A mock-drill study conducted in a third of North Carolina's hospital emergency departments (EDs) revealed that nearly all failed to properly stabilize seriously injured children during trauma simulations, according to a team of researchers at the Johns Hopkins Children's Center and Duke University Medical Center. Simulations were conducted in 35 of North Carolina's 106 EDs. Of the 35 EDs in the study, five were designated trauma centers (out of a total of 11 in the State of North Carolina), and 30 were located in community hospitals. A report on the work by the research team stating the results probably apply to hospitals nationwide is published in the March issue of Pediatrics.

Although researchers caution that observations during mock codes do not necessarily represent performance in an actual health emergency, the study's results do suggest that hospital EDs are not fully prepared to deal with pediatric emergencies, according to lead author Elizabeth A. Hunt, M. D., M. P. H., assistant professor of Anesthesiology and Critical Care Medicine at Johns Hopkins.

Hunt and colleagues staged "mock codes," using life-size child mannequins. They presented each ED team with a vignette describing the patient's symptoms, appearance and vital signs. Researchers then observed and rated the team's performance on 44 stabilization tasks, such as evaluating an airway, administering fluids and ordering appropriate tests.

None of the departments performed flawlessly, Hunt says, and while mistakes were ubiquitous, certain failures were more worrisome than others. For example, of the 35 EDs studied, 34 failed to administer dextrose properly to a child in hypoglycemic shock (a life-threatening sharp drop in blood sugar). Also, 34 of 35 failed to correctly warm a hypothermic child.

Thirty-one of the 35 also failed to order proper administration of IV fluids, and personnel in 24 out of 35 did not either attempt or succeed at accessing a child's bloodstream
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Contact: Katerina Pesheva
epeshev1@jhmi.edu
410-516-4996
Johns Hopkins Medical Institutions
6-Mar-2006

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