The Office Emergency Response

  • Rohit Shenoi
  • Faria Pereira
  • Joyce Li
  • Angelo P. Giardino
Part of the SpringerBriefs in Public Health book series (BRIEFSPUBLIC)


The office emergency manual provides a framework for achieving pediatric office emergency preparedness. The organizational aspects of an emergency response consist of office policy and procedures, emergency medications and equipment, and the roles and responsibilities of staff members who respond to an office emergency. The management section consists of treatment protocols for pediatric office emergencies and guidance in special circumstances such as psychosocial crises, disasters, and emergencies in children with special healthcare needs.


Office emergency response Emergency protocols Emergency medications 


A) Systems and Priorities

  1. Flores, G., & Weinstock, D. J. (1996). The preparedness of pediatricians for emergencies in the office: what is broken, should we care, and how can we fix it? Archives of Pediatrics and Adolescent Medicine, 150(3), 249–256.PubMedCrossRefGoogle Scholar
  2. Walsh-Kelly, C. M., Bergholte, J., Erschen, M. J., & Melzer-Lange, M. (2004). Office preparedness for pediatric emergencies: baseline preparedness and the impact of guideline distribution. Pediatric Emergency Care, 20(5), 289–294.PubMedCrossRefGoogle Scholar
  3. Shetty, A. K., Hutchinson, S. W., Mangat, R., & Peck, G. Q. (1998). Preparedness of practicing pediatricians in Louisiana to manage emergencies. Southern Medical Journal, 91(8), 745–748.PubMedCrossRefGoogle Scholar
  4. Santillanes, G., Gausche-Hill, M., & Sosa, B. (2006). Preparedness of selected pediatric offices to respond to critical emergencies in children. Pediatric Emergency Care, 22(11), 694–698.PubMedCrossRefGoogle Scholar
  5. Schmitt, B. D. (2010). Pediatric telephone protocols: office version (13th ed.). IL: American Academy of Pediatrics Elk Grove Village.Google Scholar

B) Protocols for Common Pediatric Office Emergencies Asthma

  1. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program, Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full Report, U.S. Department of Health and Human Services, National Institutes of Health, 2007.Google Scholar
  2. Murphy, K. R., Hopp, R. J., Kittelson, E. B., Hansen, G., Windle, M. L., & Walburn, J. N. (2006). Life-threatening asthma and anaphylaxis in schools: a treatment model for school-based programs. Annals of Allergy, Asthma and Immunology, 96(3), 398–405.CrossRefGoogle Scholar
  3. Clinical Guidelines. (2012). Asthma guideline evidence-based outcome center—Texas Children’s Hospital, Houston, Texas. Accessed 18 Sept 2012.Google Scholar
  4. Castro-Rodriguez, J. A., & Rodrigo, G. J. (2004). Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. Journal of Pediatrics, 145(2), 172–177.PubMedCrossRefGoogle Scholar
  5. Rowe, B. H., Spooner, C. H., Ducharme, F. M., Bretzlaff, J. A. & Bota, G. W. (2007). Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD0001 95. doi: 10.1002/14651858.CD000195.pub2.

Blunt Head Trauma

  1. Kuppermann, N., Holmes, J. F., Dayan, P. S., et al. (2009). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The Lancet, 374(9696), 1160–1170.CrossRefGoogle Scholar


  1. Diagnosis and Management of Bronchiolitis. (2006). American academy of pediatrics subcommittee on diagnosis and management of bronchiolitis. Pediatrics, 118(4), 1774–1793.CrossRefGoogle Scholar
  2. Bronchiolitis Guideline Team, Cincinnati Children’s Hospital Medical Center. (2012). Evidence based clinical practice guideline for medical management of bronchiolitis in infants 1 year of age or less presenting with a first time episode. Guideline 1, pp. 1–13. Accessed 23 Sept 2012.
  3. Viswanathan, M., King, V., & Bordley, C. (2003). Management of bronchiolitis in infants and children. Evidence report/Technology assessment no. 69. AHRQ Publication No. 03-E014. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.Google Scholar
  4. Mansback, J. M., Clark, S., Christopher, N. C., LoVecchio, R., Kunz, S., Acholonu, U., et al. (2008). Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department. Pediatrics, 121(4), 680–688.CrossRefGoogle Scholar
  5. Levine, D. A., Platt, S. L., Dayan, P. S., Macias, C. G., Zorc, J. J., Krief, W., et al. (2004). Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics, 113(6), 1728–1734.PubMedCrossRefGoogle Scholar

Cardiac Arrest

  1. Kleinman, M. E., Chameides, L., Schexnayder, S. M., Samson, R. A., Hazinski, M. F., Atkins, D. L., et al. (2010a). Part 14: pediatric advanced life support: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(3), S876–S908.PubMedCrossRefGoogle Scholar
  2. Kleinman, M. E., Chameides, L., Schexnayder, S. M., et al. (2010b). Special report—Pediatric advanced life support: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics, 126(5), e1361–1399.PubMedCrossRefGoogle Scholar

Choking (Infant and Child)

  1. Pediatric Basic Life Support (2000) Resuscitation, 46, 326–329.Google Scholar


  1. Bjornson, C., Russell, K. F., Vandermeer, B., Durec, T., Klassen, T.P., Johnson, D.W. (2011). Nebulized epinephrine for croup in children. Cochrane Database of Systematic Reviews, (2):CD006619.Google Scholar
  2. Russell, K. F., Liang, Y., O’Gorman, K., Johnson, D. W., Klassen, T. P. (2011). Glucocorticoids for croup. Cochrane Database of Systematic Reviews, (1):CD001955.Google Scholar
  3. Scolnik, D., Coates, A. L., Stephens, D., Da Silva, Z., Lavine, E., & Schuh, S. (2006). Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA: The Journal of the American Medical Association., 295(11), 1274–1280.CrossRefGoogle Scholar
  4. Moore, M., Little, P. (2011). WITHDRAWN: Humidified air inhalation for treating croup. Cochrane Database of Systematic Reviews, (6):CD002870.Google Scholar

Diabetic Ketoacidosis

  1. Glaser, N., Barnett, P., McCaslin, I., Nelson, D., Trainor, J., Louie, J., et al. (2001). Risk factors for cerebral edema in children with diabetic ketoacidosis. New England Journal of Medicine, 344(4), 264–269.PubMedCrossRefGoogle Scholar
  2. Lawrence, S. E., Cummings, E. A., Gaboury, I., & Daneman, D. (2005). Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. Journal of Pediatrics, 146(5), 688–692.PubMedCrossRefGoogle Scholar
  3. Marcin, J. P., Glaser, N., Barnett, P., McCaslin, I., Nelson, D., Trainor, J., et al. (2002). Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Journal of Pediatrics, 141(6), 793–797.PubMedCrossRefGoogle Scholar
  4. Wolfsdorf, J., Glaser, N., & Sperling, M. A. (2006). Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care, 29(5), 1150–1159.PubMedCrossRefGoogle Scholar
  5. Clinical Guidelines. (2012). Diabetic Ketoacidosis guideline. Evidence-based outcome center—Texas Children’s Hospital, Houston. Accessed 18 Sept 2012.Google Scholar


  1. Initial management of seizures (Status Epilepticus) Clinical guideline Evidence-based Outcome Center—Texas Children’s Hospital, Houston. Accessed 12 Sept 2012.Google Scholar
  2. Vilke, G. M., Castillo, E. M., Ray, L. U., Murrin, P., & Chan, T. C. (2005). Evaluation of pediatric glucose monitoring and hypoglycemic therapy in the field. Pediatric Emergency Care, 21(1), 1–5.PubMedCrossRefGoogle Scholar
  3. Kumar, G., Sng, B. L., & Kumar, S. (2004). Correlation of capillary and venous blood glucometry with laboratory determination. Prehospital Emergency Care, 8(4), 378–383.PubMedGoogle Scholar
  4. Chin, R. F. M., Verhulst, L., Neville, B. G. R., Peters, M. J., & Scott, R. C. (2004). Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. Journal of Neurology, Neurosurgery and Psychiatry, 75(11), 1584–1588.CrossRefGoogle Scholar
  5. Chin, R. F. M., Neville, B. G. R., Peckham, C., Wade, A., Bedford, H., & Scott, R. C. (2008). Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. The Lancet Neurology, 7(8), 696–703.CrossRefGoogle Scholar
  6. McIntyre, J., Robertson, S., Norris, E., Appleton, R., Whitehouse, W. P., Phillips, B., et al. (2005). Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomized controlled trial. Lancet, 366(9481), 205–210.PubMedCrossRefGoogle Scholar
  7. Mpimbaza, A., Ndeezi, G., Staedke, S., Rosenthal, P. J., & Byarugaba, J. (2008). Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pediatrics, 121(1), e58–64.PubMedCrossRefGoogle Scholar
  8. Baysun, S., Aydin, O. F., Atmaca, E., & Gurer, Y. K. Y. (2005). A comparison of buccal midazolam and rectal diazepam for the acute treatment of seizures. Clinical Pediatrics, 44(9), 771–776.PubMedCrossRefGoogle Scholar
  9. Bhattacharyya, M., Kalra, V., & Gulati, S. (2006). Intranasal midazolam vs. rectal diazepam in acute childhood seizures. Pediatric Neurology, 34(5), 355–359.PubMedCrossRefGoogle Scholar
  10. Fisgin, T., Gurer, Y., Tezic, T., Senbil, N., Zorlu, P., Okuyaz, C., et al. (2002). Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. Journal of Child Neurology, 17(2), 123–126.PubMedCrossRefGoogle Scholar
  11. Prasad, K., Al-Roomi, K., Krishnan, P. R., Sequeira, R. (2005). Anticonvulsant therapy for status epilepticus. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003723. doi: 10.1002/14651858.CD003723.pub2.
  12. Appleton, R., Macleod, S., Martland, T. (2008). Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001905. doi: 10.1002/14651858.CD001905.pub2.
  13. Silbergleit, R., Durkalski, V., Lowenstein, D., Conwit, R., Pancioli, A., Palesch, Y., Barsan, W, NETT Investigators. (2012). Intramuscular versus intravenous therapy for prehospital status epilepticus. New England Journal of Medicine 366(7), 591–600.Google Scholar

Shock and Anaphylaxis

  1. Goldstein, B., Giroir, B., & Randolph, A. (2005). International consensus conference on pediatric sepsis international pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatric Critical Care Medicine, 6(1), 2–8.PubMedCrossRefGoogle Scholar
  2. Han, Y. Y., Carcillo, J. A., Dragotta, M. A., Bills, D. M., Watson, R. S., Mark, E., et al. (2003). Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics, 112, 793–799.PubMedCrossRefGoogle Scholar
  3. Carcillo, J. A., & Fields, A. I. (2002). Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Critical Care Medicine, 30, 1365–1378.PubMedCrossRefGoogle Scholar
  4. Dellinger, R. P., Levy, M. M., Carlet, J. M., et al. (2008). Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Critical Care Medicine, 36(1), 296–327.PubMedCrossRefGoogle Scholar
  5. Sampson, H. A., Muñoz-Furlong, A., Campbell, R. L., et al. (2006). Second symposium on the definition and management of anaphylaxis: summary report—second national institute of allergy and infectious disease/food allergy and anaphylaxis network symposium. Journal of Allergy and Clinical Immunology, 117(2), 391–397.PubMedCrossRefGoogle Scholar
  6. Scott, H., Sicherer, F., Estelle, R. & The Section on Allergy and Immunology American Academy of Pediatrics. (2007). Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics 119, 638–646.Google Scholar
  7. Sampson, H. A. (2003). Anaphylaxis and emergency treatment. Pediatrics, 111, 1601–1608.PubMedGoogle Scholar

Special Situations

  1. Emergency Preparedness for Children with Special Health Care Needs. (1999). Committee on pediatric emergency medicine American academy of pediatrics. Pediatrics, 104(4), e53.CrossRefGoogle Scholar
  2. Policy Statement Emergency Information Forms and Emergency Preparedness for Children with Special Health Care (2010) Needs American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and Council on Clinical Information Technology, American College of Emergency Physicians, Pediatric Emergency Medicine Committee Pediatrics, 125, 829–837.Google Scholar
  3. Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians (2006) Summary AHRQ Publication No. 06(07)-0056-1 Rockville, MD: Agency for Healthcare Research and Quality. September 2006.Google Scholar
  4. Bair-Merritt, M. H., & Fein, J. A. (2010). Intimate partner violence and child abuse. In A. P. Giardino & E. R. Giardino (Eds.), Intimate partner violence: a resource for professionals working with children and families. St. Louis: STM Learning.Google Scholar
  5. Giardino, A. P., & Lyn, M. A. (2009). The problem. In M. A. Finkel & A. P. Giardino (Eds.), Medical evaluation of child sexual abuse: a practical guide (3rd ed.). Elk Grove Village: American Academy of Pediatrics.CrossRefGoogle Scholar
  6. Giardino, A. P., Lyn, M. A., & Giardino, E. R. (2010). Introduction: child abuse and neglect. In A. P. Giardino, M. A. Lyn, & E. R. Giardino (Eds.), A practical guide to the evaluation of child physical abuse and neglect (2nd ed.). New York: Springer Publishing.Google Scholar
  7. National Center for the Prevention of Youth Suicide. Youth Suicide Behavior Fact Sheet. REACH NOLA. Community and Academic Partnerships.
  8. Shain, B. N. (2007). Suicide and suicide attempts in adolescents. Pediatrics, 120, 669.PubMedCrossRefGoogle Scholar
  9. Tscholl, J. J., & Scribano, P. V. (2010). Intimate partner violence. In A. P. Giardino, M. A. Lyn, & E. R. Giardino (Eds.), A practical guide to the evaluation of child physical abuse and neglect (2nd ed.). New York: Springer Publishing.Google Scholar
  10. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2011). Child Maltreatment 2010. Available from
  11. U.S. Centers for Disease Control and Prevention. National Suicide Statistics at a Glance.
  12. U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Alliance for Suicide Prevention. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington: HHS, Sept 2012.Google Scholar

Copyright information

© The Author(s) 2013

Authors and Affiliations

  • Rohit Shenoi
    • 1
  • Faria Pereira
    • 2
  • Joyce Li
    • 3
  • Angelo P. Giardino
    • 4
  1. 1.Texas Children’s HospitalHoustonUSA
  2. 2.Texas Children’s HospitalHoustonUSA
  3. 3.Texas Children’s HospitalBostonUSA
  4. 4.Texas Children’s Health PlanHoustonUSA

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