CONFIDENCE IN PERFORMANCE OF PEDIATRIC EMERGENCY-MEDICINE PROCEDURES BY COMMUNITY EMERGENCY PRACTITIONERS

Objective: To survey a cohort of physicians who work in general commun ity emergency departments (ED) in order to assess their comfort levels in performing urgent and emergent medical procedures on children. Met hods: One hundred seventeen emergency physicians were surveyed at 23 i nstitutions within the referral base of Hasbro Children's Hospital, a tertiary care pediatric ED. Physicians rated their comfort levels (4-p oint scale: 1 = comfortable, 2 = moderately comfortable, 3 = uncomfort able but would perform in an emergency, 4 = uncomfortable and would ne ver perform) for all procedures in which the American Academy of Pedia trics recommends competence for pediatric emergency physicians. Result s: Sixty (51%) physicians completed the survey. Residency training inc luded internal medicine, family practice, surgery, general practice, p ediatrics, and emergency medicine, while only 32 (53%) were Board cert ified in emergency medicine. All respondents treated pediatric patient s. Over 25% were uncomfortable (level 3 or 4) with performing certain potentially life-saving pediatric procedures. These included cardiover sion, defibrillation, external pacing, nasal intubation, needle cricot hyrotomy, rapid sequence intubation, laryngoscopy, tracheostomy replac ement, chest tube placement, vascular cutdowns, emergency childbirth, pericardiocentesis, intraosseous line placement, infant subdural and v entriculoperitoneal (V-P) shunt taps, and upper airway foreign body re moval. Over 25% of respondents were also uncomfortable with non-life-s aving procedures such as temperomandibular joint (TMJ) reductions, too th reinsertions, rape evaluations, suprapubic taps, tympanocentesis, r etrograde urethrograms, thoracentesis, paraphimosis reduction, ear for eign body removal, and pain management. Conclusion: While emergency ph ysicians within the catchment area of a tertiary care children's hospi tal feel comfortable with most pediatric procedures, they express a si gnificant degree of discomfort with many potentially life-saving skill s. Because of the infrequent need for many of these interventions in c hildren, the high levels of discomfort are not surprising. These proce dures may most comfortably be performed at pediatric centers but can b e accomplished web at all EDs if personnel are adequately trained. A s trong working relationship with pediatric emergency centers and an enh anced teaching of these procedures may increase comfort levels with th ese potentially life-saving measures.