Archive for Sunday, August 8, 1993


August 8, 1993


Anyone with an active child prone to injuries has probably been there a few times -- to a hospital emergency room.

Broken bones, sprains, cuts and other injuries are common throughout the summer months.

However, according to a recent study released by the Institute of Medicine, the United States is ill-equipped to provide adequate emergency medical care for children.

The institute, a committee of the National Academy of Sciences, said few emergency medical centers take into account the differences between children and adults.

Equipment and supplies needed for children -- such as different sized instruments and different doses of different drugs -- are often unavailable in emergency care settings.

But local emergency services for children are state of the art, according to officials from the Douglas County Ambulance Service and Lawrence Memorial Hospital's emergency room.

Donald Abels, a physician who is medical director of the LMH emergency department, said the local facility is well equipped and the emergency room staff is well trained to deal with child emergencies.

Sitting ready at LMH's emergency room is a pink "crash cart," nicknamed PANDA.

PANDA, which is decorated with small panda bears, stands for Pediatric And Neonatal Drug Administration cart. The cart is full of supplies and medical instruments specific to a child's size and weight.

"If you know their age or weight, you can just look on the chart (kept in the PANDA cart) and it tells you what all the doses of the medicines are and what their normal vital signs should be," Abels said.

A Cable News Network report that many emergency personnel across the country weren't familiar with dosages and didn't have the right equipment for children made LMH take notice.

"So we've really tried to stress that," Abels said. "It's relatively easy to whip this thing open and look at the chart and if you know their age, their weight and their length, you can get a pretty good idea of what you're suppose to use."

Also, each of the physicians who work in LMH's emergency room are required to have a Pediatric Advanced Life Support (PALS) training, he said.

"One of the things that comes up if you have a really sick kid is you want to get an IV, intravenous access, to give them medications," he said. "Frequently, in the young age groups, age 2 or so, you can't get an IV, or it's very difficult."

So the emergency room and the local ambulance service have intraosseous units, which comprise large needles on plastic hubs that are inserted through the tibia into the bone marrow to deliver fluids, he said.

Abels didn't know how many of the 19,000 patients a year that come through the emergency room are children.

"We don't have an overwhelming pediatric volume, but we see what you might expect," he said.

Trauma victims include children who are involved in bicycle injuries, he said.

"A kid falls off a bike and either hits his head hard enough to be a significant injury or gets jabbed by a handlebar in the belly and he's bleeding from his liver," he said. "We see those types of injuries once a month, maybe. We see the more minor -- fall and break ribs -- maybe every day or every other day."

Trauma surgeons and pediatricians are on call and are immediately available, he said.

Abels said he thinks the local emergency room is state of the art for child emergencies.

"For the community we serve and for the volume we receive, we're pretty well-equipped," he said.

Most of the children who need intensive care are transferred to Children's Mercy Hospital in Kansas City, Mo., he said.

Meanwhile, DCAS paramedics who arrive at an accident scene have specialized equipment to treat children and have been trained in emergency pediatric care.

"The training includes special attention to kid problems," said Ted McFarlane, DCAS director.

"The common thing when you talk about pediatrics is they are not just small adults. They have different vital signs than adults and they react differently to certain external things like cold and heat. In many ways, kids are like older people in that they are more fragile."

McFarlane said there is an awareness in the medical community that it should be prepared for dealing with children.

"We carry equipment that is specific for pediatric care, such as down-sized needles and tubes and equipment that is specially designed," he said.

For example, when cardiopulmonary resuscitation is performed on a child, a different-sized mask and bag are used than for an adult.

"We carry downsized anti-shock trousers," he said. "You use them in a trauma victim. You inflate them and they pull the blood into the trunk, where it is needed."

He said ambulance units carried a range of sizes of much of the equipment that is used. For example, an 11-year-old would require different sized equipment than an infant, he said.

"You couldn't put an adult blood pressure cuff on a 3-year-old kid and get an effective reading," he said. "So we have little teeny blood pressure cuffs that are for babies all the way up to adults."

McFarlane said DCAS has nearly everything on the equipment list guidelines provided by the American College of Emergency Physicians.

"We feel like we are prepared adequately to deal with these patients," he said. "We have evaluated our system against what we consider national standards in that regard."

Michael Frakes, acting shift training officer at DCAS, has been specially trained to deal with child emergencies.

Frakes is an instructor for PALS, or the pediatric advanced life support class, offered through Children's Mercy. And he attended a national pediatrics emergency service seminar in April at the Children's National Medical Center in Washington, D.C.

"I think that there's always equipment and technology that's available that would be nice that we don't have," Frakes said. "But my impression, especially after spending a week on the East Coast and seeing how they do medicine in other parts of the country and seeing how one of the leading pediatric referral hospitals in the nation recommends how you do pediatric medicine, I felt real good about the things that we have and the care we provide."

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