The preparedness of pediatricians for emergencies in the office: What is broken, should we care, and how can we fix it?

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 1:10000, 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.