Being obliged to administer rectal diazepam to a pupil in the throes of an epileptic seizure is not a prospect that appeals to teachers. On the contrary, most of them regard it with dismay.

“It’s what really put me off when they asked if I’d volunteer to look after the medicines that kids bring to school with them,” said one infant teacher in Aberdeenshire, who wished to remain anonymous.

“You’re laying yourself open to all sorts of accusations of negligence - or even child abuse if things go wrong. So all the teachers at our school refused to volunteer, and the head had to take responsibility for children’s medicines herself.”

In today’s increasingly litigious world, teachers concerned for the welfare of sick children also have to think - whether they like it or not - about the consequences to themselves if things go wrong.

The new guidelines issued this term by the Scottish Executive, The Administration of Medicines in Schools, are intended to address teachers’ worries and clarify the position for everyone involved. But it remains to be seen if they will achieve their stated aim of fostering closer co-operation between schools, parents and health workers, and creating “a suitably supportive environment for pupils with healthcare needs”.

The simple fact is that no mainstream teacher is obliged to take any responsibility for administering medicines to a pupil. Nor is any headteacher, depute or assistant head. And the management is also within its rights to insist that pupils do not carry medicines around with them.

But if volunteers cannot be found in a school to take responsibility for these medicines - and dispense them when required - it places the school’s education authority in a tricky position.

Meeting the medical needs of children is the duty of NHS boards rather than education authorities. But the latter are required - under the terms of the Standards in Scotland’s Schools etc Act 2000 - to educate children to their fullest potential. And for some pupils that will include meeting their healthcare needs.

So it is easy to see why the Executive and the education authorities are keen to encourage mainstream teachers to take responsibility for administering prescribed medicines. It is harder to see why any teacher would want to volunteer.

“Almost at the drop of a hat people go to legislation these days,” says Ken Cunningham, headteacher at Hillhead High, Glasgow, and president-elect of the Headteachers’ Association of Scotland.

“One worry is that you do something wrong in administering a medicine and get sued for it. But the other is that through inexperience, accident or just the complex nature of the human body, you end up hurting a child.

“I know these new guidelines talk about teachers getting training to administer medicines, but even doctors sometimes get things horrendously wrong.”

This is precisely the reason the teachers’ unions have until now advised their members to take no part in administering medicines in schools. And for some unions the new guidelines will make no difference to that advice.

“I haven’t found anyone who will say that no matter what the outcome, a teacher will not be legally liable,” says NASUWT’s Scottish secretary Pat O’Donnell.

“If a child is ill our advice is that teachers should take all reasonable care and attention, and send for a doctor, nurse or first-aider if necessary. But as far as giving medicines is concerned, don’t.”

The guidelines have also met a somewhat frosty reception from the Association of Head Teachers in Scotland, whose president Bill Milligan, headteacher at Dalmilling Primary, Ayr, finds them disturbingly vague. The use of phrases such as “the employer is likely to be held responsible”, and the teacher “will normally be fully covered” in the event of legal action do not, he says, inspire confidence. “What kind of teacher with any sense would take on a responsibility merely on the ‘likelihood’ that they will not be liable if things go wrong?” he says.

But perhaps the fears of the teachers and heads are unduly pessimistic. There has not been a single case of a teacher in Scotland being sued for making a mistake with a child’s medicine. And although it is true that teachers are having to cope with more children on medication than ever before - a combination of new diseases, better diagnosis of old ones, increased incidence of asthma and allergies, and mainstream inclusion of children once sent to special schools - nobody is asking them to play doctor.

A teacher will not be expected to diagnose and treat sick children, or to administer non-prescribed medicines like paracetamol, but rather to respond, after training, to well-known medical conditions in ways that are clearly defined and have been agreed in advance between the child, the parents, the doctors and the school.

All the most common conditions - asthma, diabetes, epilepsy and allergic reactions - can occasionally result in life-threatening emergencies. And according to their support organisations, which were members of the working group that prepared the new guidelines, if a teacher follows a few straightforward rules she can save a child’s life.

The country’s largest teaching union, the Educational Institute of Scotland, has now altered its advice to members thinking of taking responsibility for the administration of medicine. At one time it was “Don’t do it”. Now it is “Don’t do it except on a voluntary basis, and only if training has been given and a written statement of indemnification obtained from your education authority”.

“What made us look at our policy,” says Ken Wimbor, the EIS’s assistant general secretary, “is the range of allergies children can have nowadays. It’s a matter of trying to strike the right balance, and I think these guidelines are pretty close to doing that.”

HM inspectors have produced a practical guide for student primary teachers, ‘Responding to Changes in Children’s Health’, www.scotland.gov.ukhmieIt is aimed at primary teachers and those in other educational settings. The new guidelines,The Administration of Medicines in Schools, have been distributed to education authorities and schools and are available at the Scottish Executive website at www.scotland.gov.uk

WHAT THE GUIDELINES SAY

* School staff should never administer medication without training from health professionals

* Schools should be encouraged to keep records of the administration of medicines to pupils and the staff involved. Records offer protection to staff and proof that they have followed agreed procedures. Some schools keep a logbook for this

* Parents should be asked to supply weekly or monthly supplies of the doses to be taken at school in their original container with the name of the pupil, the name of the drug, the dosage frequency and expiry date

* Pupils should know where their own medication is stored and who holds the key. A few medicines, such as asthma inhalers, must be readily available to pupils and not locked away

* Where a child is managing medication themselves they normally should not be expected to give up their medication for storage

* Medicines which are in use and in date should be collected by the parentcarer at the end of each term

* Pupils sometimes ask for painkillers at school such as paracetamol. School staff should generally not give non-prescribed medication to pupils. They may not know whether the pupil has taken a previous dose, or whether the medication may react with other medication being taken.

* A child under 12 should not be given aspirin, unless prescribed by a doctor

* Where practical, the school should try to arrange for two adults, one the same gender as the pupil, to be present for the administration of intimate or invasive treatment. This minimises the potential for accusations of abuse

* Generally staff should not take pupils to hospital in their own car. However, in an emergency it may be the best course of action. Wherever possible the member of staff should be accompanied by another adult and have public liability vehicle insurance

SOME COMMON COMPLAINTS

ASTHMA

Latest figures show that nearly 1 in 6 Scottish schoolchildren have a diagnosis of asthma - caused by spasm of the muscles in the bronchial tubes restricting airflow to the lungs.

A typical class will contain around five sufferers, and double that is by no means unheard-of. Physical activity is often the trigger for an asthma attack, while others include stress, smoke, chemicals, cold conditions and furry animals.

Children normally use inhalers to manage their own asthma and these should never be locked away, says Marjory O’Donnell, director of the National Asthma Campaign Scotland. Teachers of young children need to make sure they do not get separated from their inhalers, and all schools should possess readily available spares.

“Teachers sometimes worry about using an inhaler that does not belong to a child, but during an asthma attack getting air into the lungs is by far the most important consideration. In a severe attack any inhaler - even one used by someone else - is better than none at all.

“The teacher should make the child comfortable, loosen their collar, give another dose if necessary, and in the unlikely event that there is no improvement after five minutes, call a doctor.”

National Asthma Campaign Scotland

Provides information pack for teachers, with training available from next term. Tel: 0131 226 2544, helpline: 08457 01 02 03, www.asthma.org.uk EPILEPSY

This condition is caused by randomly-firing nerve cells creating a brief electrical storm in the brain. Medication helps most epileptics to become seizure-free within two years. Teachers have an important role to play in detecting early signs of seizures, and ensuring that a child with epilepsy is not stigmatised at school.

Seizures can range from the most severe, in which consciousness is lost and muscles go into spasm, to the mildest - an absence seizure - which can easily be mistaken by teachers for daydreaming. Triggers to avoid include flickering lights and sudden loud noises.

Teachers will normally administer first-aid during a seizure rather than medication, rectal diazepam needing to be given - by someone trained to do so - only if they become unremitting.

Brains and bodies work normally between seizures, although medication can sometimes cause side-effects like drowsiness. Children with epilepsy can participate fully in the academic and social life of the school.

“I know one boy whose parents were very protective and wanted him to avoid all contact sports,” says Allana Parker, information officer with Epilepsy Action Scotland. “But he took a seizure once during a chess match, so he thought ‘Stuff this’, and now he’s a keen rugby player.”

Epilepsy Action Scotland

Provides information pack and training for teachers. Tel: 0141 419 1701, helpline 0141 427 5225.

Enlighten - Action For Epilepsy

Provides training for teachers in Edinburgh, Midlothian and East Lothian funded by the education authorities. Tel: 0131 226 5458.

DIABETES

People with diabetes fail to produce the insulin needed by their body cells to turn sugar from digested food into energy. This causes muscle weakness and fatigue, and the sugar not removed from the bloodstream builds up to high levels. This causes damage to small blood vessels, especially in the eyes and kidneys.

The remedy is insulin in controlled doses, which means that each day those with the condition have to walk a careful tightrope between too much sugar in the blood and too little - the latter being caused by an excess of insulin, missing a meal, or failing to replace sugar burned off by exercise. Each child with diabetes will have his own insulin regime. Some will need injections before breakfast and lunch, some more frequently, and a few will use an insulin pump.

Child sufferers sometimes need help from the adults around them to recognise the early warning signs of low blood sugar. These can appear suddenly and be mistaken by teachers for bad behaviour. The severity of a low-blood-sugar episode steadily increases, and an emergency can be prevented by early detection and timely response - often just a glucose tablet placed on the tongue.

Teachers trained in a simple procedure to measure blood-sugar levels are valuable for some younger children with diabetes.

Diabetes UK, Scotland

Booklets, posters and leaflets are available, and a guide to main courses.

Tel: 0141 332 2700.

www.diabetes.org.uk

ANAPHYLAXIS

This severe allergic reaction experienced by some children to peanuts, eggs, milk, bee stings, or even latex, is fortunately still rare.

It is one of the most dramatic and dangerous of all medical conditions, with symptoms including: swelling of throat and mouth; difficulty in swallowing or speaking; alterations in heart rate; difficulty breathing; hives on the body; flushing of the skin; abdominal cramps, nausea and vomiting; drop in blood pressure or collapse.

Sufferers need to make sure they do not eat, touch or sometimes even smell the offending substance. This demands alertness from the child, teachers and friends - and the school kitchen.

In the case of severe anaphylaxis, a dose of adrenaline is delivered by an auto-injector.

“We have four pupils with peanut allergies,” says Bruce Johnston, headteacher at Barnhill Primary in Dundee.

“Training was organised for all our staff. A doctor came in to explain the warning signs and showed photographs of children in various stages of anaphylactic shock.

“He showed us how to use the EpiPen. You hold it against the child’s thigh for 10 seconds, push down, and out shoots a little needle that administers the right dose of adrenaline. You remove it and rub the leg. We now keep one EpiPen in the office and one in the child’s classroom.

“When they go to gym, say, the teacher brings the bag along and it’s taken back to the classroom afterwards.

“Our teachers reckon it is a bit like a road accident - if you saw one of those you wouldn’t stand back, you’d get in there and help.”

The Anaphylaxis Campaign

Provides information pack and training video. Tel: 01252 542029, www.anaphylaxis.org.uk