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Overall, meets 16 of 23 core policy standards and five of 13 extra credit indicators. Below are the standards that Tennessee meets.


The 2019 State Honor Roll of Asthma and Allergy Policies for Schools ranks the states with the best public policies for people with asthma, food allergies, anaphylaxis and related allergic diseases in U.S. elementary, middle and high schools.
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Medication and Treatment Policies:

Meets 11 of 12 core policy standards in this category:

1. State requires physician’s written instructions to be on file to dispense prescription medication to students. checkmark
2. State policy ensures students’ right to self-carry and self-administer prescribed asthma medication. checkmark
3. State policy ensures students’ right to self-carry and self-administer prescribed anaphylaxis medication. checkmark
4. State policies or procedures shield school personnel from liability for unintended injuries. checkmark
5. State requires local school districts to create asthma and anaphylaxis medication policy and provides resources, guidelines and parameters. checkmark
6. State policy mandates schools to identify and maintain records for students with chronic conditions including asthma and anaphylaxis. checkmark
7. State requires a procedure updating health records periodically. checkmark
8. State requires that schools maintain asthma/allergy incident reports for reactions, attacks and medications administered. checkmark
9. State requires a student health history form that includes asthma/allergy information to be maintained for each student. checkmark
10. State requires schools to have emergency protocols for asthma. checkmark
11. State requires schools to have emergency protocols for anaphylaxis. checkmark
12. Nurse-to-student ratio is 1:750 or better. x

Meets two of six extra credit indicators in this category:

A. State requires anaphylaxis medicine – epinephrine – stocking and authority to administer in schools. x
B. State allows and/or requires asthma quick-relief medicine – albuterol – stocking and authority to administer in schools. x
C. State has or is preparing an explicit asthma program with policies, procedures and resources for schools to manage students with asthma. checkmark
D. State has or is preparing an explicit anaphylaxis program with policies, procedures and resources for schools to manage students with allergies. checkmark
E. State has adopted policy that each school will have one full-time nurse. x
F. State has adopted policy that school districts provide case management for students with chronic health conditions such as asthma. x

Awareness Policies:

Meets both core policy standards in this category:

13. State recognizes problem of asthma in schools and has begun to address it. checkmark
14. State recognizes problem of allergy in schools and has begun to address it. checkmark

Meets one of two extra credit indicators in this category:

G. State sponsors or provides funding for staff training in asthma awareness covering school asthma program/policy and procedures. x
H. State sponsors or provides funding for staff training in food allergies. checkmark

School Environment Policies:

Meets three of nine core policy standards in this category:

15. State has mandated that all schools must have indoor air quality (IAQ) management policies. x
16. State has adopted a policy requiring that districts and schools conduct periodic inspections of heating, ventilation and air conditioning (HVAC) system & other items important in asthma/allergy management. x
17. State has IAQ policies that include specific components important in asthma/allergy management (HVAC, HEPA, carpeting, pesticide use). x
18. State recommends/requires that districts or schools use Integrated Pest Management (IPM) techniques OR ban use of pesticides inside school. checkmark
19. State requires schools to notify parents of upcoming pesticide applications. x
20. State limits school bus idling time and establishes proximity restrictions. x
21. All smoking is prohibited in school buildings and on school grounds. checkmark
22. All smoking is prohibited on school buses and at school-related functions. x
23. Tobacco-use prevention is required in health education curriculum. checkmark

Meets two of five extra credit indicators in this category:

I. State makes funding or resources available for technical IAQ assistance to schools. checkmark
J. State recommends standards and programs to promote environmentally preferable materials for school construction, maintenance and cleaning. x
K. State requires school facility design standards that include low emission construction materials, pollutant source controls, durable and easy to clean surfaces and floors, moisture/mold controls. x
L. State has implemented or actively promotes diesel school bus engine retrofitting program. x
M. State requires districts or schools to provide tobacco-use-cessation services to students. checkmark

Policy Gaps:

Nurse-to-Student Ratio; Indoor and Outdoor Air Quality


Epinephrine in Schools: A 2013 law allows local school boards to adopt rules for maintaining a supply of epinephrine auto-injectors at schools, with at least two devices unlocked in secure locations; authorizes a physician to prescribe epinephrine auto-injectors to schools; authorizes school nurses or other trained school personnel to administer the devices for any student believed to be having a life-threatening anaphylactic reaction; and limits liability in case a student is injured.

Asthma Awareness: The Tennessee Legislature directed the state's health department to develop an asthma plan for the state. Partly because of this law, the Tennessee Department of Health issued STAT Plan to Reduce Asthma in 2009. The Plan's objectives include:

  • Increase the opportunities for training and the number of students, staff, faculty, administration, coaches and school health professionals trained in asthma education and asthma management
  • Promote the 100% tobacco free schools policy and enforcement which follows the Centers for Disease Control and Prevention guidelines that all school buildings and school grounds are 100% tobacco free at all times
  • Continuously promote the federally recognized standard of one nurse per 750 students in grade K through 12 to improve school attendance and assist students with asthma in episode management
  • In partnership with the Department of Education Coordinated School Health Program, develop and implement an emergency action plan for schools in the event of an acute asthma exacerbation
  • All children with an asthma diagnosis will have an individualized asthma plan from the patient’s medical home on file in the school, child care facility or other out-of-home group care setting and used in the home for asthma management
  • At least 70 percent of the school systems will use the Indoor Air Quality- Tools for Schools program developed by EPA to improve indoor air quality

Air Quality: Some local efforts have been undertaken in Tennessee to retrofit diesel engine school buses with cleaner, more efficient equipment. For example, the Chattanooga-Hamilton County Air Pollution Control Bureau (CHCAPCB) in partnership with a local school bus contractor won a grant from the U.S. EPA to retrofit approximately 83 buses with diesel oxidation catalysts. Additionally, the CHCAPCB is working to develop other strategies to reduce emissions from school buses, such as anti-idling policies and cleaner fuels.


State Honor Roll report 2019
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