management of both emergencies following the training session, indicated by a 2.1-point increase on a 5-point Likert scale.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis pilot study demonstrates that our educational program has the potential to significantly improve the ability of school personnel to recognize and manage opioid overdose and anaphylaxis. Our results indicate that scaling the program to multiple campuses is feasible, financially sustainable, and should be considered as a proactive measure to improve safety and potentially save lives during student medical emergencies.\u003c/p\u003e","manuscriptTitle":"Empowering High School Staff to Respond to Emergencies: A Pilot Training Program for Intranasal Naloxone and Epinephrine Administration","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-15 06:21:14","doi":"10.21203/rs.3.rs-6977727/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d23987a8-82be-4d75-b806-cd59159778bd","owner":[],"postedDate":"September 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T15:38:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-15 06:21:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6977727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6977727","identity":"rs-6977727","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}