You know the drill. It’s 3 am. The emergency medical services (EMS) call comes in. They are transporting a 6 month old who is limp and blue. The EMS provider transporting the child sounds rattled, lights and sirens blazing, and they are coming to you.

Are you ready?

Ninety percent of pediatric emergencies take place close to home and school and are cared for in local general EDs rather than pediatric centers. Yet 50 percent of EDs see fewer than 10 children a day, with only a fraction of those being critically ill.¹ Our challenge is for all EDs to have the necessary equipment, policies, and appropriately trained personnel ready for those critically ill pediatric patients. The National Pediatric Readiness Project (NPRP), a collaboration between ACEP, the American Academy of Pediatrics (AAP), and the Emergency Nurses Association (ENA) and coordinated by Emergency Medical Services for Children, has taken the lead on doing just that.

The NPRP is an ongoing quality-improvement project designed to promote optimal care of children in all US state and territory EDs. Its primary purpose is threefold: first, to establish a composite baseline of the nation’s capacity to provide care to children in the ED; second, to create a foundation for EDs to engage in ongoing quality-improvement processes that include implementing the 2009 ACEP-AAP-ENA Guidelines for Care of Children in the Emergency Department; and third, to establish a benchmark that measures ED improvement over time.²

The NPRP recently reported its findings on our nation’s pediatric emergency readiness.³ Its study surveyed all 50 states plus US territories, obtaining a remarkable 83 percent response rate from more than 4,000 hospitals, with many states having a 100 percent response rate. The study, published in JAMA Pediatrics, highlights significant improvement in day-to-day pediatric readiness of US emergency departments, with the average national score rising by nearly 20 points on a 100-point scale compared to previous evaluation, with surveyed hospitals having 91 percent of the recommended equipment.¹ Clearly, we have made improvements, but opportunities remain to enhance the emergency care of children in our country. However, simple actions can significantly impact readiness in all EDs. Perhaps the most powerful is simply having pediatric coordinators to serve as champions for pediatric care at each site, as is called for in the Institute of Medicine’s “Emergency Care for Children: Growing Pains” report.⁴

Specific opportunities for improvement identified by the NPRP include creating disaster plans that incorporate pediatric concepts and needs, implementing guidelines and policies to introduce best practices for children, and ensuring that critical equipment such as pediatric Magill forceps for airway obstruction is readily available.

Our mission in emergency medicine is to provide the best care possible for anyone presenting to our departments—including children. We owe it to our patients and their families to be ready to meet their needs. Armed with knowledge gleaned from this study, emergency physicians can and should lead pediatric emergency readiness in their practice settings, promoting patient- and family-centered care for patients of all ages in our communities. Only after ensuring readiness can we integrate all of our EDs into larger systems to provide the high quality care that all of our patients deserve.

References

1. Gausche-Hill M, Schmitz C, Lewis RJ. Pediatric preparedness of US emergency departments: a 2003 survey. Pediatrics. 2007;120:1229-1237.
2. American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Committee; Emergency Nurses Association Pediatric Committee. Joint policy statement—guidelines for care of children in the emergency department. Ann Emerg Med. 2009;54:543-552.
3. Gausche-Hill M, Ely M, Schmuhl P, et al.A national assessment of pediatric readiness of emergency departments. JAMA Pediatr. 2015. Apr 13. [Epub ahead of print]
4. Institute of Medicine, Committee of the Future of Emergency Care in the US Health System. Emergency care for children: growing pains. Washington, DC: National Academies Press; 2006.

Dr. Benjamin is director of clinical operations in the pediatric emergency center at Saint Joseph Mercy Hospital in Ann Arbor, Michigan. Dr. Joseph is chief of the pediatric emergency medicine division at the University of Florida Health in Jacksonville. Dr. Perina is professor of emergency medicine at the University of Virginia School of Medicine in Charlottesville. Dr. Sacchetti is chair of emergency medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey.