Emergency Care of Children

Main Points

  • Emergency care of children in the United States is the best in the world. 
  • Emergency physicians and nurses care for nearly 22 million sick and injured children under age 15 each year (CDC), the vast majority of whom have good outcomes.
  • Emergency physicians are experts in managing childhood emergencies.  They are trained to provide the highest levels of care to all patients and receive more training in pediatric emergencies than other physicians, including pediatricians.
  • Everyone is only one step away from a medical emergency.

How much training in emergency medicine residency programs is devoted to pediatric emergencies? 

Emergency medicine residency programs provide comprehensive training in caring for childhood emergencies. The amount of time dedicated to caring for children varies among residency programs and is a reflection of the number of children being treated in the emergency department.  As a general rule, about 16 percent of emergency patients seen by emergency residents during their training will be in the pediatric age group, which approximately mirrors the ratio of pediatric-to-adult visits in emergency departments every year. 

In general, emergency physicians see far more critical care and trauma patients than pediatric emergency physicians. 

Why do we hear about problems related to emergency care of children? 

Isolated examples of tragic cases may make headlines, but they do not reflect the status of emergency care of children in the United States. Emergency care of children is better today than ever before and emergency physicians have been leaders in raising the standards and quality of care in emergency departments and in the emergency medical services (EMS) community (e.g., ambulances).
Recent studies examining the care of children have consistently demonstrated that quality emergency care is being provided. However, tragically, sometimes even with the best medical personnel, training and equipment, an injury or illness is so severe a patient cannot be saved.  This is true for adults as well as children.

In 2006, an  Institute of Medicine report,  “Emergency Care for Children: Growing Pains,”  -- claiming that only 6 percent of emergency departments are fully equipped to care for children -- is misleading, and distorts the true picture of emergency care for children in the United States.  In fact, more than 90 percent of emergency departments have the necessary equipment to care for children. The missing equipment was addressed with other equipment within the departments or hospitals.

ACEP has been directly involved with creating the recommended equipment lists and believes that emergency departments should be equipped with appropriate pediatric equipment.

Should I ask for a pediatrician to treat my child in the emergency department? 

Residency-trained emergency physicians receive more training and have far more experience than pediatricians in recognizing severely ill or injured children, urgent and emergent management of pediatric medical disorders, as well as the performance of emergency procedures  such as pediatric airway management, pediatric resuscitation and other lifesaving techniques. If necessary, the emergency physician may consult with your child’s pediatrician about his or her condition. This reciprocal consultation and discussion ensures your child has the benefit of both providers’ extensive knowledge, resources and specialized skills.

Which emergency department is best for my child? 

If your child’s condition requires transport by an ambulance, the pre-hospital providers will follow their protocols in determining which hospital is appropriate to receive your child. For example, if your child is severely injured, he or she will be delivered to the nearest emergency department associated with a trauma center that can care for children. If given a choice, or if transporting your child yourself, it is generally safest to travel directly to the closest emergency department. Most general emergency departments are properly staffed to treat all children regardless of the nature of the emergency. However, in some communities, some hospital emergency departments have elected not to provide pediatric services.  These are frequently large university hospitals associated with a nearby children’s hospital. It is important for parents to learn ahead of time which emergency departments in their area do not provide pediatric care. 

What are emergency physicians doing to improve the care of children? 

ACEP provides continuing medical education courses on pediatric emergency care for emergency physicians at its annual meeting and is a leading publisher of pediatric emergency medicine textbooks.

ACEP sets national standards on pediatric emergency care and was among the first organizations to develop guidelines for pediatric emergency equipment, staffing, training and procedures.

Emergency physicians have successfully campaigned to prevent childhood injuries through public education and political lobbying on behalf of car seats, helmet laws and gun safety.

In addition, the training curriculum for emergency physicians is continually updated to keep up with new developments. Emergency physicians have also developed innovative systems to improve treatment of pediatric patients, such as the Broselow tape, which color-codes pediatric equipment and medicines according to a child’s height and weight.

In April 2009, ACEP’s Board of Directors approved “The Guidelines for Preparedness for Emergency Care for Children,” which was developed in collaboration with the American Academy of Pediatrics, the Emergency Nurses Association and Emergency Medical Services for Children (EMS-C, a program run by the United States Health and Human Services Department).  The guidelines are a compilation of best practices, first nurse and triage guidelines and benchmarking data for improving emergency department wait times and emergency department flow for children.

In addition, ACEP is a member of the Emergency Medical Services (EMS) Partnership for Children consortium, sponsored by EMS-C — in collaboration with the National Highway Traffic Safety Administration. This nationwide effort to reduce child and youth mortality and morbidity due to severe illness or trauma is designed to ensure timely and appropriate emergency care for children. It also seeks to ensure that state-of-the art emergency medical care for the ill or injured child and adolescent is well integrated into EMS systems.

What can I do to make sure my child gets good treatment in an emergency? 

The most important factor in dealing with an emergency is to be prepared. This means talking with your child’s pediatrician about emergency care, developing an emergency plan, and being familiar with the local emergency departments before emergencies occur. Ask when you should go directly to an emergency department, when you should call an ambulance, and what to do when the pediatrician’s office is closed. If your child requires treatment in an emergency department, make sure you discuss all of your concerns with the emergency department staff.  If your child is left in someone else’s care (including a relative), always leave medical history and consent to treat forms, which also can be downloaded at http://www.emergencycareforyou.org/EmergencyManual/MedicalForms/Default.aspx.

ACEP also has numerous publications that may be helpful to you, such as “When Your Child Has an Emergency” and “A Decade of Advancements in Pediatric Emergency Care,” which are available on ACEP’s website at www.emergencycareforyou.org.

What advice do you have for parents about children’s medical emergencies? 

Preventable injuries are the leading cause of childhood death and permanent injury. Child safety seats, bicycle helmets, poison prevention, safety caps on medicines, window guards and sports safety gear are just a start. Parents should also learn to recognize the warning signs and symptoms of serious childhood illnesses and be familiar with life-saving techniques, such as the Heimlich maneuver and CPR (cardiopulmonary resuscitation). Remember that every child comes with an important safety feature: a caring parent or guardian.

What should I know about children with special health care needs? 

Children with chronic medical conditions are the most rapidly growing group of children under age 18 who need emergency medical care.   Referred to as “children with special health care needs,” these patients include children with cerebral palsy, spina bifida, asthma, hemophilia, autism, diabetes and various genetic disorders.  Children with special health care needs live in about 20 percent of U.S. households with children. 

When these children have an acute illness or injury, their underlying conditions can place them at greater risk for complications than children without chronic medical conditions.  Many children with special needs have problems that may be completely undetectable by a physician treating the child for the first time.  Some children with special health care needs do not respond to standard treatments for their diseases, but have individualized regiments developed for them through years of treatment by their own physicians.

Parents should have their child’s physicians complete the “Emergency Information Form for Children With Special Health Needs” form and bring it with them to the emergency department. They also should provide copies to all their child’s caregivers. 

Completing this form and making it available to medical personnel in emergency situations will ensure that a child’s complicated medical history is concisely summarized and available when needed most when the child comes to an emergency department with an acute health problem, especially when a parent or the child’s physician is not immediately available.

Children with special health care needs should wear medical jewelry to provide vital information in an emergency. The MedicAlert® Foundation has agreed to serve as a central repository for any child who registers with its program. MedicAlert’’s 24-Hour Emergency Response Center will keep the form on file so that health care professionals can retrieve needed information anywhere in the world, 24 hours a day.

For additional information on this and other topics, visit www.emergencycareforyou.org.

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