Childhood Student Emergencies

Emergency Care of Children

Main Points

  • InfantEmergency care of children in the United States is the best in the world.  Emergency physicians and nurses care for nearly 23 million sick and injured children under age 15 each year.
  • Emergency physicians are experts in managing childhood emergencies.  They are trained to provide the highest levels of care to all patients and receive comprehensive training in caring for childhood emergencies.
  • Emergency physicians have been instrumental in advancing the standards for emergency care of children.  They have also successfully campaigned to prevent injuries through public education and political lobbying on behalf of car seats, helmet laws and gun safety.
  • More than 90 percent of emergency departments have the necessary equipment to care for children; an IOM report in 2006 of only six percent is a little misleading, because the missing equipment was addressed with other equipment within the departments or hospitals. 

Q. How much training in emergency medicine residency programs is devoted to pediatric emergencies?
A. 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 patients being treated in the emergency department who are children.  As a general rule approximately 20 to 30 percent of emergency patients seen by emergency residents during their training will be in the pediatric age group. 

Q. Why do we hear about problems related to emergency care of children?
A. Isolated examples of tragic cases may make high-profile 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, the best training and the best equipment, an injury or illness is so severe a patient cannot be saved.

Q. Should I ask for a pediatrician to treat my child in the emergency department?
A. No. Residency-trained emergency physicians receive more training than pediatricians in 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.

Q.  Which emergency department is best for my child?
A.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 they will deliver him or her 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 their presenting problem. 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 are not providing pediatric care.
 
Q. What are pediatric emergency specialists?
A. The American Board of Emergency Medicine (ABEM) and the American Board of Pediatrics (ABP) in 1992 developed a subspecialty in pediatric emergency medicine to further advance research and education for the emergency care of children. Members from ACEP and the American Academy of
Pediatrics, who were board-certified in their specialties, were appointed to help develop the exam.  Identical exams for board certification are now given in this subspecialty. These physicians, called pediatric emergency specialists, have chosen to focus their practices on emergency care of children, including conducting research and teaching pediatric emergency medicine.

More than 1,000 doctors have become board-certified in the pediatric subspecialty, the majority of whom are pediatricians who want additional training and education in emergency care of children. These pediatric emergency medicine specialists primarily staff emergency departments in children’s hospitals.

Q. What are emergency physicians doing to improve the care of children?
A. Many physicians who specialize in emergency medicine have devoted their careers to improving the emergency care system through research, training, policy development, and public education. Just 30 years ago, there was little recognition among the public or the medical community that emergency care required unique training, equipment, and procedures.

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.

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.

ACEP and the American Academy of Pediatrics in 2001 published joint guidelines on providing optimal care to the nearly 23 million children under age 15 who come to emergency departments each year. The guidelines outline the most current requirements of equipment, staff, and policies to provide high-quality, medical care for children and are achievable for most emergency departments.

In addition, ACEP is a member of the Emergency Medical Services (EMS) Partnership for Children consortium, sponsored by the Emergency Medical Services for Children (EMS-C) program — 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.

Q. What can I do to make sure my child gets good treatment in an emergency?
A. 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. 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 the staff answers all your questions and concerns. If your child is left in someone else’s care (including a relative), always leave a consent-to-treat form and a medical history form, which also can be downloaded from ACEP’s website.

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.”

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

For additional information on this and other topics, visit www.ACEP.org, which has numerous pediatric public education materials available, including feature articles on childhood emergencies, a consent-to-treat form, and emergency information form for children with special health needs, as well as policy statements on “Care of Children in the Emergency Department: Guidelines for Preparedness” (joint policy statement of ACEP and AAP), “Immunization of Pediatric Patients,” “The Use of Pediatric Sedation and Analgesia,” and the “Role of Emergency Physicians in the Prevention of Pediatric Injury.”


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