A joint statement published in 2009 by the American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, and Emergency Nurses Association Pediatric Committee spelled out the need for reform in emergency care when it comes to caring for children.
The bottom line is this: if your child has an emergency and you have the luxury of time and choice of where to go, go to an ER at a Children’s Hospital or a pediatrician-staffed emergency room. Collect $200 and pass go. Learn from my mistakes.
Driving the joint statement was concern from both pediatricians and ER physicians about inconsistent care for children in Emergency Departments (EDs) that do not normally specialize in the care of children. The statement outlines strategies to prepare EDs around the country to care for children based on some sobering statistics…
Of the 119 million separate ED visits in 2006, nearly 20% were children. However, pediatricians or pediatric emergency medicine doctors cared for the minority of those children treated. With less than 800 board certified pediatric emergency room physicians in the US, it’s the exception more than the rule that the person in the white coat in an emergency room caring and advising you during your child’s visit is specially trained/boarded to care for your child. One survey reported that only 6% of EDs had the proper equipment ready to care for children of all ages. Another concern is that about ½ of the EDs cared for fewer than 10 pediatric patients a day, making children the small minority of whom they help. When staff, physicians, and the flow of emergency room are unaccustomed to children, care for children may falter. Some EDs may simply be ill prepared as they lack the experience.
This post and my point is not to trash very capable, compassionate ER doctors. My son received phenomenal care at an adult ER when he broke his leg. Further, my position isn’t simply because I blog for a children’s hospital. No one told me, hinted, or suggested I write this. This comes from my heart. This is simply to assert there are differences in care. And often as parents, we have a choice.
The joint statement outlines the way to prepare Emergency Departments with materials, training, and staff to properly care for kids. “It is imperative that all hospital EDs have the appropriate resources (medications, equipment, policies, and education) and staff to provide effective emergency care for children. “
Speaking of pediatric specific EDs, Dr Suzan Mazor a pediatric ER doc and toxicologist says, “We know enough to do less. As pediatric emergency physicians, we trust our exam and our questions for families and can avoid unnecessary testing. Outside EDs are likely not going to harm your kid, but may put your child through more blood work, intervention, and testing than is needed.”
Pediatricians work hard to intervene only when necessary. Another less is more nod here.
Hear my tale, learn from my mistakes:
In April of 2009 we traveled to a hotel north of San Diego for a medical conference. One morning while working off my up-all-night-in-hotel-room-with-screaming 4-month-old-hang-over, our 2-year-old F got up before me and joined my brother-in-law in the adjoining room. O and I were sleeping when I awoke to hear F’s cry.
Like every parent, I can discern that cry from about 2.5 miles; I think there is a little protected neuronal space in the brain reserved for all parents to hone their child’s cry. I’m not kidding.
My brother-in-law said he’d not been looking at F while making some coffee for about 2 minutes when F started to complain about neck pain. Then the onest of crying-screaming-grabbing his neck started. And it got louder and louder.
When I got to him, F poured into my chest and refused to let me touch him on the left side of his neck and chest. He was seemingly stabilizing himself in the bend of my own neck, his head tucked deep inside mine. F is not a massive cuddler (much to my disappointment), so this was delightful for the first few moments until I realized something was really wrong.
Mom mode, check. Internal freak-out, check. Most of my training and doctor skills now out the window in the face of worry, I started to triage and try to figure out what had happened. When he continued to cry, cling to me for dear life and refused to move for about 10 minutes, I got more suspicious we needed help. I started to suspect a collarbone injury as we pieced together the story. My brother in law had left him on the hotel bed while stepping away. Hadn’t heard a thud or fall but F immediately started to complain about neck pain when he returned after being unwitnessed. He was on sitting on the floor. Had F fallen off the bed, broken his collarbone, and then refused to move?
That was my mommy theory. Not a very good pediatrician story, it turns out. This is exactly why doctors don’t care for their own children…we get blinded by emotion.
I paged the husband, already at his conference, and piled into the car just after calling the hotel manager to find the nearest ER with x-ray. Now F had his pediatrician mom and pediatric radiologist dad driving down the highway in search of a diagnosis. In the car seat, he refused to turn his head and look at me.
Diagnosis shift. Now I was thinking of torticollis, a spasm in the neck.
We checked into the ER that was about 10 minutes from the hotel. We let them know we were both physicians when we checked in. When we met the ARNP and Emergency MD in the ER, they acted concerned but nervous that we were physicians. They asked what we, his parents, thought we should do. “What studies do you want?”
We were there for help, not to guide care.
I reflected my opinion that it was likely torticollis, but I was unsure. The ER physician suggested that we needed to do a CT scan of his head and neck because it was an unwitnessed fall. At this point, F had not even been examined. No one had even touched him.
We refused. We were worried they were just scared of caring for him. Instead of examining him and making a plan, it seemed they were treating us, not our son.
When we refused the head CT, they suggested stabilizing his neck with a C-collar and putting him on a backboard and transferring him by ambulance to a Children’s Hospital ED. They refused to allow us to transfer him by private car. Although I understood their position to protect themselves (and F), I knew we didn’t need to transfer by ambulance. So we signed out AMA (against medical advice). Unnerving and something I never thought I’d do in my lifetime,