Pediatric office emergencies and emergency preparedness in a small rural state

Objective. Although the frequency of pediatric office medical emergencies h as been investigated in a retrospective manner, there have been no prospect ive studies. We examined how often pediatricians in a small rural state enc ountered medical emergencies in the office setting. This study included an in-office educational program and the donation of resuscitation equipment t o study participants. Design and Intervention. Thirty-eight of the 40 active primary care pediatr ic practices in the state of Vermont participated in this study. Thirty-sev en sites were surveyed retrospectively regarding office preparedness for em ergencies and frequency of office emergencies. At each practice site, an ed ucational session was provided and an office resuscitation kit was donated. Thirty-seven sites were followed prospectively for a 12-month period evalu ating the incidence of office medical emergencies and the adequacy of the d onated resuscitation kit. Results. Three hundred twenty-seven individuals from 38 Vermont pediatric p ractice sites participated. Forty-nine percent had basic life support train ing and 26% had pediatric advanced life support training. Sixty-seven perce nt of practices had a plan for office medical emergencies. Forty-six percen t of practices had called local emergency medical services providers to the ir offices in the past year. Emergency preparedness ranged from a high of 9 5% 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 devi ation =.8) per office in the previous 12 months. In the 12-month study, the re 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% wer e respiratory in origin. The donated resuscitation kits proved sufficient f or all of the emergencies reported. Conclusions. Serious medical emergencies are rare events in the primary car e pediatric office, occurring less than once per office per year. The most common emergency situations encountered are respiratory. All of the emergen cies in this study were managed effectively using a simple and relatively i nexpensive resuscitation kit. We provided an emergency preparedness program for pediatric practices in a small rural state.