Pediatric equipment availability and emergency preparedness☆

See related article, p. 371.

Pediatric patients make approximately 22 to 30 million visits to emergency departments in the United States annually.1 There are little data available about the preparedness of these EDs to care for pediatric patients. A recent survey of the National Electronic Injury Surveillance System of the Consumer Product Safety Commission hospitals by the Emergency Medical Services for Children Program demonstrated deficiencies in pediatric equipment in a sample of 101 US EDs.2 This survey was completed by a diverse group of respondents, including ED directors, nurse managers, unit coordinators, ED charge nurses, presidents of health centers, hospital administrators, emergency medicine program coordinators, and other personnel. Additional limitations include the fact that there was no validation of paper survey results by a site survey.

In this issue of Annals , McGillivray et al3 report on a population-based survey of pediatric preparedness of all 737 EDs in Canada. The authors had an outstanding response rate of 88.3% of the total sample, with some of the 12 provinces having a 100% return of the questionnaire. The authors then selected a convenience sample of 38 (6%) of the responding hospitals to site visit by a team consisting of a physician, nurse, and/or research assistant to verify their preparedness. The site surveys were then compared with the paper questionnaire responses, and adjusted bootstrap confidence intervals were computed for the logistic models for 3 of the equipment items, including intraosseous needles, pulse oximeters, and pediatric defibrillation paddles. Hospitals were stratified by hospital level/category, annual census number of pediatric ED visits, availability of pediatrician on call, or availability of a physician who had completed the Pediatric Advanced Life Support (PALS) course on staff. Finally, distance from a university center and number of pediatric resuscitations per year were also used in the analysis. The authors found fewer equipment items were actually available during the on-site surveys compared with data provided in the questionnaires. The regression model demonstrated an increased unavailability of pediatric resuscitation equipment in Level III hospitals, those with a low annual census (<10,000 visits/y), those with less than 10% of ED visits by children, those without a pediatrician or PALS–trained physician on staff, those more than 200 km from a university center, and those with fewer than 3 pediatric resuscitations per year. These results highlight the need to target the smaller volume institutions for intervention to improve equipment availability for pediatric emergency patients.

This well-done and interesting study points out the limitations of doing paper surveys for hospital categorization and preparedness without on-site validation. Although there was generally good agreement between the paper survey and the on-site survey, in almost all cases, the on-site survey revealed an increase in unavailability of equipment. The authors note that a limitation of doing paper surveys is that there is no assurance that the person assigned to complete the survey is knowledgeable about the content and definitions of the survey required to accurately report the desired data. Indeed, the respondents may not be familiar with the terms or with the actual stocked equipment in the ED.

Guidelines for ED preparedness for pediatrics have been published by several groups; however, they have not been universally implemented.4, 5, 6, 7, 8, 9, 10 In response to the need for a unified strategy to improve care of children in the ED, guidelines have been jointly developed by the American Academy of Pediatrics and the American College of Emergency Physicians and are published in this issue of Annals. 11 These guidelines provide a positive step toward empowering ED administrators with the ability to provide staff and equipment to meet the needs of the pediatric patients in their community.

We have made significant progress in improving pediatric emergency care, but the article by our Canadian colleagues reminds us that simply having guidelines may not be enough. We need to motivate all those vested in pediatric emergency medical care to evaluate their equipment and staffing requirements for the ED. The authors of this article demonstrate that the costs of providing appropriate equipment are minimal. To achieve equipment preparedness, it simply takes commitment.