Report will revamp ED care of pediatric patients

The reports in the Institute of Medicine (IOM)'s The Future of Emergency Care series validate what many ED nurses have known for a long time: Overcrowding, boarding, diversion, long waits to be seen, inadequate staffing, and inconsistent competency levels all contribute to a potentially hazardous patient environment. "Add to that the increasing mental health, alcohol, and substance abuse special needs populations which have a potential for violence toward other patients and staff," says Mary M. Jagim, RN, BSN, CEN, FAEN, consultant for pandemic and emergency preparedness for MeritCare Health System in Fargo, ND, and IOM committee member.

The IOM's Emergency Care for Children: Growing Pains report found that only 6% of EDs had all the necessary supplies for pediatric emergencies. To improve pediatric care, the report calls for the following:

  • Have appropriate equipment for children. EDs often are lacking airway management and resuscitation supplies, says Jagim. She recommends using the Broselow system, using defibrillators with appropriate pediatric accessories, and implementing medication administration guidelines for children.
  • Ensure that staff are competent to care for pediatric patients. You should have appropriate training, such as the Emergency Nurses Association's Emergency Nursing Pediatric Course, Pediatric Advanced Life Support certification and demonstration of competency in pediatric sedation, advises Jagim.
  • Pay attention to pediatric needs during disaster planning. "There must be special considerations for families and for when children are separated from parents or lose parents," says Jagim. "You also need pediatric sized- ventilators and surge capacity specific to pediatrics. Children require different supplies, different equipment, accommodation of their families, or supporting the children if their family members are ill or have died."


For more information on the Institute of Medicine report, contact:

  • Mary Jagim, RN, BSN, CEN, FAEN, Internal Consultant for Pandemic and Emergency Preparedness, MeritCare Health System, 801 Broadway N., Fargo, ND 58122. Telephone: (701) 234-4893. E-mail:

Free summaries of all three reports in the Institute of Medicine's The Future of Emergency Care series are available on-line. The full reports include Emergency Medical Services at the Crossroads, Emergency Care for Children: Growing Pains, and Hospital-Based Emergency Care: At the Breaking Point. Go to and click on "Health and Medicine," "Healthcare and Quality," and scroll down to the titles.