The preparedness of pediatricians for emergencies in the office. What is broken, should we care, and how can we fix it?
G. Flores and D. J. Weinstock
Division of General Pediatrics, Boston (Mass) University School of Medicine, USA.
OBJECTIVES: To determine the frequency of emergencies in pediatric
practices, assess office emergency preparedness, and explore practitioner's
reasons for levels of preparedness. DESIGN AND SETTING: Telephone survey of
pediatric offices in Fairfield County, Connecticut. SAMPLE: Fifty-one (98%)
of 52 offices participated, representing 481 staff. RESULTS: More than 2400
emergencies are seen each year in the pediatric offices, with a median of
24 emergencies per practice annually. Forty-two (82%) of the practices
averaged at least one emergency per month, 13 (25%) experienced more than
50 emergencies annually, and seven (14%) experienced more than 100
emergencies annually. Of all eligible staff, 14% were certified in basic
life support and 17% in pediatric advanced life support. The following
emergency equipment was missing from offices: oxygen, 14 (27%); intravenous
catheters, 14 (27%); bag-valve-mask, 15 (29%); nebulizers, 17 (33%);
epinephrine 1:10 000, 27 (53%); and intravenous fluids, 28 (55%).
Thirty-seven (73%) of offices had the minimum recommended equipment and
training for status asthmaticus management; only 17 (33%) of offices had
similar preparation for each of the six other emergencies. High-level
emergency preparedness was rare. The perceptions of office pediatricians
are that office emergencies are rare, and emergency preparedness is
difficult to achieve because practices are too busy and the expense and
time commitment are too great. CONCLUSIONS: Emergencies are common in
pediatric practices, but problems in the emergency preparedness of
practices persist despite previous studies with similar findings, and
publication of guidelines. Perceptions of practitioners suggest that not
enough effort has been devoted to increasing practitioner awareness of
these problems. Greater awareness might result by emphasizing practical
instruction in residency and continuing medical education courses, and by
publication of guideline summaries.
