- Emergency care of children in the United States is the best in the world.
- Emergency physicians and nurses care for nearly 25 million sick and injured children under age 15 each year,[i] the vast majority of whom have good outcomes[ii].
- Emergency physicians are experts in managing childhood emergencies and receive more training in pediatric emergencies than other physicians, including pediatricians.
- Pediatric emergency care coordinators in emergency departments are strongly linked with readiness to care for children.[iii]
- Advance planning and a calm attitude are the keys to a good ER experience with a child.
How much training in emergency medicine residency programs is devoted to pediatric emergencies?
Emergency physicians see far more critical care and trauma patients than pediatric emergency physicians do. Emergency medicine residents receive five months of pediatric training specifically in emergencies, whereas pediatrics residents receive three months of training specifically in emergencies. As a general rule, more than 20 percent of emergency patients seen by emergency medicine 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. By contrast, only 8 percent of a pediatrics residency is dedicated to training in emergencies. [iv] [v] Emergency medicine residents must also receive four months of dedicated critical care experiences treating patients in intensive care units.[vi]
What are emergency physicians doing to improve the care of children?
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.
ACEP in 2015 joined the American Academy of Pediatrics and the Emergency Nurses Association in assessing the nation’s emergency department readiness to care for children. More than 90 percent of emergency departments had the recommended pediatric equipment readily available, and the nation’s overall pediatric readiness score increased significantly since 2003 (to nearly 70, up from 55, out of 100).
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 is the originator and main sponsor of The Advanced Pediatric Scientific Assembly, the recognized premier course in cutting edge pediatric emergency medicine. Pediatric themed courses at national ACEP meeting are among the most highly attended of all EM topics reflecting emergency physicians interest in the latest advances in the care of children.
Emergency physicians have successfully campaigned to prevent childhood injuries through public education and political lobbying on behalf of car seats, helmet laws and childhood immunizations. 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.[vii] An assessment of hospital compliance with the guidelines (published in JAMA in 2015) found that emergency departments have 91 percent of recommended pediatric equipment readily available, as defined in the joint policy statement issued by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association in 2009 (http://www.emscnrc.org/Research/ED_Readiness.aspx).[viii]
ACEP is a member of the Emergency Medical Services (EMS) Partnership for Children consortium, 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.
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 community (e.g., ambulances). A court recently ruled that general emergency physicians are well-qualified to staff pediatric emergency departments. [ix]
Can parents do anything to make sure their child gets good treatment in an emergency?
The most important factor in managing an emergency is to be prepared. Parents should talk to their child’s pediatrician about emergency care, develop an emergency plan and become familiar with the local emergency departments before emergencies occur. In addition, they should prepare a medical history that includes immunizations, doctor’s name, medications and major illnesses. If a child is left in someone else’s care (including a relative), parents should leave medical history and consent-to-treat forms, which also can be downloaded at:http://www.emergencycareforyou.org/uploadedFiles/Archive/Emergency_Manual/Medical_Forms/Consent-To-Treat%20Form.pdf
Parents of children with special health care needs 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. Copies of the form are available at http://www.emergencycareforyou.org/uploadedFiles/EIF-form.pdf.
Children take their cues from their parents, so the most important thing parents can bring to the emergency department is a calm attitude.
What other advice do emergency physicians offer parents?
Accidents are the leading cause of childhood death.[x] 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). Every child comes with an important safety feature: a caring parent or guardian.
For additional information on this and other topics, visit: http://www.emergencycareforyou.org/Emergency-101/Childhood-Emergencies/.
[vii] Annals of Emergency Medicine 2009, “American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Committee; Emergency Nurses Association Pediatric Committee. Joint policy statement-guidelines for care of children in the emergency department.”
(Last updated 2015)