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Guidelines for pediatric equipment and supplies for emergency departments

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... Concurrently, there was a proliferation of guidelines to support the preparedness of prehospital and emergency department personnel. Pre-hospital curriculum and equipment lists were established, recommendations were made and the states developed various methods to address the complexity of providing for sick and injured children (ACEP, 1998;Seidel et al., 1996). A study published in 2001 by the Consumer Product Safety Commission, on behalf of the Health Resource and Services Administration's (HRSA) Maternal Child Health Bureau's Emergency Medical Services for Children Program (EMSC), concluded that emergent and critical care of children was poorly integrated and regionalized. ...
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Previous assessments of readiness of emergency departments (EDs) have not been comprehensive and have shown relatively poor pediatric readiness, with a reported weighted pediatric readiness score (WPRS) of 55. To assess US EDs for pediatric readiness based on compliance with the 2009 guidelines for care of children in EDs; to evaluate the effect of physician/nurse pediatric emergency care coordinators (PECCs) on pediatric readiness; and to identify gaps for future quality initiatives by a national coalition. Web-based assessment of US EDs (excluding specialty hospitals and hospitals without an ED open 24 hours per day, 7 days per week) for pediatric readiness. All 5017 ED nurse managers were sent a 55-question web-based assessment. Assessments were administered from January 1 through August 23, 2013. Data were analyzed from September 12, 2013, through January 11, 2015. A modified Delphi process generated a WPRS. An adjusted WPRS was calculated excluding the points received for the presence of physician and nurse PECCs. Of the 5017 EDs contacted, 4149 (82.7%) responded, representing 24 million annual pediatric ED visits. Among the EDs entered in the analysis, 69.4% had low or medium pediatric volume and treated less than 14 children per day. The median WPRS was 68.9 (interquartile range [IQR] 56.1-83.6). The median WPRS increased by pediatric patient volume, from 61.4 (IQR, 49.5-73.6) for low-pediatric-volume EDs compared with 89.8 (IQR, 74.7-97.2) for high-pediatric-volume EDs (P < .001). The median percentage of recommended pediatric equipment available was 91% (IQR, 81%-98%). The presence of physician and nurse PECCs was associated with a higher adjusted median WPRS (82.2 [IQR, 69.7-92.5]) compared with no PECC (66.5 [IQR, 56.0-76.9]) across all pediatric volume categories (P < .001). The presence of PECCs increased the likelihood of having all the recommended components, including a pediatric quality improvement process (adjusted relative risk, 4.11 [95% CI, 3.37-5.02]). Barriers to guideline implementation were reported by 80.8% of responding EDs. These data demonstrate improvement in pediatric readiness of EDs compared with previous reports. The physician and nurse PECCs play an important role in pediatric readiness of EDs, and their presence is associated with improved compliance with published guidelines. Barriers to implementation of guidelines may be targeted for future initiatives by a national coalition whose goal is to ensure day-to-day pediatric readiness of our nation's EDs.
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In the USA, the emergency medical services (EMS) system is vital for American Indians and Alaska Natives, who are disproportionately burdened by injuries and diseases and often live in rural areas geographically far from hospitals. In rural areas, where significant health disparities exist, EMS is often a primary source of healthcare providing a safety net for uninsured individuals or families who otherwise lack access to health-related services. EMS is frequently the first entry point for children and their families into the healthcare system. The Indian Health Service (IHS) supports the federally funded, tribally operated EMS agencies to help meet the affiliated American Indian and Alaska Natives' pre-hospital needs. While periodic assessments of state EMS agencies capabilities to care for children occur, it appears a systematic assessment of IHS EMS agencies in regards to children had not been previously conducted. view open access article online at http://www.rrh.org.au/publishedarticles/article_print_2688.pdf http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2688
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The frequency of national and inter- national disaster events, increased media attention, and regulatory changes have all contributed to an improved public awareness of the vital role hospitals play in a crisis. Although hospital disaster prepa- redness efforts have matured dra- matically since the September 11th 2001 terrorist attacks, much work still remains to prepare all hospitals for potential pediatric victims. This article emphasizes key emergency response aspects of hospital pre- paredness for disasters involving children, in particular (1) hospital- based incident command, (2) stra- tegies for operational continuity, (3) pediatric principles of surge capa- city, (4) development of decontami- nation protocols, (5) infection control, (6) sheltering in place, and (7) evacuation strategies.
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Population demographics do not allow every area of the county equal access to all health care resources. Services for critically ill and injured children are no exception. Categorization and regionalization of specialized health care services have been shown to improve outcome and reduce the cost of health care for a variety of circumstances. A systems approach to caring for pediatric emergencies that assures access to stabilizing care and timely transfer to definitive care resources can save lives and improve morbidity rates. This approach can be accomplished through a process o1 assuring that every hospital with an emergency department has met minimum standards for the care of children in crisis that includes, when necessary, timely transfer to definitive care. Hospitals should be categorized according to their resources to manage pediatric emergencies and, through a process of regional cooperation, facilities should be linked to assure timely access to definitive care for children who are critically ill or injured.
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For 20 years, the Emergency Medical Services for Children (EMSC) program has raised awareness about the importance of providing emergency medical care to children that is matched to their physiological and psychological development, targeting healthcare professionals, emergency medical services (EMS) and trauma system planners, and the public. Since 1984, the EMSC program has provided federal funding to states and university schools of medicine to establish EMSC programs in all 50 states, the District of Columbia, and 5 US territories to help improve the EMS system for children. Other EMSC program grant funding has been used to establish national resource centers, develop model products and resources, and support the infrastructure for a pediatric emergency care research network. The EMSC program also established partnerships with national organizations and federal agencies to improve awareness of children's special needs and integrate pediatric emergency care into the larger EMS system.
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Urgent care centers are here to stay. Pediatric emergency medicine (PEM) providers treat a spectrum of diseases that range from medical and surgical emergencies to benign, low-acuity medical conditions. Therefore, it makes intuitive sense for PEM providers to be integrally involved in the development, support, and operations of urgent care (UC) centers as they evolve to meet the acute episodic health care needs of children and their families. This report outlines the spectrum of UC centers that exist, the interrelationship with PEM providers, and the balancing of UC centers within the spectrum of ambulatory care for children.
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Study objective: Of all child visits to emergency departments, 1% to 5% involve critically ill children who require cardiopulmonary resuscitation. Numerous versions of pediatric equipment lists for EDs have been published. Despite these efforts, many EDs remain unprepared for pediatric emergencies. The objectives of this study were to assess the availability of pediatric resuscitation equipment items in Canadian hospital EDs and to identify risk factors for the unavailability of these items. Methods: Using the updated database of the Canadian Association of Emergency Physicians (CAEP), a questionnaire survey was sent to 737 Canadian hospital EDs with a maximum of 3 mailings to nonresponders. On-site visits to a selected subset of hospital EDs were completed to validate the results obtained by the mailed questionnaire. Results: The response rate was 88.3% (650/737). Results showed the following overall equipment unavailability: intraosseous needle, 15.9%; pediatric drug dose guidelines, 6.6%; infant blood pressure cuff, 14.8%; pediatric defibrillator paddles, 10.5%; infant warming device, 59.4%; infant bag-valve-mask device, 3.5%; infant laryngoscope blade, 3.5%; 3-mm endotracheal tube, 2.5%; and pediatric pulse oximeter, 18.0%. Low percentage of pediatric visits, lack of an on-call pediatrician for the ED, and lack of a pediatric advanced life support-trained physician on staff were independently associated with equipment unavailability. Conclusion: This study demonstrated that essential pediatric resuscitation equipment is unavailable in a disturbingly high number of EDs across Canada and has identified several determinants of this unavailability.
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[Seidel JS, Gausche-Hill M. Pediatric equipment availability and emergency preparedness. Ann Emerg Med. April 2001;37:388-389.]
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[Gausche-Hill M, Wiebe RA. Guidelines for preparedness of emergency departments that care for children: a call to action. Ann Emerg Med. April 2001;37:389-391.]
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Emergency physicians have a duty to advance the care of pediatric patients in the emergency medical services (EMS) system. This policy resource and education paper, designed to support the American College of Emergency Physicians policy paper "The Role of the Emergency Physician in Emergency Medical Services for Children," describes the development of the federal EMS for Children Program, the importance of the integration of EMS for children into EMS systems, and the role of the emergency physician in EMS for children.
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The care of children is an integral aspect of emergency medicine. This article reviews the many important contributions that emergency physicians have made in advancing the acute care of children.
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Full-text available
Our goal was to assess the degree of pediatric preparedness of emergency departments in the United States. A closed-response survey based on the American Academy of Pediatrics/American College of Emergency Physicians joint policy statement, "Care of Children in the Emergency Department: Guidelines for Preparedness," was mailed to 5144 emergency department medical and nursing directors. A weighted preparedness score (scale of 0-100) was calculated for each emergency department. A total of 1489 useable surveys (29%) were received, with 62% completed by emergency department medical directors. Eighty-nine percent of pediatric (age: 0-14 years) emergency department visits occur in non-children's hospitals, 26% of visits occur in rural or remote facilities, and 75% of responding emergency departments see <7000 children per year. The vast majority of visits (89%) occur in emergency department areas shared with adult patients; 6% occur in a separate pediatric emergency department. Only 6% of emergency departments had all recommended equipment and supplies. Emergency departments frequently lacked laryngeal mask airways for children (50%) and neonatal or infant equipment. In contrast, recommended medications were more uniformly available, as were transfer policies for medical or surgical intensive care. Fifty-two percent of emergency departments reported having a quality improvement/performance improvement plan for pediatric emergency patients, and 59% of respondents were aware of the American Academy of Pediatrics/American College of Emergency Physicians guidelines. The median pediatric-preparedness score for all emergency departments was 55. Pediatric-preparedness scores were higher for facilities with higher pediatric volume, facilities with physician and nursing coordinators for pediatrics, and facilities with respondents who reported awareness of the guidelines. Pediatric preparedness of hospital emergency departments demonstrates opportunities for improvement.
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This section of Pediatrics in Review is designed to be clipped or duplicated and filed in a handy place in the office, clinic, or emergency department, providing a convenient and concise reference. All offices in which children are examined should have pediatric emergency equipment, supplies, drugs, policies, and procedures. The equipment, supplies, and drugs kept in the office will depend on the spectrum of ill or injured children seen in the practice. However, a source of oxygen, basic resuscitation drugs (suited to the patient population and experience of the health-care providers), and a dosage chart or weight-based dosing tape (Figure 1) should be available in all offices. The following list of drugs is fairly comprehensive and is organized according to sign or symptom needing treatment. Health-care providers should become familiar with the information regarding specific drugs that they use commonly, eg, choose a short-acting benzodiazepine such as diazepam or lorazepam for treating status epilepticus. The intraosseous (IO) route of drug administration can be used for the majority of emergency drugs listed in the chart that suggest administration by the intramuscular (IM) or intravenous (IV) routes. The IO route is appropriate for children age 6 years and younger and should be reserved for those circumstances where failure to achieve vascular access might result in loss of life or limb (ie, anaphylaxis, cardiopulmonary arrest).
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Housestaff residents are often the primary participants in codes that occur in a hospital setting, yet it is unknown how much confidence and knowledge they possess in the management of these medical emergencies. A study to learn the effect of a mock code program on residents' level of confidence and knowledge regarding code situations was initiated in a children's tertiary care hospital. Thirty-three residents completed a questionnaire before initiation of the study. The questionnaire revealed that codes scare them (79%), and that they felt a need for more knowledge (76%) and more experience (82%) before supervising a code. They did not feel confident in performing certain procedures such as treating dysrhythmias (79%), obtaining i.v. access (64%), and doing intubations (30%). Sixteen residents then participated in mock codes, and the other seventeen residents served as controls. Compared to the pre-study questionnaire, residents who had participated in mock codes had more confidence in their ability to supervise and felt less of a need for more knowledge before supervising a code. The participants also felt more confident in obtaining i.v. access and performing intubations during a code situation. There was no difference in the pre- and post-questionnaires of the control group. Residency programs are not meeting the educational and confidence needs of pediatric residents. A mock code program improves residents' perceived need for more knowledge before supervising a code and improves their confidence in doing many lifesaving procedures.
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Determination of the ability of a medical device to interact with the immune system currently involves assessment of the immunogenic potential and biocompatibility of the device or an extract of the device. However, implants are often in the body for extended periods of time and/or are placed by a surgical procedure that in and of itself will generate an acute inflammatory response. This symposium discussed studies that have been performed to evaluate the immunogenicity of various devices consisting of several different compositions (i.e., silicone, metals, and latex) in contact with different anatomical sites, the ability of a device to modulate an inflammatory response generated by a surgical procedure or trauma, and the response of the body to a material left in place for extended periods of time. This symposium brought together scientists from many different disciplines to begin to identify and fill in the gaps in this area.
Equipment, supplies, and medications for the care of pediatric patients in the emergency department [AppendixA].
  • California Emergency Medical Service Authority
Pediatric equipment guidelines [policy statement].
  • American College of Emergency Physicians
Pediatric emergency nursing resource guide.
  • Emergency Nurses Association