So it would seem that there are no GOOD reasons not to have an office emergency readiness plan. However, as mentioned, a low number of offices actually have such a plan. In fact, one study reported that even offices who had previously contacted EMS for transport of a critically ill child remained, in their words, "less than well prepared" to handle another such emergency.
How then to increase compliance with recommended guidelines? Two interventional studies have been published involving education and training of staff, unannounced mock codes and subsequent debriefing with constructive suggestions for improvement. These interventions, carried out by local EMS personnel and ER docs, were shown to improve office training and development of office protocols for handling emergencies. Additionally, risk management companies can offer incentives to increase compliance among their clients. Finally, pediatric training programs can help in two ways. First by emphasizing during residency the importance of office emergency readiness and secondly by insisting on maintenance of PALS certification by pediatric residents.
Remember the idea is not for an office to equip itself as a mini-ER. Rather it is for each practice to conduct an assessment of the most common emergencies they see and to construct an emergency preparedness plan accordingly. The Institute of Medicine recommends thinking of the pediatrician's office as part of a larger emergency response system comprised of the patient's medical home, EMS, local pediatric ER and tertiary care pediatric facility. Collaboration with the local EMS and ER docs for training and support is encouraged. Pediatric office emergencies, uncommon though they may be, certainly will have a better outcome with incorporation of the pediatric practice into the spectrum of emergency care.