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Outpatient Emergency Preparedness: A Survey of Pediatricians

Friday, October 19, 2012: 3:00 PM
Room 278-280 (Morial Convention Center)
Amber L. Pendleton, MD, Michelle A. Martin-Thompson, MD and Michelle D. Stevenson, MD, MS, Pediatrics, University of Louisville, Louisville, KY

Purpose Children experiencing emergencies may be seen first in the outpatient pediatric office and require urgent high-quality care. The impact of the AAP policy statement, Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers, written in 2007 and reaffirmed in 2011 is unknown. The objective of this study was to determine outpatient pediatricians’ experience with and preparation for office emergencies.

Methods A 34 question survey of 123 faculty and gratis faculty from the sole medical school in a metropolitan area was distributed electronically twice two weeks apart then sent by mail from May to September 2011. Demographic information, training and equipment for life threatening emergencies, and familiarity with the AAP policy statement were assessed.

Results Of the 57 respondents (46% response rate), 23% worked in an academic setting and 70% in private practice.  Emergencies occurred often in pediatric offices; 39% reported at least one emergency per month and 75% referred a patient to the emergency department or hospital at least monthly. The majority (84%) reported Emergency Medical Services (EMS) response time of less than 10 minutes, while 51% were unsure whether EMS responders had pediatric equipment or Pediatric Advanced Life Support (PALS) training.  Regarding certification training, 21% had current PALS and 42% had current Basic Life Support (BLS), while 35% had neither or didn’t know.  The majority (79%) agreed asthma/respiratory emergencies were most common.  Almost all had oxygen (98%) and bag-valve mask (96%) in the office; however only 65% had oropharyngeal airways.   All reported feeling somewhat or very comfortable with bag-valve mask, but only 68% reported the same comfort level with oropharyngeal airways.  About half (44%) had intubation equipment while just over half of those (58%) felt somewhat or very comfortable with intubation.  Of those with intubation equipment, 87% did not have current PALS certification.  About half (47%) had Automated External Defibrillators (AED) and 68% reported feeling somewhat or very comfortable using an AED.  About half (47%) had equipment to place an intravenous catheter.  Only 25% of pediatricians performed mock emergencies and the majority of these were practiced 1 or 2 times per year (71%).  One-third had written emergency protocols in their office.  About half of pediatricians (53%) reported awareness of the 2007 AAP policy guideline and one quarter thought their office met the guideline.  We found no association with practice type or years of practice with awareness of the policy guideline.

Conclusion Emergencies occur frequently in pediatric offices. Variability in outpatient emergency preparedness reflects the need for greater awareness and compliance with the 2007 AAP policy statement.