Preparing an office practice for pediatric emergencies
- Maya A Jones, MD, MPH
Maya A Jones, MD, MPH
- Assistant Clinical Professor of Emergency Medicine
- Seattle Children's Hospital
- Section Editors
- Richard D Zane, MD
Richard D Zane, MD
- Section Editor — Emergency Medical Services/Disaster Medicine
- Professor and Chair of Emergency Medicine
- University of Colorado School of Medicine
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss how to prepare an office practice for pediatric emergencies.
Pediatric providers deliver a variety of services to children and their families, including, on occasion, triage and treatment of childhood emergencies. Infants and children with potentially life-threatening illnesses and injuries are sometimes taken to primary care offices by parents or caregivers who are seeking help from healthcare professionals they know and trust. When this occurs, the office and staff need to be prepared to provide initial stabilization and when necessary, life-saving care . The consequences of being unprepared are serious; initial treatment provided in the office may mean the difference between life and death. Appropriate stabilization of pediatric emergencies and timely transfer to an appropriate facility for definitive care are important responsibilities of every medical provider who cares for children.
Emergency conditions in infants and children coming to medical office settings are relatively frequent, but the actual number varies significantly depending upon practice characteristics . As an example, more than 2400 life-threatening pediatric emergencies per year were reported in a telephone survey of 51 pediatric offices in one suburban county of Connecticut (an average of 24 emergencies per office per year) . In a survey of pediatricians and family medicine providers who practice in an urban setting, almost two-thirds of those who responded reported that they cared for at least one child who required hospitalization or urgent care each week, and 80 percent had cared for at least one severely ill patient in the past three months  In a separate survey of pediatricians, 73 percent reported one or more emergencies per week .
Several studies have been conducted to identify the types of pediatric emergencies that are most often encountered in the office setting [3-6]. Respiratory emergencies, seizures, infections (especially in young infants), and shock/dehydration are reported most often, and serious traumatic injuries have also been noted [4-6]. Based upon estimates from surveys of general pediatricians, the most commonly encountered emergency conditions in an office from most to least frequent include [6,7]:
●Respiratory emergencies including asthmaTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American Academy of Pediatrics Committee on Pediatric Emergency Medicine, Frush K. Preparation for emergencies in the offices of pediatricians and pediatric primary care providers. Pediatrics 2007; 120:200.
- Klig JE, O'Malley PJ. Pediatric office emergencies. Curr Opin Pediatr 2007; 19:591.
- Flores G, Weinstock DJ. The preparedness of pediatricians for emergencies in the office. What is broken, should we care, and how can we fix it? Arch Pediatr Adolesc Med 1996; 150:249.
- Fuchs S, Jaffe DM, Christoffel KK. Pediatric emergencies in office practices: prevalence and office preparedness. Pediatrics 1989; 83:931.
- American Academy of Pediatrics. Periodic survey 27. American Academy of Pediatrics, Elk Grove Village, IL. 1995. http://www.aap.org/research/periodicsurvey/ps27exm.htm (Accessed on July 19, 2010).
- Schweich PJ, DeAngelis C, Duggan AK. Preparedness of practicing pediatricians to manage emergencies. Pediatrics 1991; 88:223.
- Pendleton AL, Stevenson MD. Outpatient Emergency Preparedness: A Survey of Pediatricians. Pediatr Emerg Care 2015; 31:493.
- Massachusetts EMSC Task Force. Office Preparedness for Pediatric Emergencies, 2nd, O'Malley, P (Eds), Massachusetts Department of Public Health, 2002.
- Bordley, WC, Frush, et al. Pediatrics. In: Management of Office Emergencies, Barton, CW (Eds), McGraw-Hill, New York 1999. p.323.
- Committee on Pediatric Emergency Medicine. Your office as an emergency care site. In: Emergency Medical Services for Children, Singer, J, Ludwig, S (Eds), American Academy of Pediatrics, Elk Grove Village 1992. p.31.
- Hobgood C, Sherwood G, Frush K, et al. Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration. Qual Saf Health Care 2010; 19:e25.
- Finan E, Bismilla Z, Whyte HE, et al. High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training. J Perinatol 2012; 32:287.
- Bordley WC, Travers D, Scanlon P, et al. Office preparedness for pediatric emergencies: a randomized, controlled trial of an office-based training program. Pediatrics 2003; 112:291.
- Toback SL, Fiedor M, Kilpela B, Reis EC. Impact of a pediatric primary care office-based mock code program on physician and staff confidence to perform life-saving skills. Pediatr Emerg Care 2006; 22:415.
- Schmitt, BD. Pediatric Telephone Protocols: Office Version, 12th, American Academy of Pediatrics, Elk Grove Village 2009.
- American Academy of Pediatrics. A report from the provisional section on pediatric telephone care and the Committee on Practice and Ambulatory Medicine. November, 1998. http://www.aap.org/sections/telecare/11_98.pdf (Accessed on July 19, 2010).
- Shah AN, Frush K, Luo X, Wears RL. Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events. Arch Pediatr Adolesc Med 2003; 157:229.
- Agarwal S, Swanson S, Murphy A, et al. Comparing the utility of a standard pediatric resuscitation cart with a pediatric resuscitation cart based on the Broselow tape: a randomized, controlled, crossover trial involving simulated resuscitation scenarios. Pediatrics 2005; 116:e326.
- Lerner C, Gaca AM, Frush DP, et al. Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool. Pediatr Radiol 2009; 39:703.
- Hodge D 3rd. Pediatric emergency office equipment. Pediatr Emerg Care 1988; 4:212.
- Wheeler DS, Kiefer ML, Poss WB. Pediatric emergency preparedness in the office. Am Fam Physician 2000; 61:3333.
- Sapien R, Hodge D 3rd. Equipping and preparing the office for emergencies. Pediatr Ann 1990; 19:659.
- King B. "Interfacility" transport from the home or office. Pediatr Emerg Care 1997; 13:164.
- Schuman, AJ. Be prepared: Equipping your office for medical emergencies. Contemp Pediatr 1996; 13:27.
- Baker MD, Ludwig S. Pediatric emergency transport and the private practitioner. Pediatrics 1991; 88:691.
- www.nhtsa.dot.gov/people/injury/ems/Interfacility/index.htm/ (Accessed on January 24, 2010).
- Frush, K. Study packet for the correct use of the Broselow pediatric emergency tape. Enhancing Pediatric Safety. www.ncdhhs.gov/dhsr/EMS/pdf/kids/DEPS_Broselow_Study.pdf/ (Accessed on January 24, 2010).