Child/Adolescent Health

Some pediatric offices may not be prepared to handle emergencies such as seizures or severe asthmatic episodes

Pediatric offices occasionally see children with emergencies such as epileptic seizures or asthma-related breathing problems. Yet these offices may be unprepared to treat a critically ill child until the arrival of paramedics, according to a new study. For example, four of eight pediatric offices surveyed did not have the appropriate medications for epileptic seizures, and some lacked the basic supplies needed to handle respiratory emergencies. One office lacked an oxygen source with a flow meter, and only five of the eight offices had suction machines.

Reasons given for lack of equipment and training included office proximity to a hospital emergency department (median transport time of 5 minutes) and quick response time of emergency medical services. However, the researchers found a significant delay from the initial 911 call from the pediatrician's office until the child's arrival at the emergency department. Actions taken by the pediatrician during this time could affect the outcome, note the researchers.

The pediatric offices generally treated an average of one child a week who required emergency treatment or subsequent emergency hospitalization, mostly for respiratory emergencies and seizures. Availability of emergency equipment and medications varied. All offices stocked albuterol to open up the airways, but only two had racemic epinephrine in case the albuterol did not help, and seven out of eight had an oxygen source with a flow meter. However, only half the offices had a fast-acting anticonvulsant, and one-fourth had no anticonvulsant. Three offices lacked bag-mask (manual) resuscitators with all appropriate sized masks, and three offices lacked suction. Four offices had written guidelines for actions to be taken for medical emergencies occurring in the office. Only one office required staff to participate in mock emergency codes. The study was supported in part by the Agency for Healthcare Research and Quality (HS09166).

See "Preparedness of selected pediatric offices to respond to critical emergencies in children," by Genevieve Santillanes, M.D., Marianne Gausche-Hill, M.D., and Bernardo Sosa, M.D., in the November 2006 Pediatric Emergency Care 22(11), pp. 694-698.

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