Many EDs lack the right equipment to treat kids

Prepping EDs for children's cases 'has been slow at best'

A national assessment of more than 4,000 hospitals found that many hospital EDs are not prepared to treat children and infants, Laura Landro writes for the Wall Street Journal.

According to the assessment, which  was published this month in JAMA Pediatrics, 90% of children who visit EDs are treated in general community hospitals which often are not equipped with child-sized medical equipment like needles, catheters, and breathing tubes and have staff unfamiliar with children's medical needs. A 2006 Institute of Medicine report found that just 6% of hospitals are properly outfitted to deal with a pediatric emergency, and the majority of ED staffers did not know how to adequately stabilize critically injured or severely ill children.

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In addition, many general hospitals do not have plans in place to deal with a mass casualty situation or natural disaster that disproportionally affects children. "It would be hard to take care of the unexpected event like several dozen kids in a bus crash if you aren't prepared to take care of an emergency of one," says Steven Krug, chief of pediatric emergency medicine at Ann & Robert H. Lurie Children's Hospital of Chicago.

Nonetheless, the assessment found that U.S. hospitals' readiness for pediatric emergencies has improved in recent years, with median readiness totaling 69 on a 100-point scale, up from 55 in 2003. The assessment based its findings on how well hospitals complied with guidelines from the American College of Emergency Physicians, the American Academy of Pediatrics, and the American Nurses Association.

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Still, researchers say progress in preparing EDs for children's cases "has been slow at best," and that there is no way to verify hospitals' answers about their compliance.

In the assessment, barely 50% of hospitals met two key criteria for children's emergency readiness: a physician and nurse with expertise to coordinate emergency care for children and formal staff training. In addition, the survey found that:   

  • 50% of hospitals do not have all the necessary pediatric emergency equipment;
  • 33% do not follow guidelines to record weight in kilograms rather than pounds, which can lead to medication dosage errors; and
  • 15% are missing critical tools.

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The National Pediatric Readiness Project plans to release data that allow EDs to compare their own readiness to others in their state and across the United States. The initiative also will offer no-cost services to help EDs comply with the readiness guidelines (Landro, Wall Street Journal, 4/27).

The takeaway: Although 90% of children's emergencies end up in general EDs, just a small segment of those are properly equipped and staffed to handle such incidents.

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