Few ERs Are Equipped to Care for Children

Better Expertise Necessary for Pediatric EDs

And pediatric emergency medicine is a relatively new specialty, although it is poised for rapid growth, according to data from the Association of American Medical Colleges. Currently, there are 758 active pediatric ED doctors. Almost 100 additional doctors entered training for the specialty in 2008.

Without trained pediatric emergency physicians, patients are subject to delays as equipment is gathered or as they are stabilized for transfer to a different facility.

"It is crucial that emergency departments of all types be fully capable of handling whatever comes their way," said Dr. Robert Field, professor of Health Management and Policy at the Drexel University School of Public Health in Philadelphia, Pa. "It's not like deciding between supermarkets. In a state of crisis, most people will go wherever is closest, or wherever the ambulance takes them. They should not have to second-guess whether that is a wise choice."

Although doctors agree that expertise is paramount, some are not convinced that acquiring a cache of pediatric equipment is the best course of action for every ED.

Physician Coordinators Could Assist EDs

"It depends how you set up the criteria. If one missing minor piece of equipment is the way you "fail" the test, well then that does not mean you can't treat children," said Dr. Richard O'Brien, an emergency physician at Moses Taylor Hospital in Scranton, Pa. "Only by going piece by piece -- and person by person -- can any one department come up with a consensus about [the report's] applicability in a single hospital... I suspect it will be a help, as such, to many EDs."

But with children at increased risk for the novel H1N1 influenza virus, EDs may be more inclined to embrace guidelines that will help them prepare for a potential influx of pediatric patients.

"Since the ratio of kids infected with H1N1 is higher than other age groups, and the severity of the strain is still unknown, it is important for emergency facilities treating pediatric patients to be well prepared," said Dr. Alison Tothy, medical director of pediatric emergency medicine at the University of Chicago Medical Center.

Tothy pointed out that the number of pediatric ER patients at the University of Chicago's Comer Children's hospital rose 150 percent over a two-week period during the spring H1N1 outbreak. She added they expect another significant increase in pediatric patients due to H1N1, seasonal flu, and other winter respiratory viral outbreaks in the coming months.

More Leadership Crucial for Upgrading EDs

"We shouldn't wait for H1N1 flu, or a similar disaster, to teach us the importance of uniform quality emergency care," Field said.

According to the joint report, fewer than 20 percent of EDs appoint either a physician or a nurse coordinator for pediatric emergency care, but those EDs tend to show more compliance with pediatric care guidelines established by the ACEP and the American Academy of Pediatrics.

Increased trained leadership in pediatric emergency care to oversee general treatment and safety for patients, disaster preparedness, acquiring proper equipment and continuing education for staff, among other responsibilities, is one of the primary recommendations from the ACEP and ENA joint report.

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