Coronavirus disease 2019 in the pediatric emergency department: unique considerations in preparation and response

Abstract

Purpose of review Pediatric Emergency Departments (PEDs) have experienced unique considerations throughout the coronavirus disease 2019 (COVID-19) pandemic. We review the adaptations and challenges surrounding the preparation and response for pediatric emergency patients, with a specific focus on operational modifications, evolving personal protected equipment (PPE) needs, protected resuscitation responses, clinical characteristics in children, and the unintended effects on children and youth. Recent findings COVID-19 has thus far proven to have a milder course in children, with manifestations ranging from asymptomatic carriage or typical viral symptoms, to novel clinical entities such as ‘COVID toes’ and multisystem inflammatory syndrome in children (MIS-C), the latter associated with potentially significant morbidity. It has had an important effect on primary prevention, injury rates, reduced presentations for emergency care, and increased mental health, abuse and neglect rates in children and youth. PEDs have prepared successfully. The most significant adjustments have occurred with screening, testing, and consistent and effective use of PPE, along with protected responses to resuscitation, adaptations to maintain family-centered care, and technological advances in communication and virtual care. Simulation has been key to the successful implementation of many of these strategies. Summary COVID-19 has pushed PEDs to rapidly adapt to evolving clinical and societal needs, with both resultant challenges and positive advances. Further experience and research will guide how in the face of a global pandemic we can further optimize the clinical and operational care of children and youth, ensure robust educational training programs, and maintain provider safety and wellness.

The responsibility to care: lessons learned from emergency department workers’ perspectives during the first wave of the COVID-19 pandemic in Canada

“…Resources exist to assist ED workers in fostering resilience, but these alone are insufficient to sustain them through protracted crises [ 30 ]. COVID-19 pandemic policies and education programs have focused on PPE use and patient care guidelines [ 31 – 33 ]. Our study suggests that ED workers may also benefit from training on navigating other underrepresented aspects of working during a pandemic, like its moral complexity and emotional load.…”

Challenges Created by the COVID-19 Pandemic: Pediatric Emergency Medicine and Disaster Management Perspectives

“…Tablets with video conferencing capability, baby monitors and 2-way radios, secure network cell phones, and white boards are all ways to enhance communication during the care of these complex patients during a pandemic. [25][26][27] Disease outbreaks and other public health emergencies highlight the necessity of strong hospital and departmental leadership, as well as having a flexible plan for addressing the emergency. The top-down leadership approach during a pandemic or other disaster is often not well-received by ED physicians who wish to participate.…”

“…adults, 9,26,[29][30][31][32] keeping plans up-to-date, and knowing the supply chain. While it is challenging to predict the need, having those ACSs available and knowing how to re-purpose them is invaluable to an institution's pandemic preparation.…”

“…The wide array of symptoms observed in pediatric patients, including not only respiratory but also gastrointestinal, musculoskeletal, and cardiovascular symptoms, persuaded many centers to treat everyone like a PUI and institute universal PPE procedures for all patients. 26,[35][36][37] During a pandemic or other public health disaster, health care workers routinely put themselves in danger as they are filled with a sense of duty to assist. This lack of regard for personal safety does not extend to the fear health care workers have of transmitting illnesses to their families or to other patients.…”

Day-to-day life during the COVID-19 pandemic: A longitudinal qualitative study with Canadian parents of young children

“…To this end, they applied relational autonomy in decision-making about their children by adapting prior knowledge to develop new skills when navigating the changing health system. The parents recognized that the pandemic was disrupting services, which resulted in readjustments that focused on improving their health-literacy skills ( Centers for Disease Control and Prevention, 2021 ) in finding, filtering, understanding and then applying information to inform health-related decisions.…”