This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
Ill and injured children have unique needs that can be magnified when the child' s ailment is serious or life-threatening. This is especially true in the outof-hospital environment. Providing high-quality out-of-hospital care to children requires an emergency medical services (EMS) system infrastructure designed to support the care of pediatric patients. As in the emergency department setting, it is important that all EMS agencies have the appropriate resources, including physician oversight, trained and competent staff, education, policies, medications, equipment, and supplies, to provide effective emergency care for children. Resource availability across EMS agencies is variable, making it essential that EMS medical directors, administrators, and personnel collaborate with outpatient and hospital-based pediatric experts, especially those in emergency departments, to optimize prehospital emergency care for children. The principles in the policy statement "Pediatric Readiness in Emergency Medical Services Systems" and this accompanying technical report establish a foundation on which to build optimal pediatric care within EMS systems and serve as a resource for clinical and administrative EMS leaders. DEFINITIONS • Emergency medical services (EMS): An intricate and comprehensive system, which in a coordinated response, provides the arrangements of personnel, facilities, and equipment for the effective, coordinated, and timely delivery of health and safety services to provide emergency care. 1,2 • Out of hospital: A term used in emergency medicine to mean "in the field," "in the community," "at the patient's home or workplace," or "prehospital." Assessments performed and treatments given out of
The pediatric emergency care setting is recognized as a high-risk environment for medication errors because of a number of factors, including medically complex patients with multiple medications who are unknown to emergency department (ED) staff, a lack of standard pediatric drug dosing and formulations, 5 weight-based dosing, 6, 7 verbal
The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.
This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. CURRENT STATUS AND NEEDS ED Use and ED Crowding in the United StatesApproximately 800 000 children seek care in the emergency department (ED) each day in the United States. Additionally, it is estimated that 3.4% of US children use EDs as their source for sick care. The vast majority (92%) of these children are seen in community EDs, with a smaller percentage seen in pediatric EDs. The increase in ED utilization has saturated the capacity of EDs and emergency medical services in many communities. Increases in patient volume and decreases in resources, including fragmentation of resources and shortage of critical subspecialists, have resulted in EDs facing crowding and ambulance diversion.The need for emergency medical services outstrips the available resources on a daily basis. This mismatch is reflected by the considerable increase in the number of patients visiting EDs. In 1993, 90.3 million patients visited EDs; in 2003 that number increased to 113.9 million patients. Approximately 21% of these patients were younger than 15 years. Despite the increase in ED visits, the number of hospitals decreased by 703, the number of hospital beds decreased by 198 000, and the number of EDs decreased by 425.
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