Background: Schools are responsible for handling life-threatening events due to a variety of conditions, including anaphylaxis. California is one of a few states that permits school districts to stock emergency epinephrine auto-injectors and to train unlicensed assistive personnel to administer epinephrine for a life-threatening event. We surveyed school nurses in California to explore their experience with life-threatening anaphylaxis, implementation of allowable stock epinephrine auto-injector programs, and the barriers to program implementation. Methods: An exploratory, cross-sectional, descriptive design was used for this study. Data was obtained from a convenience sample of 171 credentialed California school nurses via an online survey service. Descriptive statistics and Pearson's chi-square were used to analyze the data. Results: Thirty percent of school nurses reported using 1 student's prescribed medication to rescue another student in distress. Despite the frequency of using another student's rescue medication and California's permissive policy, only 13% of nurses reported having stock epinephrine programs. Barriers to stock epinephrine programs included: (a) limited availability of school nursing services, (b) lack of policies or guidelines, (c) inadequate funding for training and medication, and (d) lack of education. Limited awareness of susceptibility and the immediate life-threatening nature of anaphylaxis were also contributing factors. Conclusions: Legislative initiatives are sufficient to develop safe, effective policies and protocols to manage life-threatening allergic reaction in schools. The findings indicate that more education is needed for school personnel and research is needed to determine an effective mechanism to remove barriers for emergency care during school hours. (Contains 1 table.)