[Has the presence of parents during invasive procedures in the emergency department increased in the last few years?]. / ¿Ha aumentado la presencia de los padres durante los procedimientos invasivos en urgencias en los últimos años?

INTRODUCTION: In the recent years, parents are playing an important role in Pediatric Emergency Department (PED), and wish to be present when invasive procedures (IP) are performed. OBJECTIVES: 1) To compare the presence of parents during IP in PED in Spain between 2008 and 2012. 2) To compare the arguments to restrict the presence and problems arising from this, and 3) To determine whether the views of health personnel have changed on this subject. METHODOLOGY: A descriptive multicenter comparative study was conducted in 2008 and 2012. A total of 42 questionaires were sent by email to PED managers, with the responding hospitals being included in the 2 periods of the study. RESULTS: A total of 22 hospitals participated in the study. The presence of parents in the PED increased between 2008 and 2012 for all IP, significantly in the blood test and urine catheterization. In 2012, managers state that children are not so nervous, and anxiety of the parents and staff fear of a poorer performance, as an argument to restrict family presence. There were few problems during the 2 periods, with the poor behavior of the children decreasing. According to managers, the opinion of health personnel has not changed in the last four years. CONCLUSIONS: The presence of parents during the IP in the PED has increased in the last four years, although the presence is low for more invasive procedures. Managers argue the presence of fewer behavior problems to restrict family presence. The opinion of the staff has not changed in the last four years, although more studies are required on this issue.

¿Estamos preparados para una catástrofe? Estudio multicéntrico español / Are we prepared for a disaster? Spanish multicentre study

Introducción: Los servicios de urgencias pediátricos (SUP) deben tener planes de actuación ante una catástrofe, para poder actuar rápida y eficazmente. Objetivos: a) Conocer si los SUP españoles tienen planes de catástrofes; b) describir sus características, y c) si contemplan las necesidades pediátricas. Material y métodos: Estudio observacional descriptivo multicéntrico, mediante encuestas dirigidas a responsables de los SUP de España. Se incluyen preguntas sobre los planes de catástrofes externas (PCE) y sobre los planes de catástrofes internas (PCI). Resultados: De 44 encuestas enviadas, 25 hospitales responden. Dieciocho disponen de PCE, con una antigüedad de 10 años y que se revisa cada 3 años o más (9 hospitales), bienalmente (4) y anualmente (2). El PCE es conocido por el personal en 11/18 hospitales. En 13/18 hospitales nunca se realizan simulacros del PCE. Veintiún hospitales disponen de PCI, con una antigüedad de 8 años y frecuencia de revisión de cada 3 años o más (11), bienalmente (3) y anualmente (3). El PCI es conocido por el personal en 13/21 hospitales. Nunca se realizan simulacros del PCI en 12/21. Los PCI incluyen plan de evacuación (22), incendios (19), amenazas de bomba (13) e inundaciones (9). En 9 hospitales, los planes son pediátricos; en 7, son planes generales que contemplan las necesidades de los niños; el resto no tiene en cuenta a víctimas pediátricas. Conclusiones: La mayoría de SUP dispone de planes de catástrofes, pero estos están poco actualizados, son poco conocidos y la mitad no tiene en cuenta al paciente pediátrico. Es necesario mejorar los planes de catástrofe(AU)

Introduction: Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response. Objectives: 1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them. Material and methods: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP). Results: Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP. Conclusions: Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED(AU)

[Are we prepared for a disaster? Spanish multicentre study]. / ¿Estamos preparados para una catástrofe? Estudio multicéntrico español.

INTRODUCTION: Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response. OBJECTIVES: 1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them. MATERIAL AND METHODS: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP). RESULTS: Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP. CONCLUSIONS: Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED.

Situaciones de catástrofes: ¿qué debemos saber y hacer? / Diaster situations. What must we know and do?

Las catástrofes son situaciones que superan la capacidad local de respuesta, produciendo un número significativo de víctimas. A pesar de su baja frecuencia, su extrema gravedad obliga al personal sanitario a estar preparado para enfrentarse rápida y eficientemente a los diferentes tipos de desastres. La población infantil es especialmente vulnerable a sus efectos, por lo que el papel del pediatra es esencial no sólo durante la catástrofe sino también durante la planificación previa. En el presente artículo de revisión, se describen los diferentes tipos de catástrofes, las peculiaridades físicas y psicológicas de los niños, el papel del pediatra en los desastres, las fases de manejo de las catástrofes y por último la planificación en los centros sanitarios (AU)

Disasters are situations or events that overwhelm local capacity and can cause great damage and human suffering. Disasters are uncommon but their consequences may be extremely serious; that is why it is absolutely necessary that health care providers become fully prepared. The paediatric population is especially vulnerable to disasters effects, and so paediatricians have to play an essential role, not only during the disaster but also previously, during disaster planning. This review aims to provide an overview of the different types of disaster, the role of paediatricians in disaster preparedness, the stages of disaster managing and finally, hospital preparedness (AU)

[Disaster situations. What must we know and do?]. / Situaciones de catástrofes: ¿qué debemos saber y hacer?

Disasters are situations or events that overwhelm local capacity and can cause great damage and human suffering. Disasters are uncommon but their consequences may be extremely serious; that is why it is absolutely necessary that health care providers become fully prepared. The paediatric population is especially vulnerable to disasters effects, and so paediatricians have to play an essential role, not only during the disaster but also previously, during disaster planning. This review aims to provide an overview of the different types of disaster, the role of paediatricians in disaster preparedness, the stages of disaster managing and finally, hospital preparedness.

¿Están presentes los padres durante los procedimientos invasivos? Estudio en 32 hospitales de España / Are parents present during invasive procedures? Assessment in 32 Spanish hospitals

Introducción: La participación de los padres en la toma de decisiones médicas sobre su hijo es esencial, siendo fundamental su presencia durante la realización de procedimientos invasivos (PI). Objetivos1) Estimar la frecuencia de la presencia familiar durante diferentes PI en los servicios de Urgencias Pediátricas (SUP) españoles; 2) estudiar los motivos por los que se restringe esta presencia; 3) conocer el grado de acuerdo del personal sanitario sobre esta. Material y métodos: Estudio descriptivo multicéntrico basado en encuestas dirigidas a responsables de SUP españoles. Resultados: Se envían 43 encuestas, respondiendo 32 hospitales. En 11 hospitales nunca se da opción a los padres de presenciar los PI. En el resto, los padres pueden presenciar la extracción sanguínea (en 15 hospitales), sutura de heridas (14), sondaje vesical (9), punción lumbar (7), intubación (1) y maniobras de reanimación (1), sin encontrarse diferencias entre hospitales. Para restringir la presencia familiar, los encuestados argumentan la ansiedad de los padres (26/30) y un peor rendimiento del personal (23/30). Ocasionalmente han surgido problemas derivados de la presencia familiar, siendo el más frecuente el mareo (22/28). Los responsables creen que el personal está poco o nada de acuerdo con la presencia familiar, especialmente cuanto más invasivo es el PI. Dos hospitales tienen un grupo de trabajo y uno un protocolo específico. Conclusión: La presencia familiar en nuestros SUP es escasa, probablemente por la ansiedad de los padres y el temor al peor rendimiento del personal. Los sanitarios están poco de acuerdo, especialmente durante las técnicas más invasivas (AU)

Introduction: Parental participation in medical decisions involving their children is essential and family presence during invasive procedures (IP) is fundamental. Objectives: 1) To determine the frequency of parental presence during different IP in Spanish Paediatrics Emergency Departments (PED). 2) To assess the reasons for restricting parental presence. 3) To evaluate the agreement of health care professionals with regards to parental presence. Materials and methods: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. Results: Thirty-two out of 43 questionnaires were replied. Family presence during IP is never allowed in 11 hospitals. In the rest, this varies depending on the type of IP: blood sampling (15 hospitals), wound suture (14), urethral catheterization (9), lumbar puncture (7), intubation (1) and cardiopulmonary resuscitation (1), with no significant differences between hospitals. The main arguments for restricting parental presence are parental anxiety (26/30) and a lower performance by health personnel (23/30). Occasional problems, such as nausea (22/28), have arisen due to family presence. The interviewed physicians in charge think that health care professionals’ agreement rates for parental presence decrease significantly with the increasing invasiveness of the procedure. Two hospitals have a working group and one a specific protocol to address parental presence. Conclusions: Parental presence during IP is limited in Spanish PED, due to parental anxiety and is detrimental to the success of the procedure. Physicians and nurses disagree with family presence, especially during the most invasive procedures (AU)

[Are parents present during invasive procedures? Assessment in 32 Spanish hospitals]. / ¿Están presentes los padres durante los procedimientos invasivos? Estudio en 32 hospitales de España.

INTRODUCTION: Parental participation in medical decisions involving their children is essential and family presence during invasive procedures (IP) is fundamental. OBJECTIVES: 1) To determine the frequency of parental presence during different IP in Spanish Paediatrics Emergency Departments (PED). 2) To assess the reasons for restricting parental presence. 3) To evaluate the agreement of health care professionals with regards to parental presence. MATERIALS AND METHODS: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. RESULTS: Thirty-two out of 43 questionnaires were replied. Family presence during IP is never allowed in 11 hospitals. In the rest, this varies depending on the type of IP: blood sampling (15 hospitals), wound suture (14), urethral catheterization (9), lumbar puncture (7), intubation (1) and cardiopulmonary resuscitation (1), with no significant differences between hospitals. The main arguments for restricting parental presence are parental anxiety (26/30) and a lower performance by health personnel (23/30). Occasional problems, such as nausea (22/28), have arisen due to family presence. The interviewed physicians in charge think that health care professionals' agreement rates for parental presence decrease significantly with the increasing invasiveness of the procedure. Two hospitals have a working group and one a specific protocol to address parental presence. CONCLUSIONS: Parental presence during IP is limited in Spanish PED, due to parental anxiety and is detrimental to the success of the procedure. Physicians and nurses disagree with family presence, especially during the most invasive procedures.

[Parental presence during invasive procedures in the emergency department]. / ¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias?

Over the last decades, health care has been moving away from the paternalistic model, to one of family-centered care. In the pediatric emergency department, this new trend has led to parents playing a larger role in the health care of children, particularly during invasive procedures and/or resuscitation. Despite the increased attention to family presence, it remains a controversial topic, especially among emergency medical staff. Several studies have been performed that look at the advantages and disadvantages of this new way of conceiving child health care. To our knowledge, there is only one Spanish article on this topic, which is the reason why we performed a literature review on family presence in the emergency department.

¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias? / Parental presence during invasive procedures in the emergency department

En las últimas décadas, el modelo de medicina paternalista se ha sustituido por un modelo centrado en el sujeto y sus familiares. En el ámbito de las urgencias pediátricas, este hecho ha conllevado un mayor protagonismo de los padres, especialmente durante la realización de procedimientos invasivos. Numerosos autores han estudiado las ventajas y los inconvenientes de esta nueva práctica, tanto para los sujetos y sus familiares como para el personal sanitario. Dada la escasa bibliografía española, se revisó la literatura médica publicada hasta el momento y se analizaron los posibles beneficios y perjuicios para el sujeto y sus familiares, así como la posición de los profesionales sanitarios(AU)

Over the last decades, health care has been moving away from the paternalistic model, to one of family-centered care. In the pediatric emergency department, this new trend has led to parents playing a larger role in the health care of children, particularly during invasive procedures and/or resuscitation. Despite the increased attention to family presence, it remains a controversial topic, especially among emergency medical staff. Several studies have been performed that look at the advantages and disadvantages of this new way of conceiving child health care. To our knowledge, there is only one Spanish article on this topic, which is the reason why we performed a literature review on family presence in the emergency department(AU)