The article on pediatric emergency preparedness by Wheeler and colleagues1 in this issue of American Family Physician should encourage many family physicians to review their office plans for management of pediatric emergencies. Because it is not possible to prepare for every conceivable emergency, the question of appropriate preparation arises.
Proper preparation requires knowing what emergencies may occur. Unfortunately, the literature gives different definitions of office emergencies. Some common emergencies reported include asthma, meningitis, severe dehydration, trauma, reactions to allergy injections, epiglottitis, sepsis, endocrine emergencies, status epilepticus, sickle cell crisis and cardiopulmonary arrest.2–4 While the published data constitute a useful starting point, physicians should be prepared to treat the emergencies most likely to occur within the practice's unique patient mix. For example, a practice with many epileptic patients must be more prepared to treat seizures. Physicians should also prepare for any adverse reactions resulting from office procedures, such as administration of an allergy injection.
The distance to hospital pediatric emergency care and the availability and type of transport are also important factors to consider when developing an emergency plan for the office. An office that is part of a hospital medical complex may need less equipment than one in a rural location that is 25 miles from the nearest hospital. Another factor to be considered is availability of emergency medical technicians who are prepared to manage pediatric emergencies. If they are not available, the patient's condition may require stabilization before transport.
It is imperative that practitioners keep their skill training up to date. Keeping skills current requires repeated training, which is costly and time consuming. If training is not kept current, skills may be forgotten or out of date when an emergency occurs. Periodic basic life support training seems appropriate for medical personnel in all offices, and advanced life support training should be considered. If services are not readily available, physicians who must treat pediatric emergencies should consider training in intubation and interosseous access.
Preventing cardiopulmonary arrest is more cost effective than treating it. Also, most children who survive a cardiopulmonary arrest have severe neurologic deficits. For children with life-threatening emergencies, access to prehospital parenteral antibiotics, epinephrine, steroids, oxygen and a nebulizer machine are more effective emergency tools than intubation equipment and a defibrillator.
With proper planning, a family physician's office and staff can be prepared to treat most common pediatric emergencies and, even more importantly, save many children's lives.