Society for Pediatric Urgent Care

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Society for Pediatric Urgent Care

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EMERGENCIES IN URGENT CARE

SCOPE OF PRACTICE

Defining scope of practice for your Urgent Care will depend on several factors including distance to local emergency department, availability of subspecialty consultation and transport resources.

Walk in care offers the advantage of convenience for families, but requires increased vigilance of the provider. While most families are able to recognize emergent conditions and seek care in the appropriate environment, each Urgent Care practitioner should be able to evaluate and stabilize emergent conditions prior to transport to the appropriate facility. Providers who will evaluate children should be comfortable with Advanced Life Support practices.

Understanding the transport modalities available to you will also help in defining your scope of practice. It is also important to understand if EMTALA applies to your specific location.

The list below is an example of signs and symptoms often necessitating acute emergency evaluation and management, specialty consultation, and/or hospital admission that are best stabilized in urgent care and transferred to a local emergency department or subspecialty hospital. Each individual practice should at least have protocol for managing conditions on this list and understand when transport is necessary

  • Shock
    • Hemodynamic instability
    • Anaphylaxis
  • Trauma
    • Cervical spine injury
    • Child Abuse and Neglect
    • Multiple Traumatic Injuries, Penetrating Trauma, or Distracting Injuries
    • Physical and Sexual Assault
    • Suspected abuse or neglect
  • HEENT
    • Headache with associated neurologic symptoms
    • Mastoiditis
    • Peritonsillar Abscess
    • Suspected abuse or neglect
  • Cardiovascular
    • Arrhythmia
  • Respiratory
    • Respiratory distress and impending respiratory failure
  • Gastrointestinal
    • Bilious emesis
    • Peritoneal abdominal exam
    • Intussusception
  • Genitourinary
    • Acute scrotum
    • Ovarian Torsion
  • Musculoskeletal
    • Displaced fracture
    • Significant lacerations
  • Neurologic
    • Acute Visual Disturbances
    • Afebrile or atypical febrile seizure activity
    • Altered mental status
    • Ataxia and Vertigo
    • Weakness, Palsy, Paralysis (including Cranial Nerve Palsies)
  • Skin
    • Invasive or rapidly progressing soft tissue infection
  • Psychiatric
    • Suicidality or psychosis
    • Depression, Anxiety, Psychosis and Suicidality
    • Hyperactivity, Aggression, and Antisocial Behavior
    • Eating Disorders
  • Infectious Disease
    • The Immunocompromised Patient with fever (sickle cell, oncology, HIV, etc)
    • Fever and petechiae/purpura
    • Neonatal fever (<1month age)
  • Underlying Complex or Multisystem Chronic Diagnoses

    • METHODS OF TRANSPORT

    It is important to access the mode of transportation that will support the medical needs of the patient, taking into consideration acuity, time of transportation to the facility, barriers to transportation (weather, traffic). The following are examples of transport modalities: BLS, ALS, Medflight, hospital based transport teams. Understanding the limitations of each will allow you to transport children safely and efficiently to the nearest emergency center.