Pediatric offices were urged to strengthen emergency preparedness through structured assessments, defined response protocols, and staff training, according to an updated policy statement and technical report from the American Academy of Pediatrics.

The guidance updates 2007 recommendations and introduces a framework for individualized emergency preparedness across primary care and subspecialty settings, highlighting that office-based emergencies, although infrequent, require rapid stabilization and coordinated transfer to higher levels of care.

Low Frequency, High Stakes

The technical report characterized pediatric office emergencies as uncommon but consequential, occurring at a rate of approximately one to two events per office annually in recent estimates. The events most commonly consist of respiratory distress, seizures, and psychiatric or behavioral emergencies, with allergic reactions also frequently encountered.

Despite their rarity, multiple studies cited in the report identified gaps in preparedness, including lack of standardized procedures, insufficient equipment, and limited staff confidence in emergency management.

Core Framework: Assessment, Protocols, and Training

The American Academy of Pediatrics (AAP) recommends that practices conduct structured, recurring assessments of emergency readiness that incorporate common types of pediatric emergencies, office setting and layout, staff roles, patient population, proximity to emergency departments, and emergency medical services (EMS) response times.

Protocols should address:

• Telephone and in-office triage

• Management algorithms for common emergencies

• Transport decisions based on patient acuity and available EMS resources.

The technical report noted that EMS response times vary substantially, averaging about 7 minutes in nonrural settings and more than 14 minutes in rural areas, with nearly 10% of very rural setting responses approaching 30 minutes. These differences directly influence the level of in-office stabilization required.

Staff training is a central component of preparedness. At minimum, all clinical staff should maintain Basic Life Support certification, with additional training such as Pediatric Advanced Life Support, Advanced Pediatric Life Support, or Pediatric Emergency Assessment, Recognition, and Stabilization recommended depending on the practice setting.

Simulation-based training—conducted at least annually—can be associated with improved confidence, preparation, and performance in managing emergencies.

Equipment and Medication Standards

The policy divides supplies into essential and additional categories to allow for flexibility based on the practice characteristics.

Essential equipment includes airway management tools, oxygen delivery systems, defibrillators, and monitoring devices; while essential medications include albuterol, epinephrine, dexamethasone, and naloxone.

Additional supplies—such as intravenous access materials or advanced airway devices—may be appropriate in settings with longer EMS response times or higher-acuity patient populations.

Management of Common Emergencies

The technical report provides evidence-based guidance for frequent office emergencies:

• Respiratory distress: Treatment includes beta-2 agonists, corticosteroids, and supplemental oxygen. Adding nebulized ipratropium bromide to beta-agonists reduced hospitalization risk, with 16 patients needing treatment to prevent one admission.

• Seizures: Benzodiazepines remain first-line therapy for seizures lasting 5 minutes or longer, with intranasal midazolam showing comparable or superior effectiveness vs rectal diazepam in small studies.

• Anaphylaxis: Intramuscular epinephrine can be a lifesaving treatment and is associated with reduced hospitalization and mortality; antihistamines don't address life-threatening symptoms.

• Mental health emergencies: Approximately 22% of US high school students reported seriously considering suicide in 2021, highlighting the need for screening tools and access to crisis resources.

Systems-Based Response and Communication

Early EMS activation is highlighted as a critical step, with evidence linking rapid activation to shorter times to definitive treatment in conditions such as shock and respiratory failure.

The guidance also recommends:

• Designated emergency response roles

• Structured communication methods, including closed-loop communication

• Standardized handoff tools for EMS transitions

• Documentation systems capturing patient, event, and outcome variables.

Limitations and Evidence Base

The policy statement and technical report highlight that preparation for pediatric emergencies varies based on office setting, patient population, available resources, and proximity to emergency services.

The guidance authors note that offices differ in location, staffing, and access to emergency medical services and hospitals, and that these factors should be considered when planning for emergencies.

Accordingly, the recommendations are intended to support flexibility and allow health care practices to develop an individualized approach to emergency preparedness based on their specific circumstances and patient needs.

The report also outlines that readiness involves multiple components, including assessment of the practice environment, development of protocols, availability of equipment and medications, and training of personnel to recognize and manage emergencies.

“Preparation for and management of these emergencies is guided by the most common types of emergencies; the office setting, location, and size; and anticipated timeliness of EMS arrival,” wrote lead author Patricia Cantrell, MD, FAAP, of the Department of Pediatrics at the Southern California Permanente Medical Group, and colleagues. "The information and resources in [the] technical report can be used to help improve medical care delivery and patient outcomes when pediatric emergencies present in the offices that care for [pediatric] and adolescent [patients]," they concluded.

Full disclosures of the study authors can be found in the policy statement and technical report.

Source: Pediatrics Policy Statement, Technical Report