I am hoping that someone can help me with my concerns about performing tilt table testing on patients under age 18. I am concerned about the safety of this procedure. We are the only hospital in the area doing this. Even the children's hospital and cardiac hospital will not do this test on children. We do not have a pediactric unit or a PICU. Half of our hospitalists are PALS certified and may not be on duty when we need them. These patients typically remain in asystole until we can get the tilt table down and legs elevated, approximately 6-10 seconds. We always have IV access and continuous cardiac monitoring and the crash cart is in the room but every time this happens, my heart stops as well. We don't have a specific policy for children. If anyone can help me by sharing experiences, suggestions and policy examples, I will be grateful.