To determine the preparedness of pediatric offices that had activated emergency medical services (EMS) for a critically ill child requiring airway management.
Fifteen patients who initially presented to pediatric or family practice offices but required EMS activation and cardiac and/or respiratory support were identified from a previous prospective study of airway management in children. Two to 4 years after the emergency requiring EMS activation, the offices were contacted to complete a written survey about office preparedness for pediatric emergencies.
Eight of 15 offices (53%) returned a survey. Pediatricians staffed all responding offices, and all offices were within 5 miles of an emergency department. Airway emergencies were the most common emergencies seen in the offices. Availability of emergency equipment and medications varied. All offices stocked albuterol, and most (7/8) had an oxygen source with a flowmeter. However, only half of the offices had a fast-acting anticonvulsant, and a quarter had no anticonvulsant. Three offices lacked bag-mask (manual) resuscitators with all appropriate sized masks, and 3 offices lacked suction. The most common reasons cited for not stocking all emergency equipment and drugs were quick response time of EMS and proximity to an emergency department.
Even after treating a critically ill child who required advanced cardiac and/or pulmonary support, offices were ill prepared to handle another serious pediatric illness or injury.
*Department of Pediatrics, and †Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA; ‡Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA and §Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA.
The authors acknowledge grant support to M.G.H. from the following agencies: Agency for Health Care Research and Quality and the Health Resources and Services Administration (grant no. 1R01HS9166); the State of California Emergency Medical Services Authority under special project grants (grant nos. EMS 2031, 3036, 4051, and 5034); and the Maternal and Child Health Bureau in collaboration with the National Highway Traffic Safety Administration, Health Resources and Services Administration (grant no. MCH-064004).
Address correspondence and reprint requests to Genevieve Santillanes, MD, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 W. Carson St, Box 17, Torrance, CA 90509. E-mail: email@example.com.