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Preparedness of Selected Pediatric Offices to Respond to Critical Emergencies in Children

Santillanes, Genevieve MD*; Gausche-Hill, Marianne MD†‡§; Sosa, Bernardo MD

doi: 10.1097/01.pec.0000238744.73735.0e
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Objective: To determine the preparedness of pediatric offices that had activated emergency medical services (EMS) for a critically ill child requiring airway management.

Methods: 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.

Results: 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.

Conclusions: 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: gsantillanes@hotmail.com.

© 2006 Lippincott Williams & Wilkins, Inc.