SB 2610: Department of Education; Public Schools; Emergency Medication Administration and Assistance; Protocol; Blood Glucose Monitoring; Diabetes Testing; Seizure Rescue Medication; Inhalers; School Health Assistants; Prescriptions; Indemnification

THE SENATE	S.B. NO.	2610
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII

A BILL FOR AN ACT

 

 

Relating to emergency medication in schools.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  The legislature finds that asthma is a leading chronic condition in school-aged children, affecting approximately ten per cent of school-aged children in the United States and afflicting Native Hawaiian children at a higher‑than‑average rate in the State.  Additionally, food allergies and anaphylaxis are increasing in prevalence.  As many as one-quarter of school-aged children in the United States are impacted by allergies, while more than forty per cent of children with food allergies suffer a severe allergic reaction before turning eighteen-years-old.  Furthermore, an estimated 460,000 school-aged children in the United States have epilepsy or other seizure disorders, representing approximately 0.6 per cent of the student population.

     The legislature therefore finds that access to emergency medications for students with chronic health conditions is essential to school safety and equity in student success.  Epinephrine is the first-line, life-saving treatment for anaphylaxis and must be administered immediately upon recognition of symptoms.  Delays in administration can result in severe complications or death.  Similarly, timely administration of asthma rescue medications can prevent respiratory distress from escalating to a life-threatening emergency, and seizure rescue medications administered within appropriate timeframes can prevent status epilepticus, a prolonged seizure state that can cause permanent neurological damage or death.  As these medical emergencies may occur in the classroom, cafeteria, or playground, rapid response school personnel properly trained and authorized to administer emergency medications serve a critical role in protecting student health and safety.

     Accordingly, the purpose of this Act is to:

     (1)  Establish provisions for emergency medication administration by trained school personnel separately from regulations for student self-administration of medications;

     (2)  Update the terminology for anaphylaxis emergency rescue medication to encompass epinephrine in all forms approved by the United States Food and Drug Administration, including but not limited to auto‑injectors, pre-filled syringes, and nasal sprays, ensuring that new technologies and easy-to-use devices are included by applicable state laws;

     (3)  Expand the scope of covered emergency medications to include asthma rescue inhalers and seizure rescue medications, recognizing that these interventions are medically necessary, life-saving, and appropriate for administration by trained school personnel in emergency situations; and

     (4)  Extend liability protections for public schools, school personnel, and medical providers acting in good faith to save lives, while maintaining essential safeguards including requirements for parent or guardian authorization, prescriptions from licensed medical practitioners, and training by qualified health care providers.

     SECTION 2.  Chapter 302A, Hawaii Revised Statutes, is amended by adding a new section to subpart F of part III to be appropriately designated and to read as follows:

     "§302A-    Emergency administration of medication by volunteer; assistance with diabetes testing, blood glucose monitoring, and inhalers; permitted.  (a)  Employees and agents of a public school, including school health assistants, who volunteer, may administer epinephrine, glucagon, seizure rescue medication, and inhalers to a student in emergency situations; provided that the administration of medication meets the requirements of this section.

     (b)  Employees and agents of a public school who volunteer may administer:

     (1)  Insulin or assist a student in administering insulin via the insulin delivery system that the student uses; and

     (2)  Blood glucose monitoring or assist a student with blood glucose monitoring;

provided that the administration of insulin or blood glucose monitoring meets the requirements of this section.

     (c)  In the case of the administration of emergency medication prescribed to a specific student, including epinephrine, glucagon, seizure rescue medication, and inhalers:

     (1)  The student's parent or guardian shall provide the public school with:

          (A)  A written request and authorization from the parent or guardian for the administration of the medication;

          (B)  Written medical orders for the medication from the student's physician, advanced practice registered nurse, physician assistant, or other practitioner with prescriptive authority; and

          (C)  The supply of medication prescribed to the student and any necessary devices or inhalers as required for the requested emergency medication administration;

     (2)  The permission shall be effective for the school year for which the permission is granted and shall be renewed for each subsequent school year upon the fulfillment of the requirements pursuant to this section;

     (3)  The public school may store the student's medication and related supplies in a secure but accessible location; and

     (4)  Any employee or agent who volunteers to administer the medication shall receive instruction in the proper administration of epinephrine, glucagon, seizure rescue medication, or inhalers by a licensed physician, physician assistant, registered nurse, advanced practice registered nurse, or other qualified licensed health care professional.

     (d)  In the case of the administration of, or assistance in the administration of, insulin or blood glucose monitoring to a student:

     (1)  The student's parent or guardian shall provide the public school with:

          (A)  A written request and authorization from the parent or guardian for the administration of insulin or blood glucose monitoring;

          (B)  Written medical orders for the administration of insulin or blood glucose monitoring from the student's physician, advanced practice registered nurse, physician assistant, or other practitioner with prescriptive authority; and

          (C)  The supply of insulin prescribed to the student and any supplies necessary to administer insulin or blood glucose monitoring, as required for the requested administration or assistance;

     (2)  The permission shall be effective for the school year for which the permission is granted and shall be renewed for each subsequent school year upon the fulfillment of the requirements pursuant to this section;

     (3)  The public school may store the student's medication and related supplies in a secure but accessible location; and

     (4)  Any employee or agent who volunteers to administer insulin or blood glucose monitoring shall receive instruction in the proper administration of insulin or blood glucose monitoring by a licensed physician, physician assistant, registered nurse, advanced practice registered nurse, or certified diabetes educator.

     (e)  The department shall permit its employees and agents to volunteer to administer:

     (1)  Insulin, or assist a student in administering insulin, via the insulin delivery system that the student uses;

     (2)  Glucagon in an emergency situation to students with diabetes;

     (3)  Epinephrine in an emergency situation to students with anaphylaxis;

     (4)  Blood glucose monitoring, or assist a student with blood glucose monitoring;

     (5)  Seizure rescue medication in an emergency situation to students with epilepsy or other seizure disorders; or

     (6)  An inhaler in an emergency situation to students with asthma or other chronic lung diseases.

     (f)  The department or public school shall inform the student's parent or guardian in writing that the department or public school and its employees and agents shall not incur any liability as a result of any injury arising from compliance with this section.

     (g)  The student's parent or guardian shall sign a statement acknowledging that:

     (1)  The department or public school and its employees and agents shall not incur any liability as a result of any injury arising from compliance with this section; and

     (2)  The parent or guardian shall indemnify and hold harmless the department or public school and its employees and agents against any claims arising out of compliance with this section.

     (h)  Any public school or person, including the health professionals providing training to persons who volunteer subject to this section, the prescribing physician, physician assistant, advanced practice registered nurse, or other practitioner with prescriptive authority, and the pharmacist or pharmacy dispensing the prescription, who acts in accordance with the requirements of this section, shall be immune from any civil or criminal liability arising from these acts, except where the person's conduct would constitute gross negligence, wilful and wanton misconduct, or intentional misconduct.

     (i)  As used in this section:

     "Bronchodilators" includes any medication used for the quick relief of asthma symptoms that dilates the airways and is recommended by the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program guidelines for the treatment of asthma.  "Bronchodilators" may include an orally inhaled medication that contains a premeasured single dose of albuterol or albuterol sulfate delivered by a nebulizer (compressor device) or by a metered dose inhaler used to treat respiratory distress, including wheezing, shortness of breath, and difficulty breathing, or another dosage of a bronchodilator recommended in the guidelines for the treatment of asthma.

     "Epinephrine" includes any device available by prescription that is designed to deliver a premeasured dose of epinephrine, including auto-injection devices, nasal spray devices, or oral formulation.

     "Glucagon" includes any device available by prescription that is designed to deliver a premeasured dose of glucagon or dasiglucagon, including injection kits, auto-injection devices, or nasal spray devices.

     "Inhaler" includes:

     (1)  Metered-dose, breath-actuated, and dry powder inhalers;

     (2)  Spacers and holding chambers; and

     (3)  Bronchodilators.

     "Seizure rescue medication" includes any medication or device prescribed for use in an emergency situation to stop a seizure or prevent a seizure from becoming more severe, which is delivered as a premeasured dose."

     SECTION 3.  Section 302A-1164, Hawaii Revised Statutes, is amended to read as follows:

     "§302A-1164  Self-administration of medication by student [and emergency administration]; self-testing and self-management of diabetes by student; [assistance with diabetes testing;] blood glucose monitoring by student; [assistance with blood glucose monitoring;] permitted.  (a)  The department shall permit[:

     (1)  The] the self-administration of[:

          (A)  Medication] medication by a student for asthma, anaphylaxis, diabetes, or other potentially life‑threatening illnesses[;] and

         [(B)  Blood] blood glucose monitoring by a student[; and

     (2)  Department employees and agents to volunteer to administer:

          (A)  Insulin or assist a student in administering insulin via the insulin delivery system that the student uses;

          (B)  Glucagon in an emergency situation to students with diabetes;

          (C)  Auto-injectable epinephrine in an emergency situation to students with anaphylaxis; or

          (D)  Blood glucose monitoring or assist a student with blood glucose monitoring].

     (b)  The student's parent or guardian shall provide the department with:

     (1)  Written authorization from the parent or guardian for the self-administration of medication [or the emergency administration of glucagon or auto-injectable epinephrine;] by the student;

     (2)  In the case of self‑administration of medication[:

          (A)  Written] or blood glucose monitoring by a student with diabetes, written certification from the student's physician, advanced practice registered nurse, [or] physician assistant, or other qualified health care provider stating that the student with diabetes may perform the student's own blood glucose checks, administer insulin through the student's insulin delivery system, and otherwise attend to the care and management of the student's diabetes during any school‑related activity, and that the student may possess on the student's person all necessary supplies and equipment to perform the diabetes monitoring and treatment activities, if applicable; and

          [(B)] (3)  Written certification from the student's physician, advanced practice registered nurse, [or] physician assistant, or other qualified health care provider stating that the student:

               [(i)](A)  Has asthma, anaphylaxis, diabetes, or another potentially life-threatening illness; and

               [(ii)](B)  Is capable of, and has been instructed in, the proper method of self-administration of medication or blood glucose monitoring[; and

     (3)  In the case of administration of insulin or emergency administration of glucagon to a student with diabetes, blood glucose monitoring of a student, or auto-injectable epinephrine to a student with anaphylaxis, written certification from the student's physician, advanced practice registered nurse, or physician assistant stating that the student has medical orders that insulin, glucagon, blood glucose monitoring, or auto-injectable epinephrine may be administered by a volunteer].

     (c)  The department shall inform the student's parent or guardian in writing that the department and its employees or agents shall not incur any liability as a result of any injury arising from compliance with this section.

     (d)  The student's parent or guardian shall sign a statement acknowledging that:

     (1)  The department and its employees or agents shall not incur any liability as a result of any injury arising from compliance with this section; and

     (2)  The parent or guardian shall indemnify and hold harmless the department and its employees or agents against any claims arising out of compliance with this section.

     (e)  The permission shall be effective for the school year for which it is granted and shall be renewed for each subsequent school year upon the fulfillment of the requirements in this section.

     (f)  Notwithstanding any other law to the contrary, a student who is permitted to self-administer medication under this section shall be permitted to carry [an inhaler or auto‑injectable epinephrine, or both,] the medication, and any devices necessary to perform the permitted self-administration of medication, at all times if the student does not endanger the student's person or other persons through the misuse of the [inhaler;] permitted medication or devices; provided that the department[,] or its employees or agents may confiscate a student's medication[, inhaler, or auto-injectable epinephrine] or devices if the student's self‑administration of the medication exceeds the student's prescribed dosage, or if the student endangers others with the student's medication[, inhaler, or auto-injectable epinephrine.] or device.

     [For the purposes of this section, the term "inhaler" includes:

     (1)  Metered-dose, breath-actuated, and dry powder inhalers; and

     (2)  Spacers and holding chambers.

     (g)  Any employee or agent who volunteers to administer insulin or glucagon in an emergency situation to a student with diabetes or auto-injectable epinephrine to a student with anaphylaxis or who volunteers to administer or assist a student with blood glucose monitoring shall receive instruction in the proper administration of insulin, glucagon, auto-injectable epinephrine, or blood glucose monitoring by a qualified health care professional.  A "qualified health care professional" means a licensed physician, physician assistant, advanced practice registered nurse or registered nurse, or certified diabetes educator.  The student's parent or guardian shall supply the school with the glucagon kit required to administer the glucagon, any supplies necessary to administer insulin, blood glucose monitoring, or with auto-injectable epinephrine supplies to administer epinephrine.  The school shall store the glucagon kit, insulin supplies, blood glucose monitoring supplies, or auto-injectable epinephrine supplies in a secure but accessible location.

     (h)] (g)  Any person[, except for a qualified health care professional providing the training required in subsection (g),] who acts in accordance with the requirements of this section shall be immune from any civil or criminal liability arising from these acts, except where the person's conduct would constitute gross negligence, wilful and wanton misconduct, or intentional misconduct."

     SECTION 4.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 5.  This Act shall take effect upon its approval.

 

INTRODUCED BY:	_____________________________

 

 

 

Report Title:

Department of Education; Public Schools; Emergency Medication Administration and Assistance; Protocol; Blood Glucose Monitoring; Diabetes Testing; Seizure Rescue Medication; Inhalers; School Health Assistants; Prescriptions; Indemnification

 

Description:

Establishes provisions regarding the volunteered administration of certain medications by authorized persons at public schools, including requirements for parent authorization, administration instruction, and liability protections.  Expands permitted emergency treatments to include epinephrine, inhalers, seizure rescue medication, glucagon, insulin, and blood-glucose monitoring. 

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.