Where to take your child in an
EMERGENCY

by Gilda McHenry

While we don’t like to think about it, knowing whom to call and where to go if your child has a medical emergency can help you keep a clear head and ensure your child will receive the best possible treatment.

Your first decision is often whether to call 911 for emergency medical services (EMS). But where will EMS take your child? If you decide to transport your child yourself, where should you go? Experts advise that if you’re unsure, call 911.

When should you call 911?
Joseph Zorc, MD, an attending physician at Children’s Hospital of Philadelphia has identified ten top problems treated at CHOP’s ER and whether a call to 911 is recommended:

Complaint Call 911 for these symptoms
Respiratory Distress Working hard to breathe, unable to speak; dusky color around mouth; limpness
Fever Febrile seizure — convulsions brought on by a fever in infants or small children
Trauma to extremities Severe pain; deformed fracture; long-bone or multiple-bone injuries; amputations
Vomiting Accompanied by severe abdominal pain
Trauma to face, head or neck Altered or loss of consciousness; excessive blood loss
Abdominal pain Severe pain
Rash Not necessary to call 911
Eye Emergencies Not necessary to call 911
Earache Not necessary to call 911
Dehydration Altered or loss of consciousness

If you’re unsure whether to call 911, err on the side of caution and call.“With traffic you can never predict how long it’s going to take to get to the ER,” says Dr. Zorc. Seemingly stable conditions can escalate rapidly in a short period of time, particularly with younger children.

Between 30 and 50 percent of children seen at trauma centers are transported by their parents in a private vehicle, which Connie Potter, executive director of the National Foundation of Trauma Care, finds disturbing. These children miss out on “pre-hospital intervention like oxygen and IVs that could alter their condition for the better,” she says. “If a child with a fracture or neck injury is not properly immobilized, he can be paralyzed.”Also, attending to a sick child while driving could result in an accident.

If you decide to drive to the ER, should you go to the nearest hospital or a pediatric emergency room? “Even if you’re unable to get to a pediatric ER, your child can always be transferred to one once the condition stabilizes, should the need arise,” says Monica Penhollow, evening supervisor at Urgent Ambulance Service in Newark, DE.
Talk to your pediatrician ahead of time about which hospital to take your child to in an emergency, particularly for children with chronic health concerns. That way, if you drive to the ER, you’ll know your doctor’s advice.

Can a parent decide where EMS transports her child?
”If a parent is adamant about having his child transported to a particular hospital, emergency medical personnel can confer with doctors to determine a course of action,” says Shawn Finnigan, chief of operations for Whitemarsh EMS. Bypassing appropriate hospitals could jeopardize the child, he warns.

Extenuating circumstances may warrant a parent’s need to redirect EMS. “Children who have received organ transplants should go back to the transplant center in an emergency,” says Jeremiah Laster, Chief of EMS Operations for the Philadelphia Fire Department.

If you call 911, where will emergency medical services transport your child? Each state has rules that govern where, and under what circumstances, patients are transported in a pediatric emergency.

For example, depending on the emergency and location, Whitemarsh EMS in Lafayette Hill, PA, transports children to Abington Memorial Hospital or St. Christopher’s Hospital for Children, but patients suffering from bee stings, asthma and febrile (fever) seizures are often taken to CHOP, says Finnigan.

Depending on the severity of the emergency, EMS can bypass the nearest hospital in favor of one with a pediatric trauma center, says Fred Ellinger of Em-Star Ambulance Services in Pennsauken, NJ. Em-Star transports many of its patients to Cooper Hospital in Camden, a Level 1 pediatric trauma center.

However, the nearest hospital is often the best option. “Even a Level 4 trauma center has advanced cardiac life support,” says Potter. Airway distress such as with asthma usually calls for driving to the closest ER.

Different Types of ERs and Trauma Centers

Though all emergency rooms can treat children, not all ERs are pediatric ERs. “In an emergency room you’ll typically find attending physicians, residents and nurses, all capable of treating medical issues,” says Laster. But a pediatric ER has medical staff trained to treat children. It is equipped with child-sized furniture and medical equipment capable of accommodating infants’ and children’s immature anatomical features.

Beyond having a pediatric ER, some hospitals have regional trauma centers. To qualify, they must meet criteria outlined by governing agencies such as the American College of Surgeons.

Trauma centers have teams of specialists who treat severe, life-threatening injuries or critical conditions such as a near drowning or severe injuries from a car accident. If your child needs to go to a trauma center, you’ll probably want to call 911 and have an emergency vehicle transport her.

Trauma centers are classified based on the level of care they provide. “Only ten percent of hospitals in this country are classified as Level 1 or Level 2 regional trauma centers,” says Potter.


Trauma Center Levels

Level 1: Fully staffed with general surgeons, anesthesiologists and specialists to provide 24-hour instant coverage in a wide variety of disciplines such as neurosurgery, orthopedic surgery, oral surgery and critical care. Level 1 trauma centers are research and teaching facilities.

Level 2: Although many Level 2 trauma centers conduct research and training, they are not required to. In addition, the trauma team and surgeons, on call around the clock, are required to assemble within a specified time frame to evaluate the patient in need.

Level 3: Can perform resuscitation and intensive care as well as simple orthopedic and surgical procedures. However, full availability of specialists is not required. Level 3 trauma centers have transfer agreements with Level 1 or Level 2 centers to accommodate patients with exceptionally severe injuries.


Delaware Valley Pediatric ERs and Trauma Centers
Has Both Trauma Center and Pediatric ER
   Delaware:
      Alfred I. DuPont Hospital for Children (Level 1), Wilmington, DE,
      Christiana Hospital (Level 1), Newark
      Wilmington Hospital (Level 1), Wilmington
   New Jersey:
      Children’s Regional Hospital at Cooper (Level 1), Camden, NJ
      Kennedy Memorial, (Level 3) Washington Township
   Pennsylvania
      Abington Memorial (Level 2)
      Children’s Hospital of Philadelphia (Level 1), Phila.
      Crozer-Chester (Level 2), Upland
      St. Christopher’s Hospital for Children (Level 1), Phila.
Has Trauma Center, no Pediatric ER
   Delaware:
      Bayhealth Medical Center (Level 3), Dover and Milford
      Beebe Medical Center (Level 3), Lewes
      Nanticoke Memorial Hospital (Level 2), Seaford
   Pennsylvania
      Albert Einstein Medical Center (Level 1), Phila.
      Hahnemann University Hospital (Level 1), Phila.
      Thomas Jefferson University Hospital, Level 1), Phila.
No Trauma Center, Pediatric ER,
   New Jersey:
      Our Lady of Lourdes, Camden
      Underwood Memorial, Woodbury
      Virtua Memorial, Mt. Holly
      Virtua West Jersey, Voorhees
   Pennsylvania
      Bryn Mawr Hospital
      Chester County Hospital, West Chester
      Holy Redeemer, Meadowbrook
      Lower Bucks Hospital, Bristol
      Montgomery Hospital, Norristown

Most Common Injuries Treated in Trauma Centers
ERs and trauma centers treat approximately 30 million children nationwide each year. The American College of Surgeons has documented the most frequent types of traumas by age group.

Up to age 6: Isolated brain injuries resulting from falls due to proportionately larger heads.

Ages 6-12: Traumatic brain injury in conjunction with chest, abdomen and skeletal injuries resulting from motor vehicle-related trauma (either as a pedestrian, bicyclist or unrestrained passenger).

Ages 13-19: Risk-taking behavior becomes more common at this age; more often victims of homicide or suicide.

“The majority of calls we receive involve trauma resulting from a fall of some kind,” says Shawn Finnigan of Whitemarsh EMS in Lafayette Hill, PA.

Gilda McHenry is a local freelance writer.