Preparedness and Response to Pediatric COVID-19 in European Emergency Departments: A Survey of the REPEM and PERUKI Networks

Abstract

Study objective: We aim to describe the variability and identify gaps in preparedness and response to the coronavirus disease 2019 pandemic in European emergency departments (EDs) caring for children.

Methods: A cross-sectional point-prevalence survey was developed and disseminated through the pediatric emergency medicine research networks for Europe (Research in European Pediatric Emergency Medicine) and the United Kingdom and Ireland (Paediatric Emergency Research in the United Kingdom and Ireland). We aimed to include 10 EDs for countries with greater than 20 million inhabitants and 5 EDs for less populated countries, unless the number of eligible EDs was less than 5. ED directors or their delegates completed the survey between March 20 and 21 to report practice at that time. We used descriptive statistics to analyze data.

Results: Overall, 102 centers from 18 countries (86% response rate) completed the survey: 34% did not have an ED contingency plan for pandemics and 36% had never had simulations for such events. Wide variation on personal protective equipment (PPE) items was shown for recommended PPE use at pretriage and for patient assessment, with 62% of centers experiencing shortage in one or more PPE items, most frequently FFP2 and N95 masks. Only 17% of EDs had negative-pressure isolation rooms. Coronavirus disease 2019-positive ED staff was reported in 25% of centers.

Conclusion: We found variation and identified gaps in preparedness and response to the coronavirus disease 2019 epidemic across European referral EDs for children. A lack in early availability of a documented contingency plan, provision of simulation training, appropriate use of PPE, and appropriate isolation facilities emerged as gaps that should be optimized to improve preparedness and inform responses to future pandemics.

Figure 1

Map of participating countries and number of EDs participating in the survey per country.

Figure 2

Reported reduction in pediatric ED visits of participating EDs by time since first reported COVID-19 case in their country of origin. Participating EDs were at different time in the pandemic spread.

Figure E1

Percentage distribution of ED (A), ICU (B) and admission ward (C) surge capacity according to ED volume

Figure E1

Percentage distribution of ED (A), ICU (B) and admission ward (C) surge capacity according to ED volume

Figure E1

Percentage distribution of ED (A), ICU (B) and admission ward (C) surge capacity according to ED volume