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PEDIATRICS Vol. 106 No. 6 December 2000, pp. 1391-1396

Pediatric Office Emergencies and Emergency Preparedness in a Small Rural State

Received Dec 7, 1999; accepted Feb 15, 2000.

Barry W. Heath*, Jean S. CoffeyDagger , Patrick Malone§, and James Courtney§

From the * Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont; the Dagger  Children's Health Care Service, Fletcher Allen Health Care, Burlington, Vermont; and the § Office of Emergency Medical Services, Vermont Department of Health, Burlington, Vermont.

Objective.  Although the frequency of pediatric office medical emergencies has been investigated in a retrospective manner, there have been no prospective studies. We examined how often pediatricians in a small rural state encountered medical emergencies in the office setting. This study included an in-office educational program and the donation of resuscitation equipment to study participants.

Design and Intervention.  Thirty-eight of the 40 active primary care pediatric practices in the state of Vermont participated in this study. Thirty-seven sites were surveyed retrospectively regarding office preparedness for emergencies and frequency of office emergencies. At each practice site, an educational session was provided and an office resuscitation kit was donated. Thirty-seven sites were followed prospectively for a 12-month period evaluating the incidence of office medical emergencies and the adequacy of the donated resuscitation kit.

Results.  Three hundred twenty-seven individuals from 38 Vermont pediatric practice sites participated. Forty-nine percent had basic life support training and 26% had pediatric advanced life support training. Sixty-seven percent of practices had a plan for office medical emergencies. Forty-six percent of practices had called local emergency medical services providers to their offices in the past year. Emergency preparedness ranged from a high of 95% of sites with oxygen to a low of 27% of sites with intraosseous needles. The estimate of the frequency of medical emergencies was .9 (standard deviation = .8) per office in the previous 12 months. In the 12-month study, there were 28 medical emergencies reported, averaging .8 (standard deviation = 1.5) emergencies per office per year. Sixty-five percent of participating sites had no emergencies in the study. Of the emergencies reported, 75% were respiratory in origin. The donated resuscitation kits proved sufficient for all of the emergencies reported.

Conclusions.  Serious medical emergencies are rare events in the primary care pediatric office, occurring less than once per office per year. The most common emergency situations encountered are respiratory. All of the emergencies in this study were managed effectively using a simple and relatively inexpensive resuscitation kit. We provided an emergency preparedness program for pediatric practices in a small rural state.  Key words:  office practice, emergency, emergency equipment.




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