Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers

Abstract

High-quality pediatric emergency care can be provided only through the collaborative efforts of many health care professionals and child advocates working together throughout a continuum of care that extends from prevention and the medical home to prehospital care, to emergency department stabilization, to critical care and rehabilitation, and finally to a return to care in the medical home. At times, the office of the pediatric primary care provider will serve as the entry site into the emergency care system, which comprises out-of-hospital emergency medical services personnel, emergency department nurses and physicians, and other emergency and critical care providers. Recognizing the important role of pediatric primary care providers in the emergency care system for children and understanding the capabilities and limitations of that system are essential if pediatric primary care providers are to offer the best chance at intact survival for every child who is brought to the office with an emergency. Optimizing pediatric primary care provider office readiness for emergencies requires consideration of the unique aspects of each office practice, the types of patients and emergencies that might be seen, the resources on site, and the resources of the larger emergency care system of which the pediatric primary care provider's office is a part. Parent education regarding prevention, recognition, and response to emergencies, patient triage, early recognition and stabilization of pediatric emergencies in the office, and timely transfer to an appropriate facility for definitive care are important responsibilities of every pediatric primary care provider. In addition, pediatric primary care providers can collaborate with out-of-hospital and hospital-based providers and advocate for the best-quality emergency care for their patients. INTRODUCTIONPediatricians and pediatric primary care providers (PPCPs) are vitally important members of the emergency care system for children. Children with potentially life-threatening illnesses and injuries are sometimes taken to primary care offices, which often serve as the child's medical home, by parents or caregivers seeking help from health care professionals they know and trust. The office site then serves as an entry into the emergency care system, and it is there that vital, perhaps even life-saving, care is provided.Studies have shown that emergencies are common in primary care practices that provide care to children. In 1 study, the authors surveyed 52 pediatric offices and found that these practices saw a median of 24 emergencies per year. 1 Most of the offices (82%) reported that they encountered, on average, at least 1 emer-

Development of Pediatric Emergency Protocols and Communication Plans in Pediatric Radiation Oncology: Multidisciplinary Core Competencies

“…Pediatric preparedness required the procurement of specialized equipment, medications, and supplies suitable for pediatric patients. 2 Initial preparation included obtaining multiple pediatric sizes of airway management devices, vascular access and fluid management, and a pediatric code cart. A separate airway cart with color-coded, weight-based supplies was obtained to support the placement of an advanced airway in case of respiratory compromise.…”

“…In anticipation of receiving high-acuity pediatric oncology patients with the potential for acute illnesses and exacerbation of chronic illnesses, emergency guidelines about both the pediatric primary care setting and the emergency department supported the protocol development. 2 , 3 Core competencies surrounded 3 main elements: policy and protocols, team-building, and facility preparation. 5 A review process by a collaborative team (including representatives from radiation oncology, medical oncology, anesthesiology, and emergency medicine) was then cyclically used to reinform the 3 categories as needs were realized (Fig.…”

“…Definitive policy statements from national practice associations provide recommendations on pediatric readiness for emergency departments and pediatric primary care providers. 2 , 3 These include information on equipment, supplies, personnel, and training best suited to aid in a pediatric emergency. Although national endeavors over the last 20 years have greatly improved pediatric readiness, recent assessments have demonstrated a continued deficit in preparedness for pediatric emergencies.…”

Medical Transport of Children with Complex Chronic Conditions

“…The American Academy of Pediatrics has recently outlined recommendations for pediatric office emergencies [29]. Of utmost importance is the identification of a medical team leader.…”

“…Pediatric Advanced Life Support certification is recommended. Recommended office equipment at a minimum includes an oxygen source, a nonrebreather mask, a bag-valve-mask resuscitator, suction, nebulizer, oropharyngeal airways, pulse oximeter, drug dose reference, rigid board, sphygmomanometer, splints, sterile dressings, epinephrine, and albuterol for inhalation [29]. For practices caring for children with complex conditions, we additionally suggest intravenous catheters, intraosseous needles, a cardiac monitor, an automated external defibrillator, atropine, adenosine, and amiodarone.…”