[Excerpted from The Smart Parent’s Guide to Getting Your Kids Through Checkups, Illnesses, and Accidents: Expert Answers to the Questions Parents Ask Most by Jennifer Trachtenberg with Ron Geraci and Eileen Norris. Copyright © 2010 by The Joint Commission Resources. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.]
That mammoth city hospital about sixteen miles from your home may be "world renowned," offer the absolute best emergency care in a hundred-mile radius, and even have the spiffiest cafeteria known to medical science.
So why could it be a bad choice for your child?
Because kids -- especially when they're younger than ten -- need to be treated in emergency departments that are specially designed and equipped to treat little bodies. Yes, sometimes speed is crucial, and then any medical care is always (well, almost always) better than none. But in the vast majority of cases, taking your child to a well-equipped pediatric emergency department is much safer and wiser than opting for a closer ED that doesn’t cater to children. And there’s more to that than having wallpaper with duckies.
Shockingly, even though children make up 27 percent of all ED visits, 94 percent of hospitals in the United States do not have all the necessary supplies for pediatric emergencies, according to a study by the Institute of Medicine. One hospital reported it didn't have child-sized neck braces, so the ED staff used rolled-up towels to stabilize children's spines. Did that make you wince? It made me wince.
What's more, some 85 percent of the beds and equipment in most hospitals are designed for adults. That's also not good, as small kids can roll under adult-bed handrails and hit the floor. Other reports found that some hospitals had only adult-sized oxygen masks, which are too big for a child's face and wouldn't effectively deliver oxygen to a kid having a severe asthma attack.
Shortcomings like these persist among many hospitals despite standards and regulations meant to prevent them. The American Academy of Pediatrics has minimum requirements for equipment, supplies, and medicine that should be available in any ED that treats children. The list is long, and it includes pediatric-sized blood pressure devices, stethoscopes, oxygen masks, chest tubes, butterfly needles, infant scales, splints, and more. Seeing the words "Pediatric Emergency Department" on the hospital’s double doors is no guarantee that the ED is up to standard.
So how can you find the best pediatric emergency department in your area? Ask your pediatrician, of course, but do some detective work, too. Start by calling or stopping by an ED to speak with the hospital's director of emergency services and asking these questions:
1. Do you have a pediatric emergency care specialist on staff -- or at least pediatricians available 24/7? About 40 percent of EDs in the U.S. don't even have round-the-clock access to pediatricians, according to the Centers for Disease Control and Prevention. You want to be sure that your child's ED is staffed with pediatricians, pediatric nurses, and ideally, pediatric emergency medicine specialists (not just general emergency physicians). If it is, in my experience it's the strongest indication that they'll have the right equipment that you need in a pediatric ED.
2. Do you have medications in doses appropriate for children? Are they available in liquid forms or chewables? This is important. Many hospitals don't have pediatric medications, and it can cause life-threatening complications. Here's a common example: Recently, one of my patients -- a toddler with asthma -- had a sudden onset of respiratory distress. Unfortunately, his mother didn't call me and went straight to a hospital that didn't have a pediatric ED. He needed to take an oral steroid to control his symptoms, so the doctors crushed adult tabs for him. Not surprisingly, he kept spitting them out. Given how horribly bitter they must have tasted, I can't blame him. In the end, the toddler didn't get the dosage he needed, which probably hindered his recovery. His mother did bring him to see me in the morning, though, and I was able to give him the appropriate medicine then.
3. Does your ED have child-sized resuscitation equipment? Are there beds, IVs, and oxygen masks made for children? They need to be well stocked in extra-smalls.
4. Do you have a separate area just for pediatric patients? A good pediatric ED will have a kid-friendly section that will look more like a Chuck E. Cheese restaurant than an acute medical care facility. You should find a TV, cartoon DVDs, a few toys, and coloring books (though try to remember to bring comforting favorites from home, too). While the distractions are helpful, here's the real benefit: Your child will be shielded from the drama in the average ED and won’t have to watch people arriving with heart attacks, gushing blood, or knife wounds. As a bonus, neither will you. Germ-wise, stress-wise, and sanity-wise, this is better for everybody. Unfortunately, many hospitals don't have a special emergency area for children, which means your four-year-old could be sitting next to an inebriated guy who just shot a .22 bullet into his foot and is not happy about it.
5. How many children under age five do you treat every week? More than fifty is a good answer; three is not. You want an ED staff that's adept in dealing with screaming babies, frantic toddlers, and -- not that you’ll personally need this angle of their expertise, of course -- hysterical parents.
6. Do you have a separate urgent-care satellite center? If a nearby hospital doesn't have a dedicated pediatric ED, at least you’re likely to get treated faster in the satellite center than the general ED. Similarly, the ED will be less crowded with non-life-threatening cases due to the satellite center.
7. Is the hospital accredited by The Joint Commission? If so, it means the hospital has voluntarily met national health and safety standards. You don’t need to interrogate an ED staffer to find this out; you can learn if the hospital is accredited (as well as how it’s performing in several key areas) at www.qualitycheck.org.
8. Are there Spanish and/or other translators on-site? You may speak English, but -- and this is a big point that many people dangerously overlook -- does your child's nanny, babysitter, or grandparent-who-watches-her-every-day speak English? Believe me, this can be critical. When your mother-in-law is on a cell phone with a bad connection and I have to rely on what I remember from French 101 to decipher what she's telling me about your son's bike accident and medication allergies, no one is happy.
Once you've identified your best emergency option, map out how to get there and do a couple of dry runs before you actually have a crying little one gushing blood in your backseat. In a real emergency, you might not be driving -- you might not even be in your own vehicle -- but at least you'll know how to get there. Someday, that might also help you decide whether to drive yourself and your child to the ED or to call 911.
But don't throw away your list of other choices. If an emergency strikes when your daughter is at a sleepover four towns away or your son is playing Little League in a neighboring community, it may come in handy. Unfortunately, by their very nature, emergencies are unplanned. Be prepared. Have backups.
