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    Office preparedness for childhood emergencies

    Many pediatric practices are not prepared for an in-office emergency. These AAP recommendations will help you make your office code-blue ready.



    Maintain recommended emergency medications and use a resuscitation aid or tool that provides suggested protocols with precalculated medication doses.

    The policy statement also provides a listing of office emergency drugs that are similarly identified as essential or strongly suggested depending on EMS response time (Table 3). As with the equipment, medications and fluids should be checked regularly to make sure that all are present and that expired products are replaced.

    The recommendation to use a resuscitation aid or tool providing protocols with precalculated medication doses recognizes that dosing errors are a particular problem in pediatric patients.


    Develop a plan to provide education and continuing medical education for all staff.

    This recommendation recognizes the need for all personnel who may encounter a child in an emergency situation to have proper training to perform their duties and to maintain their knowledge and skills. Front-office staff must be able to recognize an emergency and initiate the response plan. Professional staff must be capable of providing basic airway management and initiating treatment of shock.

    As identified in the policy statement, the AAP/American College of Emergency Physicians (Advanced Pediatric Life Support [APLS]: The Pediatric Emergency Medicine Resource: www.apisonline.com/default.aspx; Advanced Life Support [ALS]: bit.ly/ALS-courses), the American Heart Association (PALS: Pediatric Advanced Life Support: bit.ly/PALS-training), and the Emergency Nurses Association (ENPC: Emergency Nursing Pediatric Course: bit.ly/ENPC-course) offer relevant instructional courses.


    Practice mock codes in the office on a regular basis (quarterly or biannually).

    Beyond having the knowledge and skills to respond to an emergency, office staff must be able to implement their responsibilities. Rehearsing by conducting mock emergency situations provides practice for maintaining preparedness and allows identification of ways to improve the response. Practicing mock codes also has been demonstrated to improve the confidence and comfort of pediatric providers for performing life-saving skills.9

    The mock codes should involve as many office staff as possible and, ideally, also participation of local EMS personnel. To facilitate a postexercise review and development of action plans to fine-tune the response, the policy statement recommends that one person should be designated to observe and document the event. Evaluation checklists are found in the appendices.

    A sample resuscitation log that can be used for collecting information during real emergency situations that will be vital for the child’s continuity of care is also included in the guideline.

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    The guideline also recommends including disaster-preparedness scenarios in the mock exercises.


    Educate families about what to do in an emergency.

    Family education aims to facilitate the fastest delivery of appropriate care that will optimize the outcome of a childhood emergency. It includes helping families to identify emergencies, decide where they should seek care, maintain information for children with special healthcare needs, and respond themselves by getting training in first aid and cardiopulmonary resuscitation. In addition to providing educational materials with information relevant to these topics, families should be provided with access numbers for reaching the office after hours as well as the emergency response system and poison centers. Resources available through the AAP include The Injury Prevention Program (TIPP), the first-aid chart, and an EMS information card.


    Partner with EMS and hospital-based emergency providers to ensure optimal emergency care and emergency/disaster readiness for children.

    The policy statement also suggests working with local EMS personnel who can provide in-office training or educational sessions as well as practice-specific input on the logistics of handling an emergency.


    1. Pendleton AL, Stevenson MD. Outpatient emergency preparedness: a survey of pediatricians. Pediatr Emerg Care. 2015;31(7):493-495.

    2. Flores G, Weinstock DJ. The preparedness of pediatricians for emergencies in the office: what is broken, should we care, and how can we fix it? Arch Pediatr Adolesc Med. 1996;150(3):249-256.

    3. Fuchs S, Jaffe DM, Christoffel KK. Pediatric emergencies in office practices: prevalence and office preparedness. Pediatrics. 1989;83(6):931-939.

    4. American Academy of Pediatrics. Periodic survey #27: Emergency readiness of pediatric offices. Available at: https://www.aap.org/en-us/professional-resources/Research/Pages/PS27_Exe.... Accessed April 20, 2017.

    5. Santillanes G, Gausche-Hill M, Sosa B. Preparedness of selected pediatric offices to respond to critical emergencies in children. Pediatr Emerg Care. 2006;22(11):694-698.

    6. Mansfield CJ, Price J, Frush KS, Dallara J. Pediatric emergencies in the office: are family physicians as prepared as pediatricians? J Fam Pract. 2001;50(9):757-761.

    7. Heath BW, Coffey JS, Malone P, Courtney J. Pediatric office emergencies and emergency preparedness in a small rural state. Pediatrics. 2000;106(6):1391-1396.

    8. American Academy of Pediatrics Committee on Pediatric Emergency Medicine; Frush K. Preparation for emergencies in the offices of pediatricians and pediatric primary care providers. Pediatrics. 2007;120(1):200-212.

    9. Toback SL, Fiedor M, Kilpela B, Reis EC. Impact of a pediatric primary care office-based mock code program on physician and staff confidence to perform life-saving skills. Pediatr Emerg Care. 2006;22(6):415-422.


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