Crisis in the ER

Pediatric Paddles -- Stat

Seven sizes of breathing masks hang on a child's examining room wall at Robert Wood Johnson University Hospital in New Brunswick, NJ. The Disney-themed room also stocks scaled-down resuscitation equipment, three sizes of blood pressure cuffs, and two sizes of ear speculums. The reason: "We care for newborns to teens. How could they use the same equipment as one another, let alone adults?" asks Thomas Bojko, M.D., director of operations and critical care. "For instance, the breathing mask has to fit snugly around the face so all the air can reach the lungs. Using the wrong size mask can be life-threatening."

But what seems obvious to Dr. Bojko is anything but at some community hospitals. "Some doctors who are transferring a child can't give me a blood pressure reading because they don't have a pediatric cuff," says Joseph Wright, M.D., a pediatric emergency medicine specialist at Children's National Medical Center in Washington, DC.

Last year, the American Academy of Pediatrics (AAP) issued updated guidelines for the care of children in the emergency department. They included a list of more than 50 kinds of kid-related equipment and supplies that ERs should stock. But no one's mandating that hospitals do so. So are they? It's questionable.

A survey sent to 101 ERs in 1998 and 1999 found that 43% lacked infant cervical collars, used in spinal injuries. Overall, though, most ERs claimed that much of the necessary pediatric equipment was on hand. Still, no one checked to make sure. In a similar study, doctors at Montreal Children's Hospital in Canada surveyed 737 Canadian ERs and visited 38 to verify the accuracy of the responses. The result: Eight of the nine types of equipment examined weren't as available as hospitals claimed. In the survey, 24% of hospitals admitted that they didn't have intraosseous needles (used for giving IVs to infants), but during the visits, 38% of hospitals lacked them; 11% indicated they didn't have infant blood pressure cuffs, but 16% were missing them.

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