JLK AcademyCore Compliance · Bronze · Emergency Drills

🚨 Core Compliance Academy · Bronze · ~28 min · Termly drill · Annual course refresh

Anaphylaxis & Choking Response Drill

The allergen course tells you how to prevent an allergen incident. This course tells you what to do when prevention fails. Both response sequences below are practised as termly drills at JLK — the seconds you save by having drilled it are the seconds that matter.

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Module 1

Anaphylaxis — recognise, act, don't wait

~9 min

Anaphylaxis is a severe, potentially fatal allergic reaction. It can happen within seconds or minutes of exposure. The correct response is epi-pen first, ambulance immediately, no hesitation — even if you're not 100% sure it's anaphylaxis.

Recognise — the AAAA signs:

  • Airway. Swelling of tongue or throat. Difficulty swallowing. Hoarse voice or noisy breathing. Persistent cough.
  • Air (breathing). Wheeze. Rapid or laboured breathing. Struggling to complete sentences.
  • Alertness. Sudden extreme sleepiness. Confusion. Floppy child.
  • Appearance. Sudden widespread rash / hives. Swelling of face or lips. Pale or blue-tinged skin.

ANY ONE of Airway, Air, or Alertness — treat as anaphylaxis. Give the epi-pen. Now.

The JLK anaphylaxis response — timed drill sequence:

  1. 0:00 — Recognise. Adult witnesses a sign. Calls loud and clear: “ANAPHYLAXIS — NEED SECOND ADULT NOW.” No whispering, no polite tone. Loud.
  2. 0:05 — Get the epi-pen. Every JLK room has the emergency medication kit at the room exit — not locked away. First adult retrieves it while calling for backup.
  3. 0:15 — Second adult arrives. Their job: dial 999. State clearly: “Anaphylaxis. Child aged [X]. Adrenaline being administered. [Site address].” Stay on the line.
  4. 0:30 — Administer the epi-pen. Correct pen for weight (typically 150mcg for under 30kg, 300mcg for 30kg+). Firm press against outer mid-thigh. Hold for the count required by the specific device (typically 3–10 seconds). Time of administration recorded.
  5. 0:45 — Position the child. If breathing is the main issue: sitting up, leaning slightly forward. If low blood pressure / floppy: lying flat, legs raised. Do NOT stand them up. Do NOT let them walk.
  6. 1:00 — Third adult manages the room. Move other children calmly to the opposite side of the room or the adjacent room. Not gawking, not standing over. A calm voice: “let's look at the storybook over here.”
  7. 1:30 — Manager alerted. Second adult (still on 999 call) sends someone to fetch the manager. Manager fetches the child's family emergency contact list.
  8. 3:00 — Manager arrives. Takes over 999 handling. First adult stays with child. Second adult calls the family. Third adult keeps the room calm.
  9. 5:00 — If second dose needed. If no improvement or symptoms return, second epi-pen may be given 5 minutes after the first. Only under 999 operator guidance.
  10. Ambulance arrival. First adult travels with the child (with parent if possible). Setting-facing paperwork stays behind for records.

The three fears that kill children in anaphylaxis — and how JLK removes them:

  1. Fear it's not really anaphylaxis. → JLK rule: if in doubt, treat as anaphylaxis. Adrenaline given unnecessarily is far less dangerous than adrenaline withheld.
  2. Fear of using the epi-pen wrong. → JLK termly drill on the trainer pen. Muscle memory removes the freeze.
  3. Fear of “overreacting” on the 999 call. → Anaphylaxis is a Category 1 call. It's exactly what 999 is for. Never apologise or downplay on the line.
Module 2

Choking — the age-specific response

~8 min

Choking response depends on the child's age and whether they can still cough. Every JLK first-aider is trained on this — but every practitioner should be able to recognise the difference between a mild airway obstruction (coughing, can breathe) and a severe one (can't cough, can't breathe, silent).

MILD obstruction: child is coughing effectively, can still breathe or make sound.
Response: encourage coughing. Stay close. Do NOT do back blows — coughing is more effective. Watch for deterioration. Only intervene if it becomes severe.

SEVERE obstruction: child is silent, can't cough, can't breathe, may go blue. Panicked face, hands to throat, eyes wide.
Response: immediate action needed. Sequence below.

Infants under 1 year — severe choking sequence:

  1. Call for help loud. “CHOKING — NEED HELP.”
  2. Position for back blows. Baby face-down along your forearm, head lower than body, head supported by your hand (jaw between thumb and finger, don't press throat).
  3. Up to 5 sharp back blows between shoulder blades with the heel of your other hand. Check the mouth between each.
  4. If unsuccessful — up to 5 chest thrusts. Flip baby face-up, two fingers on the breastbone one finger's-width below the nipple line, 5 firm inward-upward thrusts.
  5. Cycle back blows → chest thrusts until object clears or baby becomes unresponsive.
  6. Second adult: dial 999 the moment the shout goes up. Don't wait for the first-aider to try first.
  7. Never do abdominal thrusts on an infant. Can cause internal injury.

Children 1–8 years — severe choking sequence:

  1. Call for help loud. “CHOKING — NEED HELP.”
  2. Position for back blows. Child leaning forward, adult supporting the chest with one hand.
  3. Up to 5 sharp back blows between shoulder blades with the heel of the hand.
  4. If unsuccessful — up to 5 abdominal thrusts. Stand behind child, one fist above navel, other hand over fist, sharp upward pull.
  5. Cycle back blows → abdominal thrusts until object clears or child becomes unresponsive.
  6. Second adult: dial 999 immediately.

If the child becomes unresponsive at any point: start infant/child CPR. First-aider takes over if not already present. 999 stays on the line. Manager fetches AED (defibrillator) if the site has one.

Every choking incident where back blows or thrusts were used — even successful ones — requires medical review. Ambulance called or GP contacted same-day. Object may have caused internal injury.

Common choking hazards to know: whole grapes (always halve/quarter for under-5s), whole cherry tomatoes (halve), whole nuts (never for under-5s), popcorn, marshmallows, sausages in whole rounds (slice lengthways), hard sweets, chunks of raw carrot or apple.

Never at JLK: a child eating unsupervised. A child running while eating. A child eating while lying down. Adults distracted at snack.

Module 3

Termly drills — how JLK practises

~5 min

Reading a response sequence and doing it under pressure are different things. JLK runs three drills per term across the group:

Termly drill 1: Anaphylaxis response.

  • Manager announces the drill at handover. Not a surprise (that adds real-world stress). But not scheduled to the minute either.
  • Uses trainer epi-pen (no needle). Doll or trained staff volunteer as the “child”.
  • 999 is NOT actually called — the second adult runs the call script aloud so timing is real.
  • Manager times the drill: recognise-to-adrenaline should be under 60 seconds, adrenaline-to-999-connect under 30 seconds beyond that.

Termly drill 2: Choking response.

  • Uses a choking manikin (infant + child). Every staff member practises back blows and thrusts on the manikin.
  • Room-scenario version: run through severe choking during snack time with adult roles as they would be.

Termly drill 3: Fire evacuation. Covered in the Fire Safety course.

Debrief after every drill — the JLK 4 questions:

  1. What went well? Specific and named.
  2. What was clumsy? Where did we hesitate, mispronounce, get the sequence wrong?
  3. What would we change for real? Room layout, kit location, adult roles.
  4. What are we doing before next term? Concrete action per person.

Logged: drill date, staff present, timing, debrief notes, actions. Ofsted reviews these on inspection. Sign-off by manager.

Post-incident (real one, not drill):

  1. Ambulance called — incident continues in child's medical care.
  2. Family notified — by manager, not by first adult on scene.
  3. Ofsted notified — any serious accident, injury or death is a statutory notification within 14 days.
  4. Incident form completed within the shift, factually, no speculation.
  5. Staff debrief — same day or next, warm, not blame-focused. What happened, what went well, what we'd change.
  6. Wellbeing check on staff who were involved. Emergency response is traumatic. Manager checks in individually.
  7. Review of prevention: how did the allergen / choking hazard get past prevention? What changes now?
Scenario

The lunchtime shout

~3 min

It's 12:15. The pre-school room is having lunch. Amira, an apprentice, is at the far table. Suddenly Priya, another practitioner near the door, calls out sharply: “Kai's face is really swollen — he can't talk!”

Kai is 3, sitting at the middle table. He's supposed to be nut-free. Lunch today is pasta with a new pesto sauce.

Walk through what happens in the next 60 seconds — and who does what.

Reveal JLK response

0:00. Priya (nearest adult) sees Kai's face swelling and hoarse breathing. Recognises airway signs. Calls LOUD: “ANAPHYLAXIS — NEED SECOND ADULT NOW.” No whispering.

0:05. Priya goes to the room-exit medication kit for Kai's named epi-pen. Amira (second nearest) is at Kai's side.

0:10. Third adult (room leader) arrives from the corridor, having heard the shout. She dials 999 immediately: “Anaphylaxis. Child aged 3. Adrenaline about to be administered. [Site address].” Stays on the line.

0:15. Amira has moved the remaining children calmly to the other side of the room with the book corner. Voice stays calm: “let's look at the storybook over here.”

0:20. Priya administers the epi-pen: 150mcg into Kai's outer mid-thigh, firm press, hold for the count on the device. Records time.

0:30. Priya positions Kai lying flat with legs raised (he's floppy). Does NOT stand him up. Stays with him.

0:45. Room leader (still on 999) shouts through the door for someone to fetch the manager. Amira runs to the office.

1:30. Manager arrives. Takes over 999 handling. Calls Kai's mum on the way. Room leader calls the kitchen to freeze the pesto sauce and check ingredients for later investigation.

Ambulance ETA ~8 mins. Priya stays with Kai. Second dose ready if no improvement or symptoms return at 5 mins.

Ambulance arrives. Priya travels with Kai. Manager phones the mum to meet at hospital. Room leader stays with the room.

Same shift: incident form completed. Kitchen sauce label + supplier info kept. Ofsted notified within 14 days.

Next day: team debrief. Wellbeing check with Priya and Amira. Manager reviews how a pesto sauce with pine nuts got into a nut-free room — supplier check, sauce policy tightened.

Knowledge check

End-of-course quiz · 5 questions

Pass 80%

You need 4 out of 5 to pass.

  1. You witness a child with sudden facial swelling and a hoarse voice. You're 60% sure it's anaphylaxis. Correct action:

  2. The AAAA anaphylaxis signs are:

  3. For a choking infant (under 1) severe airway obstruction, the sequence is:

  4. After a successful choking rescue where back blows or thrusts were used:

  5. The JLK termly drill schedule includes:

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