• The Needle Tip - Pediatric Readiness Comes of Age

    Mary E. Fallat, MD

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    Pediatric Readiness Comes of Age

    Being “ready”, willing or capable of performing a task has taken on new meaning since the COVID pandemic. “Readiness” as defined as “being fully prepared for something” is now much more about being ready every day for the mass casualty event that might take place tomorrow. It used to be easier for a trauma or acute care surgery team to say, “we don’t take care of kids here” and to send the children to a center that specializes in pediatric care. As we consider the consequences and increasing frequency of mass shootings and of climate change and natural disasters (tornados, hurricanes, floods, mudslides, fires, and the threat of earthquakes), there will be circumstances where children must be managed in the rural or underserved environment at least temporarily and possibly for a couple of days until a tertiary or quaternary center can accept them in transfer. These high-level pediatric trauma centers are also at risk to be damaged or inaccessible during a disaster.

    The American College of Surgeons has partnered with the programs in the Health Resources and Services Administration (HRSA) including Emergency Medical Services for Children (EMSC) and the EMSC Innovation and Improvement Center (EIIC) to promote the importance of “pediatric readiness” in the emergency departments of trauma centers. There are several other key stakeholders including the American Academy of Pediatrics, the American College of Emergency Physicians, and the Society for Trauma Nurses. A recent publication has highlighted the survival benefits of a pediatric ready emergency department for injured children, but it also makes sense that injured patients of any age should be taken to a trauma center preferentially. There are many areas of the country, particularly in the northern plains and western parts of the United States where pediatric trauma centers are hours away from injured children and children need to be triaged to and stabilized at adult trauma centers, some of which see few children in their emergency departments daily. The pediatric readiness project enables the emergency department team to better prepare for both medical and surgical emergencies that involve children by doing a survey and understanding the gaps in equipment, supplies, medications and dosing, education, training, protocols and transfer agreements needed to optimize care. The program also champions designation of a key person or Pediatric Emergency Care Coordinator (PECC) to be the program manager in charge of pediatric readiness. Optimally, there will be a dyad of MD/RN who can oversee quality improvement and making sure there are quality and safety monitors in place for the program.

    What do trauma centers need to look forward to? Beginning in August 2023 when the new Resources for Optimal Care of the Injured Patient go into effect, there will be a new standard in place for all levels of trauma center verified by the ACS (see table). The best way to approach the standard is to work with your emergency department team, who will oversee making sure your center is pediatric ready. Your responsibilities will include understanding gaps in care for children and having a plan in place to address them when you submit your PRQ and have your site visit. Feel free to reach out to the Pediatric Subcommittee of the AAST with questions and we can help you work through the process.

     

    Standard 5.10-Pediatric Readiness

    Applicable Levels

    LI, LII, LIII, PTCI, PTCII

    Definition and Requirements

    In all trauma centers, the emergency department must evaluate its pediatric readiness and have a plan to address any deficiencies. 

    Additional Information

    “Pediatric readiness” refers to infrastructure, administration and coordination of care, personnel, pediatric-specific policies, equipment, and other resources that ensure the center is prepared to provide care to an injured child. The components that define readiness are available in the Resources link below.

    https://emscimprovement.center/domains/pediatric-readiness-project/readiness-toolkit/

    Measures of Compliance

    Gap analysis with plan to address deficiencies in pediatric readiness

     

     

    References:

    Resources for Optimal Care of the Injured Patient (2022 Standards)

    https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwi-07KZ-tP5AhWdKFkFHRvcCe8QFnoECBYQAQ&url=https%3A%2F%2Fwww.facs.org%2Fquality-programs%2Ftrauma%2Fquality%2Fverification-review-and-consultation-program%2Fstandards%2F&usg=AOvVaw2JoOKiMdPFrc-IaPqPN-oA

     

    https://emscimprovement.center/domains/pediatric-readiness-project/

     

    Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL; AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine and Section on Surgery; AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee; EMERGENCY NURSES ASSOCIATION Pediatric Committee. Pediatric Readiness in the Emergency Department. Pediatrics. 2018 Nov;142(5):e20182459. doi: 10.1542/peds.2018-2459. Erratum in: Pediatrics. 2019 Mar;143(3): PMID: 30389843.

    https://publications.aap.org/pediatrics/article/142/5/e20182459/38608/Pediatric-Readiness-in-the-Emergency-Department

     

    Newgard CD, Lin A, Olson LM, Cook JNB, Gausche-Hill M, Kuppermann N, Goldhaber-Fiebert JD, Malveau S, Smith M, Dai M, Nathens AB, Glass NE, Jenkins PC, McConnell KJ, Remick KE, Hewes H, Mann NC; Pediatric Readiness Study Group. Evaluation of Emergency Department Pediatric Readiness and Outcomes Among US Trauma Centers. JAMA Pediatr. 2021 Sep 1;175(9):947-956. doi: 10.1001/jamapediatrics.2021.1319. PMID: 34096991; PMCID: PMC8185631.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185631/

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