To sharpen focus on the unique needs of pediatric patients, the American Academy of Pediatrics (AAP) recently updated a cornerstone clinical report on medications for responding to pediatric medical emergencies and issued a joint policy statement with leading emergency medicine organizations.
The pharmacological guidance is included in Drugs Used to Treat Pediatric Emergencies.¹ It’s an update to an AAP committee report originally published in 2008, Preparing for Pediatric Emergencies: Drugs to Consider.²
The newly issued report includes:
- Indications and dosages of medications used to treat pediatric emergencies in the prehospital, pediatric clinic, and emergency department settings
- Recommendations consistent with current medical emergency guidance such as the Advanced Pediatric Life Support and Pediatric Advanced Life Support textbooks and the
American Heart Association resuscitation guidelines.
- Additional references to pediatric resuscitation algorithms, rapid-sequence intubation (RSI), procedural sedation, and medical management.
Pediatric Medical Emergencies Present Unique Challenges
Although roughly one in 10 pre-hospital emergencies involves pediatric patients, not all responders have the expertise or equipment necessary to treat pediatric medical emergencies, says Dr. Scott A. Cohen, Chief Medical Information Officer and Chief Performance Improvement Officer for Bassett Healthcare Network.
“The AAP’s updates reflect the pervasive problems in emergency services and physician offices where medical emergency equipment and appropriate training can be problematic,” Dr. Cohen says. “There’s an acknowledgment that too many providers and systems don’t have, for example, the right size bag valve mask, the right pediatric auto-injector or the right size airways.
Pediatric medical emergency response is different from adult response in many ways, Dr. Cohen says. “The AAP is helping to raise awareness to improve the emergency care delivery system for all.”
The AAP further states: “Given the scope of pediatric emergency care in the United States and to facilitate consistency in the pharmacotherapy of medical emergencies in children, it is incumbent that all health providers who manage critically ill or injured children be knowledgeable of the medications used to treat pediatric emergencies. Changes in the pattern and scope of practice, changes in the dosages and indications of medications, availability of newer drugs, and the discontinuation of older pharmacotherapeutic agents make it necessary to stay updated.”
General recommendations currently focus on the determination of which drug to use based on the likely etiology of the problem. The use of preprinted weight-based medication cards and/or length-based resuscitation tapes is recommended when treating an emergency regardless of location (prehospital, ED, hospital ward, outpatient, or community clinic).
Support for a Standard Approach to Pediatric Emergency Care
The AAP’s updated report should encourage medical offices to take a standardized approach to pediatric medical emergency readiness, says nationally recognized patient safety expert Dr. Kenneth P. Rothfield. It also reflects the on-the-ground reality of medical systems everywhere.
“In accord with the Joint Commission’s recommendations, we have to be ready for unexpected pediatric emergencies anywhere in the hospital—even if that hospital does not normally take care of children,” says Dr. Rothfield. “The same logic extends to medical practices outside the hospital, particularly pediatric practices, where AAP surveys show a medical emergency occurs on average anywhere between once or more per week and once or more per month in pediatricians’ offices.”
“A standardized approach to pediatric readiness includes an appropriate pediatric emergency crash cart, BLS, ACLS and PALS training,” Dr. Rothfield says. ”It’s essential to make it as easy as possible for pediatric non-specialists to select the correct medications, dosages, and devices—that’s the real value of the Broselow system.”
Call for Medical Emergency Readiness in EMS
The AAP separately joined with four other medical groups to issue a policy statement urging that pediatric services be embedded into the Emergency Medical Services infrastructure nationwide. The policy and technical report from the AAP Committee on Pediatric Emergency Medicine and Section on Emergency Medicine’s EMS Subcommittee are available here.
1. Rohit P. Shenoi, Nathan Timm, COMMITTEE ON DRUGS and COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE,
Journal of the American Academy of Pediatric January 2020, 145 (1) e20193450; doi: https://doi.org/10.1542/peds.2019-3450
2. Hegenbarth, M.A. American Academy of Pediatrics Committee on Drugs,2008. doi:10.1542/peds.2007-3284