Pediatric asthma fatalities put caregivers on Red Alert
After a child died of asthma symptoms in Gainesville, FL, in 1988, Cindy L. Capen, MSN, RN, began to develop the Red Alert Program at The University of Florida, in order to decrease asthma mortality among children.
The child’s death was attributed to a combination of factors that programs like Red Alert can prevent, says the pediatric pulmonary division nursing specialist at the University of Florida in Gainesville. These factors include:
• family members uneducated about asthma;
• delays seeking medical attention;
• communication errors in emergency departments causing delays in treatment.
Capen says Red Alert helps at-risk children get rapid access to a network of health care professionals who are trained to swiftly respond to their needs. The program also provides individually tailored education and prevention techniques to parents and caregivers, as well as to others who interact with the child, such as school officials, teachers, EMS technicians, and primary care physicians.
"This is an aggressive safety net program," she says. "There’s a lot of education and a lot of people involved."
The approach is proactive. On three occasions, medical teams sought medical foster home placement when parents of young asthmatic children "failed to appropriately intervene in life-threatening episodes," Capen says.
Patients are recommended for the program after showing difficulty controlling their disease. They may have had an asthma-related emergency, needed hospitalization three or more times, lack family support, or have other difficulty with asthma symptoms.
Here’s what is included in the Red Alert Program’s multidisciplinary intake assessments:
• the child’s asthma history;
• the child and the family’s knowledge of asthma and asthma management;
• family health beliefs;
• the child’s environmental and socio-economic factors.
A key to the Red Alert program is a rapid response network composed of family caregivers, the local emergency department, local ambulance service, child’s primary care physician, school or day care center, tertiary caregivers and the hospital’s pediatric pulmonary team.
Details of the child’s medical history, medications and instructions about appropriate responses to an acute episode are given to all those who were part of each child’s support network with the parents’ permission.
Local EMS crews in the child’s area get information about the patient, directions to the child’s residence, and instructions for emergency treatment specific to the equipment available to them.
Emergencies that take place during office hours are given immediate attention, and handled by a nurse specialist. At other times, a call to the hospital operator sets off a chain of emergency events:
• first, a STAT page to a pulmonologist;
• if the page is not answered within two minutes, a second pulmonologist is paged;
• if that page is not answered with two minutes, the senior pediatric resident is to be paged (Capen says this third step has never been necessary in the University of Florida’s experience).
"I think the idea is a really, really exciting one," says Diane McLean, PhD, MPH, director of the Childhood Asthma Initiative for the Children’s Health Fund at Montefiore Medical Center Schering-Plough in New York City. "They recognized all the factors predictive of mortality and addressed them."
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