North Carolina Emergency Medical Services for Children

Enhancement Grant“Office Preparedness for Pediatric

Emergencies”

OFFICE PREPAREDNESSOFFICE PREPAREDNESSforfor

PEDIATRIC EMERGENCIESPEDIATRIC EMERGENCIES

Objectives...Objectives...1. Recognize an emergency1. Recognize an emergency

2. Ensure staff preparation2. Ensure staff preparation

3. Choose approp. equipment3. Choose approp. equipment

4. Update provider skills4. Update provider skills

5. Maintain readiness5. Maintain readiness

6. Recognize EMS: member of 6. Recognize EMS: member of the teamthe team

Scenario:

A six-month old infant is brought into your office during the lunch hour with severe wheezing. The mother tells a receptionist that she didn’t think baby could wait until her appointment later that day The infant has retractions; she then becomes cyanotic and begins gasping.

Questions:

1. Are your non-medically trained office personnel prepared to respond to this or other emergency situations?

2. Do you have the necessary equipment and medicines needed to manage this infant? Are they readily available?

3. Who will call 911 or your local emergency number? What level of pediatric care is provided by your local EMS system?

Recognizing an Recognizing an EmergencyEmergency

• Train your secretary or Train your secretary or receptionist how to receptionist how to recognize a pediatric recognize a pediatric emergency.emergency.

• Develop office Develop office protocols, including protocols, including accessing EMSaccessing EMS

What is a true What is a true emergencyemergency??

• labored labored breathingbreathing

• cyanosiscyanosis

• stridor or stridor or audible audible wheezingwheezing

• stupor or coma stupor or coma

• seizuresseizures

• vomiting after a vomiting after a head injuryhead injury

• uncontrollable uncontrollable bleedingbleeding

Response to a Pediatric Response to a Pediatric EmergencyEmergency

• Establish and post office protocols Establish and post office protocols regarding:regarding:

a. accessing EMSa. accessing EMS

b. notification of b. notification of

provider or nurse.provider or nurse.• Have contingency plans for staff if Have contingency plans for staff if

no physician or PCP is in the officeno physician or PCP is in the office• Have office nurse periodically check Have office nurse periodically check

the waiting areathe waiting area

Pre-assign roles of Pre-assign roles of “resuscitation team“resuscitation team””

STAFF STAFF PREPARATIONSPREPARATIONS

•Train receptionist to identify Train receptionist to identify infants and children in infants and children in distressdistress

•Determine skill level and Determine skill level and knowledge of newly employed knowledge of newly employed medical personnelmedical personnel

Teach Staff Teach Staff About:About:

• respiratory respiratory distress distress (stridor and (stridor and wheezing)wheezing)

• shockshock• anaphylaxisanaphylaxis• seizures seizures

EMS EMS

Equipment & Equipment & MedicationsMedications

Location of Location of EquipmentEquipment

• Resuscitation Resuscitation RoomRoom

• Code BoxCode Box

Specialized Specialized OrganizersOrganizers•Bag systemsBag systems

•Cart systemsCart systems

•Other itemsOther items

EQUIPMENT LISTEQUIPMENT LIST• Oxygen sourceOxygen source• Oxygen masksOxygen masks• Self-inflating Self-inflating

bag-valve bag-valve resuscitatorsresuscitators

• Nasal cannulaNasal cannula• Nebulizer for Nebulizer for

inhalation inhalation treatmentstreatments

• Suction Suction apparatusapparatus

• Suction cathetersSuction catheters• Oral airwaysOral airways• FluidsFluids• IV Access IV Access

catheterscatheters• Intraosseous Intraosseous

needlesneedles

Miscellaneous EquipmentMiscellaneous Equipment

• Blood Blood pressure cuffspressure cuffs

• Nasogastric Nasogastric tubestubes

• Feeding tubesFeeding tubes• MonitorMonitor

• Wt. Based Wt. Based tapetape

• Pediatric Pediatric backboardbackboard

• Foley urine Foley urine catheterscatheters

• Pulse Pulse oxymeteroxymeter

MedicationsMedications• LorazepamLorazepam

• Sterile WaterSterile Water

• NalaxoneNalaxone

• CetfriaxoneCetfriaxone

• DiphehydramineDiphehydramine

• AlbuterolAlbuterol

• EpinephrineEpinephrine

• Sodium bicarbonateSodium bicarbonate

• D50D50

• AtropineAtropine

• CorticosteroidCorticosteroid

Maintaining Resuscitation Skills and Knowledge

Continuing Education

PALS

ENPC

APLS

CME

Maintaining “Readiness” for a Maintaining “Readiness” for a Pediatric EmergencyPediatric Emergency

Mock CodesMock Codes

Scavenger HuntsScavenger Hunts

DocumentationDocumentation

Maintaining ReadinessMaintaining Readiness

Mock CodesMock Codes

Scavenger HuntsScavenger HuntsDocumentationDocumentation

Maintaining ReadinessMaintaining Readiness

Mock CodesMock CodesScavenger HuntsScavenger Hunts

DocumentationDocumentation

EMS: EMS: Members of the health care Members of the health care

teamteam

EMS LevelsEMS Levels

Pediatric Training and Pediatric Training and ExperienceExperience

Call 911Call 911

Scenario:

A six-month old infant is brought into your office during the lunch hour with severe wheezing. The mother tells a receptionist that she didn’t think baby could wait until her appointment later that day The infant has retractions; she then becomes cyanotic and begins gasping.

Recognize an EmergencyRecognize an Emergency

SummarySummary

• Recognize an emergencyRecognize an emergency• Staff preparationStaff preparation

• EquipmentEquipment• Provider SkillsProvider Skills

• Maintain ReadinessMaintain Readiness• EMS: member of the health care EMS: member of the health care

teamteam