Get to Know the ER

If your child were to enter a hospital for a planned stay, you’d spend time sticking bandages on teddy bears and reading Curious George Goes to the Hospital. Perhaps you’d even visit the hospital ahead of time for an orientation. On the other hand, an unexpected trip to a crowded emergency room (ER) when your youngster is in pain and you’re anxious and overwhelmed – well, that can be troubling, even terrifying.

by Lynn Pribus

Be Prepared

Become informed. Be ready to help your child by taking a class in first aid, which can help you assess injuries and decide when to seek emergency medical attention. First-aid kits are a must for every family – one in the home and one in each vehicle. The Red Cross cardiopulmonary resuscitation course (CPR) is only four hours and it could be a lifesaver when minutes count.
Describe an ER. Reading about a hospital or seeing an ambulance can offer an opportunity to discuss an ER with children. Stories of friends who have been treated for an emergency will also help. Kids should be prepared that an ER is often hectic or noisy or chilly and that there could be a long wait before seeing a doctor. There might be X-rays and strange technology, or there could be blood tests and strange smells. Talk about the ER experience more than once, so it becomes less intimidating.

 

When Disaster Strikes

Kedra, 10, was hit by a car in front of her house. Her mother was ready to rush her to the hospital when a neighbor stopped her, saying, “My son is calling for help.”
9-1-1 is the quickest access to help. Give concise information on your location and the patient’s condition. Example: “A 10-year-old girl was struck by a car in front of 222 Elm Street. She is conscious, but in a lot of pain. There is blood on her face and her arm is bleeding profusely but I do not see any bone.” Remember that while a home landline usually displays your address for 9-1-1 dispatchers, most cellphones don’t show your location, so don’t hang up until the dispatcher tells you to.
Wait for the emergency unit. Help is often on the scene in a matter of minutes. Racing to an ER, especially if you must drive alone, could be risky if the youngster should vomit, go into shock or have a seizure. Besides, arrivals by ambulance go to the head of the line at the ER.
Don’t move the child if there is any chance of serious injury. If the patient absolutely must be moved – if there is a danger of fire, for example – support the head and neck and move in a straight line by pulling with your hands under both armpits. If there is bleeding, apply direct pressure with the cleanest item around, which could be an unread newspaper or female sanitary supplies. Concentrate your energies on immediate life-saving maneuvers from your first-aid class.
Stay calm. Easy to say, but it’s important to cloak obvious anxiety, which can feed a child’s fear. Everyone is tense when a child is hurt, and a distraught or hysterical parent escalates the stress for everyone.
Provide clear information. The first responders will need to know the child’s age, weight, allergies and any medications being taken. You may need to repeat this several times, since each person along the route to treatment needs to know what’s going on.
Be there for your child. Generally, a parent may ride in an emergency vehicle. If you can’t go along, assure your youngster you will be at the ER very soon. Have a friend or relative meet you at the hospital to make phone calls, stay with your child if you are needed elsewhere, and offer any support necessary.

 

Children's Healthcare of Atlanta

At the ER

Within 15 minutes, Kedra was tentatively diagnosed with a mild concussion, abrasions on her arm, a cracked collarbone and a broken wrist. X-rays were done, but some patients who arrived later were cared for first. Kedra’s sense of fairness was outraged when it was nearly four hours before she was treated.
Explain. Tell your child that unlike most places, ERs aren’t first-come, first-served. Life-threatening and critical cases are given priority.
Be honest. Say it’s understandable to be frightened, but that you won’t lie about anything. Explain things as well as you can. Minimize fears, but be straightforward if the wait will be lengthy or treatment “uncomfortable.”
“Do people die here?” Don’t be surprised at such a question. Simply say that sometimes people are so sick or injured that they do die, but emphasize it is unusual and that your child is not in danger of dying.
Your child counts on you. The combination of injury and apprehension may unnerve you as well as your youngster. Strive to remain calm. If you are agitated or loud, the doctor will probably insist on seeing your child without you.
Be sure you understand. Although minutes count in an ER, you and your child are entitled to a clear explanation of any diagnosis or recommended treatment. Most ERs provide written information or instructions. Still, in the rush and anxiety of the moment, you may not remember things clearly. Be sure to jot down the doctor’s name, and ask that the medical record be sent to your family’s healthcare provider.

 

After the Fact

When Carmen, 7, gashed her leg on a rusty nail, she received 11 carefully counted stitches and a tetanus shot. While she was being treated, a man who was bloodied and disoriented from a head injury stumbled through the privacy curtain and collapsed on the floor at her feet. The scene only lasted a moment before medics lifted him and led him away, but weeks later Carmen still resisted going to bed. When she tried to talk about the “bloody man,” her mother dismissed the subject, not wanting to remind her daughter of it.
Talk about it. Discuss the medical emergency during the following days and weeks. Children need to feel they have permission to deal with a frightening ordeal by reliving it. Talking about a recent traumatic experience gives a person (of any age) power over it. This is why people often repeat stories about everything from an auto accident to an operation.
Play it through. Especially with young children, giving a doll an IV or re-creating other painful events with something tangible, gives them some control over a scary memory. For example, after he was fully recovered and healed, one boy who had fallen from a tree later spent several weeks displaying his 22 stitches (which had been taped to a tongue depressor as a souvenir when they were removed from his arm).
Schedule a follow-up. Depending on the situation, you may need to see your own family doctor.
Remember, when you are prepared, calm and encouraging, a visit to an ER can be handled as just another incident in the adventure of growing up.

 

Urgent Care or the ER?

For plenty of kids, summer may mean bike riding all day, perfecting those skateboard tricks and horsing around at the pool. But for parents, summer is the height of injury season for kids. A lot of unstructured play and activity can lead to scraped knees, broken bones and even worse. How do you know when to head to a hospital emergency room, and when a mishap can be treated instead at an urgent-care facility?
Urgent-care facilities are often overlooked when kids get hurt. But for such things as minor cuts that could require stitches, or bone fractures that need a splint, urgent care may be the best bet. An urgent-care clinic is good for easily treated situations where you need prompt, inexpensive diagnosis and treatment, and it can mean a shorter wait and a less expensive bill. And it is usually less frightening and intimidating for a child than the ER.
Atlanta Parent spoke with Dr. Deirdre Stewart, lead physician at Forsyth Urgent Care, part of Children’s Healthcare of Atlanta. We wanted some advice on how to determine when your child needs a trip to the ER, and when an urgent-care center is the better option.
Stewart says typical summer injuries include sprains, head injuries and a lot of fractures. Cuts can be a big question mark for parents. Knowing whether a cut needs stitches or not is probably the most common dilemma among worried parents.
“If the cut is deep and less than one inch, bringing the child to urgent care is recommended,” says Stewart. “Only about four times per month do we need to redirect parents to the ER.
“If there is ever any loss of consciousness when it comes to a head injury, parents should always go straight to the ER,” Stewart says, while urgent care is OK for mild head injuries if there has been no loss of consciousness.
In any situation requiring medical attention, Stewart says that “the No. 1 thing a parent can do to help their child is to stay calm and reassuring. If the parent is calm, the child is more likely to be brave. It really makes a world of difference.”
It’s also a good idea for parents to take a first-aid or CPR class, which would help them better assess injuries. Stewart also advises parents to talk with their child’s pediatrician, who can provide helpful tips for avoiding and treating common childhood injuries.
 – Kate Wallace

 

 

Informed Consent Is Essential

When Ethan, 4, broke his wrist at his grandparents’ house, they took him to the nearest ER. The hospital insisted on cash because they didn’t know what sort of medical coverage Ethan’s parents had.
As they waited, a panicky Ethan watched a progression of patients, including a screaming infant and a woman crying out profanities. Even more upsetting, a doctor immobilized the entire arm and dictated that Ethan should have no food or drink in case surgery was needed, but would provide no further treatment without “informed consent” from Ethan’s parents – who were hiking the Appalachian Trail for four days.
It was nearly 12 hours before Ethan’s parents came into an area with cellphone service and were able to give oral permission for treatment.
You can forestall such a worrisome situation for your youngster. Laws may vary from state to state, but in most cases only a parent may consent to treatment for a minor. A grandparent or in some cases even a stepparent may not. The law leans toward treatment in cases of injuries threatening life, limb or the nervous system. Still, in our litigious society, a doctor who does not know you may be reluctant to treat your child.
Therefore, if there are times you cannot be reached, give a medical power of attorney to a relative, friend or childcare provider. You may also leave a signed and dated consent for treatment with your family physician or medical facility. Write down for babysitters or other care providers exactly what you want done in an emergency; include phone numbers for a trusted relative or friends in case you can’t be reached.
Prepare a brief medical history, including allergies, regularly taken medications, immunizations (especially tetanus) and blood type, if known. Make a photocopy along with health insurance information and give a copy to anyone who looks after your child.
Know the closest location where you can obtain emergency services. This may be dictated by your medical insurance.