Use of Epinephrine Nasal Spray.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 2
HOUSE BILL 397
Committee Substitute Favorable 4/1/25

Short Title: Use of Epinephrine Nasal Spray. (Public)
Sponsors:
Referred to:
March 17, 2025
*H397-v-2*
A BILL TO BE ENTITLED 1
AN ACT TO ALLOW THE USE OF EPINEPHRINE N ASAL SPRAY IN ADDITI ON TO 2
AUTO-INJECTORS. 3
The General Assembly of North Carolina enacts: 4
SECTION 1.(a) G.S. 115C-375.2(a) reads as rewritten: 5
"(a) Local boards of education shall adopt a policy authorizing a student with asthma or a 6
student subject to anaphylactic reactions, or both, to possess and self -administer asthma 7
medication on school property during the school day, at school-sponsored activities, or while in 8
transit to or from school or school-sponsored events. As used in this section, "asthma medication" 9
means a medicine prescribed for the treatment of asthma or anaphylactic reactions and includes 10
a prescribed asthma inhaler or epinephrine auto-injector. delivery system . The policy shall 11
include a requirement that the student's parent or guardian provide to the school: 12
…." 13
SECTION 1.(b) G.S. 115C-375.2A reads as rewritten: 14
"§ 115C-375.2A. School supply of epinephrine auto-injectors.delivery systems. 15
(a) A local board of education shall provide for a supply of emergency epinephrine 16
auto-injectors delivery systems on school property for use by trained school personnel to provide 17
emergency medical aid to persons suffering from an anaphylactic reaction during the school day 18
and at school-sponsored events on school property. Each school shall store in a secure but 19
unlocked and easily accessible location a minimum of two epinephrine auto-injectors. delivery 20
systems. For purposes of this section, "school property" does not include tran sportation to or 21
from school. 22
(b) For the purposes of this section and G.S. 115C-375.2, "epinephrine auto-injector" 23
delivery system" means a disposable drug delivery system with a spring -activated, concealed 24
needle that is designed for emergency administration of epinephrine to provide rapid, convenient 25
first aid for persons suffering a potentially fatal reaction to anaphylaxis.anaphylaxis, including 26
nasal sprays and injectors with a spring-activated, concealed needle. 27
(c) The principal shall designate one or more school personnel, as part of the medical 28
care program under G.S. 115C-375.1, to receive initial training and annual retraining from a 29
school nurse or qualified representative of the local health department regarding the storage and 30
emergency use of an epinephrine auto-injector. delivery system s. Notwithstanding any other 31
provision of law to the contrary, the school nurse or other designated school personnel who has 32
received training under this subsection shall obtain a non -patient specific prescript ion for an 33
epinephrine auto-injectors delivery system from a physician, physician assistant, or nurse 34
practitioner of the local health department serving the area in which the local school 35
administrative unit is located. 36
General Assembly Of North Carolina Session 2025
Page 2 House Bill 397-Second Edition
(d) The principal shall collaborate with appropriate school personnel to develop an 1
emergency action plan for the use of epinephrine auto-injectors delivery system s in an 2
emergency. The plan shall include at least the following components: 3
(1) Standards and procedures for the storage and emergency use of epinephrine 4
auto-injectors delivery systems by trained school personnel. 5
(2) Training of school personnel in recognizing symptoms of anaphylaxis. 6
(3) Emergency follow-up procedures, including calling emergency services and 7
contacting a student's parent and parent, guardian, and physician. 8
(4) Instruction and certification in cardiopulmonary resuscitation. 9
(e) A supply of emergency epinephrine auto-injectors delivery system s provided in 10
accordance with this section shall not be used as the sole medication supply for students known 11
to have a medical condition requiring the availability or use of an epinephrine auto-injector. 12
delivery system . Those students may be authorized to possess and self -administer their 13
medication on school property under G.S. 115C-375.2. 14
…." 15
SECTION 1.(c) G.S. 115C-218.75(a) reads as rewritten: 16
"§ 115C-218.75. General operating requirements. 17
(a) Health and Safety Standards. – A charter school shall meet the same health and safety 18
requirements required of a local school administrative unit. unit, including the following: 19
(1) The Department of Public Instruction shall ensure that charter schools provide 20
parents and guardians with information about meningococcal meningitis and 21
influenza and their vaccines at the beginning of every school year. This 22
information shall include the causes, symptoms, and how meningococcal 23
meningitis and influenza are spread and the places where parents and 24
guardians may o btain additional information and vaccinations for their 25
children. 26
(2) The Department of Public Instruction shall also ensure that charter schools 27
provide parents and guardians with information about cervical cancer, cervical 28
dysplasia, human papillomavirus, and the vaccines available to prevent these 29
diseases. This information shall be provided at the beginning of the school 30
year to parents of children entering grades five through 12. This information 31
shall include the causes and symptoms of these diseases, how they are 32
transmitted, how they may be prevented by vaccination, including the benefits 33
and possible side effects of vaccination, and the places where parents and 34
guardians may obtain additional information and vaccinations for their 35
children. 36
(3) The Department of Public Instruction shall also ensure that charter schools 37
provide students in grades seven through 12 with information annually on the 38
preventable risks for preterm birth in subsequent pregnancies, including 39
induced abortion, smoking, alcohol consumption, the use of illicit drugs, and 40
inadequate prenatal care. 41
(4) The Department of Public Instruction shall also ensure that charter schools 42
provide students in grades nine through 12 with information annually on the 43
manner in which a parent may l awfully abandon a newborn baby with a 44
responsible person, in accordance with Article 5A of Chapter 7B of the 45
General Statutes. 46
(5) The Department of Public Instruction shall also ensure that the guidelines for 47
individual diabetes care plans adopted by the State Board of Education under 48
G.S. 115C-12(31) are implemented in charter schools in which students with 49
diabetes are enrolled and that charter schools otherwise comply with 50
G.S. 115C-375.3. 51
General Assembly Of North Carolina Session 2025
House Bill 397-Second Edition Page 3
(6) The Department of Public Instruction shall ensure that charter schools comply 1
with G.S. 115C-375.2A. The board of directors of a charter school shall 2
provide the school with a supply of emergency epinephrine auto-injectors 3
delivery systems necessary to meet the requirements of G.S. 115C-375.2A." 4
SECTION 1.(d) G.S. 115C-238.66(7) reads as rewritten: 5
"(7) Health and safety. – The board of directors shall require that the regional 6
school meet the same health and safety standards required of a local school 7
administrative unit. 8
The Department of Public Instruction shall ensure that regional schools 9
comply with G.S. 115C-375.2A. The board of directors of a regional school 10
shall provide the school with a supply of emergency epinephrine 11
auto-injectors delivery systems necessary to carry out the provisions of 12
G.S. 115C-375.2A." 13
SECTION 1.(e) G.S. 116-239.8(b)(9) reads as rewritten: 14
"(9) Health and safety. – The chancellor shall require that the laboratory school 15
meet the same health and safety standards required of a local school 16
administrative unit. The Department of P ublic Instruction shall ensure that 17
laboratory schools comply with G.S. 115C-375.2A. The chancellor shall 18
provide the laboratory school with a supply of emergency epinephrine 19
auto-injectors delivery systems necessary to carry out the provisions of 20
G.S. 115C-375.2A." 21
SECTION 1.(f) This section is effective when it becomes law and applies beginning 22
with the 2025-2026 school year. 23
SECTION 2. G.S. 90-21.15A reads as rewritten: 24
"§ 90 -21.15A. Emergency treatment using epinephrine auto-injector; delivery system s; 25
immunity. 26
(a) Definitions. – The following definitions apply in this section: 27
(1) Administer. – The direct application of an epinephrine auto-injector delivery 28
system to the body of an individual. 29
(2) Authorized entity. – Any entity or organization, other than a school described 30
in G.S. 115C-375.2A, at which allergens capable of causing anaphylaxis may 31
be present, including, but not limited to, recreation camps, colleges, 32
universities, day care facilities, youth sports leagues, amusement parks, 33
restaurants, places of employment, and sports arenas. An authorized entity 34
shall also include any person, corporation, or other entity that owns or operates 35
any entity or organization listed. 36
(3) Epinephrine auto-injector. delivery system. – A single-use device used for the 37
automatic injection of a premeasured dose of disposable drug delivery system 38
that is designed for emergency admin istration of epinephrine into the human 39
body.to provide rapid, convenient first aid for persons suffering a potentially 40
fatal reaction to anaphylaxis, including nasal sprays and injectors with a 41
spring-activated, concealed needle. 42
(4) Health care provider. – A health care provider licensed to prescribe drugs 43
under the laws of this State. 44
(5) Provide. – To supply one or more epinephrine auto-injectors delivery systems 45
to an individual. 46
(b) Prescribing to Authorized Entities Permitted. – A health care provider may prescribe 47
epinephrine auto-injectors delivery systems in the name of an authorized entity for use in 48
accordance w ith this section, and pharmacists and health care providers may dispense 49
epinephrine auto-injectors delivery systems pursuant to a prescription issued in the name of an 50
General Assembly Of North Carolina Session 2025
Page 4 House Bill 397-Second Edition
authorized entity. A prescription issued pursuant to this section shall be valid for no more than 1
two years. 2
(c) Authorized Entities Permitted to Maintain Supply. – An authorized entity may acquire 3
and stock a supply of epinephrine auto-injectors delivery systems pursuant to a prescription 4
issued in accordance with this section. An authorized entity that acquires and stocks epinephrine 5
auto-injectors delivery systems shall make a good-faith effort to store the supply of epinephrine 6
auto-injectors delivery systems in accordance with the epinephrine auto-injector delivery system 7
manufacturer's instructions for use and any additional requirements that may be established by 8
the Department of Health and Human Services. An authorized entity that acquires and stocks a 9
supply of epinephrine auto-injectors delivery systems pursuant to a prescription issued in 10
accordance with this section shall designate employees or agents to be responsible for the storage, 11
maintenance, control, and general oversight of epinephrine auto-injectors delivery systems 12
acquired by the authorized entity. 13
(d) Use of Epinephrine Auto-Injectors Delivery Systems by Authorized Entities. – An 14
employee or agent of an authorized entity or other individual who has completed the training 15
required by subsection (e) of this section may use epinephrine auto-injectors prescribed pursuant 16
to G.S. 90-726.1 delivery systems to do any of the following: 17
(1) Provide an epinephrine auto-injector delivery system to any individual who 18
the employee, agent, or other individual believes in good faith is experiencing 19
anaphylaxis, or a person believed in good faith to be the parent, guardian, or 20
caregiver of such individual, for immediate administration, regardless of 21
whether the individual has a prescription for an epinephrine auto-injector 22
delivery system or has previously been diagnosed with an allergy. 23
(2) Administer an epinephrine auto-injector delivery system to any individual 24
who the employee, agent, or other individual believes in good faith is 25
experiencing anaphylaxis, regardless of whether the individual has a 26
prescription for an epinephrine auto-injector delivery system or has previously 27
been diagnosed with an allergy. 28
(e) Mandatory Training Program. – An authorized entity that elects to acquire and stock 29
a supply of epinephrine auto-injectors delivery systems as described in subsect ion (c) of this 30
section shall designate employees or agents to complete an anaphylaxis training program. The 31
training may be conducted online or in person and shall, at a minimum, include all of the 32
following components: 33
(1) How to recognize signs and symptoms of severe allergic reactions, including 34
anaphylaxis. 35
(2) Standards and procedures for the storage and administration of an epinephrine 36
auto-injector.delivery system. 37
(3) Emergency follow-up procedures. 38
In-person training shall cover the three components listed in this subsection and be conducted 39
by (i) a physician, physician assistant, or registered nurse licensed to practice in this State; (ii) a 40
nationally recognized organization experienced in training laypersons in emergency health 41
treatment; or (iii) an entity or individual approved by the Department of Health and Human 42
Services. 43
Online training shall cover the three components listed in this subsection and be offered (i) 44
by a nationally recognized organization experienced in training laypersons in emergency health 45
treatment; (ii) by an entity or individual approved by the Department of Health and Human 46
Services; or (iii) by means of an online training course that has been approved by another state. 47
(f) Immunity. – 48
(1) The following persons are immune from criminal liability and from suit in any 49
civil action brought by any person for injuries or related damages that result 50
from any act or omission taken pursuant to this section: 51
General Assembly Of North Carolina Session 2025
House Bill 397-Second Edition Page 5
a. Any authorized entity that voluntarily and without expec tation of 1
payment possesses and makes available epinephrine 2
auto-injectors.delivery systems. 3
b. Any employee or agent of an authorized entity, or any other individual, 4
who provides or administers an epinephrine auto-injector delivery 5
system to an individual whom the employee, agent, or other individual 6
believes in good faith is experiencing symptoms of anaphylaxis and 7
has completed the required training set forth in subsection (e) of this 8
section. 9
c. A health care provider that prescribes epinephrine auto-injectors 10
delivery systems to an authorized entity. 11
d. A pharmacist or health care provider that dispenses epinephrine 12
auto-injectors delivery systems to an authorized entity. 13
e. Any individual or entity that conducts the training mandated by 14
subsection (e) of this section. 15
(2) The immunity conferred by this section does not apply to acts or omissions 16
constituting willful or wanton conduct as defined in G.S. 1D-5(7) or 17
intentional wrongdoing. 18
(3) Nothing in this section creates or imposes any duty, obligatio n, or basis for 19
liability on any authorized entity, any employee or agent of an authorized 20
entity, or any other individual to acquire, possess, store, make available, or 21
administer an epinephrine auto-injector.delivery system. 22
(4) This section does not eliminate, limit, or reduce any other immunity or defense 23
that may be available under State law, including the protections set forth in 24
G.S. 90-21.14. 25
(g) Liability for Acts Outside of This State. – An authorized entity located in this State 26
shall not be liable under the laws of this State for any injuries or related damages resulting from 27
the provision or administration of an epinephrine auto-injector delivery system outside of this 28
State under either of the following circumstances: 29
(1) If the authorized entity would not have been liable for such injuries or related 30
damages if the epinephrine auto-injector delivery system had been provided 31
or administered within this State. 32
(2) If the authorized entity is not liable for such injuries or related damages under 33
the laws of the state in which the epinephrine auto-injector delivery system 34
was provided or administered. 35
(h) Does Not Constitute Practice of Medicine. – The administration of an epinephrine 36
auto-injector delivery system in accordance with this section is not the practice of medicine or 37
any other profession that otherwise requires licensure." 38
SECTION 3. Except as otherwise provided, this act is effective when it becomes 39
law. 40