1. North Carolina Emergency Medical Services for Children Enhancement Grant Office Preparedness for Pediatric Emergencies

2. OFFICE PREPAREDNESS for PEDIATRIC EMERGENCIES Objectives... 1. Recognize an emergency 2. Ensure staff preparation 3. Choose approp. equipment 4. Update provider skills 5. Maintain readiness 6. Recognize EMS: member of the team

3. 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 didnt think baby could wait until her appointment later that day The infant has retractions; she then becomes cyanotic and begins gasping.

4. 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?

5. Recognizing an Emergency Train your secretary or receptionist how to recognize a pediatric emergency. Train your secretary or receptionist how to recognize a pediatric emergency. Develop office protocols, including accessing EMS Develop office protocols, including accessing EMS

6. What is a true emergency? labored breathinglabored breathing cyanosiscyanosis stridor or audible wheezingstridor or audible wheezing stupor or comastupor or coma seizuresseizures vomiting after a head injuryvomiting after a head injury uncontrollable bleedinguncontrollable bleeding

7. Response to a Pediatric Emergency Establish and post office protocols regarding:Establish and post office protocols regarding: a. accessing EMS b. notification of provider or nurse. provider or nurse. Have contingency plans for staff if no physician or PCP is in the officeHave contingency plans for staff if no physician or PCP is in the office Have office nurse periodically check the waiting areaHave office nurse periodically check the waiting area

8. Pre-assign roles of resuscitation team Pre-assign roles of resuscitation team

9. STAFF PREPARATIONS Train receptionist to identify infants and children in distressTrain receptionist to identify infants and children in distress Determine skill level and knowledge of newly employed medical personnelDetermine skill level and knowledge of newly employed medical personnel

10. Teach Staff About: respiratory distress (stridor and wheezing)respiratory distress (stridor and wheezing) shockshock anaphylaxisanaphylaxis seizuresseizures

11. EMS

12. Equipment & Medications

13. Location of Equipment Resuscitation RoomResuscitation Room Code BoxCode Box

14. Specialized Organizers Bag systemsBag systems Cart systemsCart systems Other itemsOther items

15. EQUIPMENT LIST Oxygen source Oxygen source Oxygen masks Oxygen masks Self-inflating bag- valve resuscitators Self-inflating bag- valve resuscitators Nasal cannula Nasal cannula Nebulizer for inhalation treatments Nebulizer for inhalation treatments Suction apparatus Suction apparatus Suction catheters Suction catheters Oral airways Oral airways Fluids Fluids IV Access catheters IV Access catheters Intraosseous needles Intraosseous needles

16. Miscellaneous Equipment Blood pressure cuffsBlood pressure cuffs Nasogastric tubesNasogastric tubes Feeding tubesFeeding tubes MonitorMonitor Wt. Based tapeWt. Based tape Pediatric backboardPediatric backboard Foley urine cathetersFoley urine catheters Pulse oxymeterPulse oxymeter

17. Medications LorazepamLorazepam Sterile WaterSterile Water NalaxoneNalaxone CetfriaxoneCetfriaxone DiphehydramineDiphehydramine AlbuterolAlbuterol EpinephrineEpinephrine Sodium bicarbonateSodium bicarbonate D50D50 AtropineAtropine CorticosteroidCorticosteroid

18. Maintaining Resuscitation Skills and Knowledge

19. Continuing Education PALS ENPC APLS CME

20. Maintaining Readiness for a Pediatric Emergency Mock Codes Mock Codes Scavenger Hunts Documentation

21. Maintaining Readiness Mock Codes Scavenger Hunts Documentation

22. Maintaining Readiness Mock Codes Scavenger Hunts Documentation

23. EMS: Members of the health care team

24. EMS Levels

25. Pediatric Training and Experience

26. Call 911

27. 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 didnt think baby could wait until her appointment later that day The infant has retractions; she then becomes cyanotic and begins gasping.

28. Recognize an Emergency

29. Summary Recognize an emergency Recognize an emergency Staff preparation Staff preparation Equipment Equipment Provider Skills Provider Skills Maintain Readiness Maintain Readiness EMS: member of the health care team EMS: member of the health care team