Decades have passed since the fictional Pearson family dealt with their holiday emergency, which resulted in an appendectomy for Kate. The show, set in the Pittsburgh suburbs in the 1980s, depicts the harsh realities, risks, insecurities and fears associated with bringing a child to an ER. Yet even 30 years later, there is little information available for parents when it comes to identifying, locating and navigating appropriate pediatric emergency medical facilities. There is still no common definition of a pediatric emergency room. This isn't just about doctors; equipment in any given ER is not necessarily appropriate for small children. According to the R Baby Foundation data, only six percent of ERs in the United States have the necessary supplies to treat pediatric emergencies.
The holidays are a busy time in ERs. Parents need to know both where and how to get the care their child needs. The landscape can be confusing and that, layered on top of an emotionally charged and time-sensitive moment, can be a recipe for disaster.
Suzanne Chan, a certified registered nurse with Northwell Health, has experienced this challenge from both sides of the bed. She is a parent with a chronically ill child who has spent much time in the ER with her son. And as a pediatric nurse practitioner doing her ER/PICU rotation, she knows what can help make the visits go a little more smoothly. Her list includes something to occupy the child. "An iPad and a charger can go a long way, especially if the ER is backed up - this will help to keep your child calm and busy," she said.
She also said it's important for parents to be prepared with information. "You will be asked a million questions and it's all in the details," Chan said. "Write things down or even record with your phone or video. I had a parent come in describing a rash that had come and gone only to reappear somewhere else. It was really helpful that the parent took pictures to support the medical team"
Finally, she said, trust yourself. "You have to be your child's biggest advocate - if the doctor says she'll be back in an hour, don't hesitate to hit the call button if it has been more than that."
I also spoke with Audrey Paul, a physician who created parental guidelines for the RBaby Foundation for ER visits, and Marilyn Gale, a Crisis Intervention Therapist at Suburban Hospital in Bethesda, Md., to get advice on how parents can be emergency room ready during the holiday season and throughout the year. Here are their suggestions:
• Learn what facilities are nearby and the difference in the services each provides. "Although routine testing and evaluation of a sick baby is provided in all emergency rooms, experience with newborns and ready availability of services, specialties and even equipment can and do vary between emergency rooms," Paul said. "The goal is to know what exists where and when you need it."
• Know where you would go in case of an emergency. "Investigate and make note of the types of services (pediatric or general care) available at your local hospitals," Paul said. "Make note of the location of the nearest pediatric ER. Not all doctors practice at all local hospitals. Keep this list easily accessible."
• Know when to call 911 and know the route to your closest ER. Paul suggests that you map your route to the nearest ER and the nearest pediatric ER, in case of emergency. Even If you need to call 911 to get there, you may need this information for someone else to follow the ambulance and/or to share with the friends and family who offer assistance.
• Have items on hand for parents and for baby. Similar to preparing a bag for yourself for the hospital before delivering a baby, it's prudent to keep a "just-in-case" baby bag handy for emergency use. Hopefully, you won't need it. Items to pack include comfort objects, bottles, diapers and changing gear, and a swaddling blanket. For parents, Paul suggests a change of clothing, a breast pump, nonperishable snacks, contact information for family and friends, a document with medical information, including insurance policies, and a reminder to request both "Sweeties" (sugar water) and numbing cream upon arriving at the ER, to help with pain relief for the IV or other needle sticks.
• Check your stress. Anxiety is passed from parents to baby. Prepare ways to keep yourself calm. "The ER is a stressful place and the holidays are a stressful time. The parent is the role model and needs to be set up to provide the positive support a baby needs," Gale says. "The parent needs to remain calm. Having a relative or friend there to create a support system is essential." Gale also suggests parents "bring a transitional object for baby, something to soothe such as a pacifier, stuffed animal or a familiar blanket."
And where can parents go to get information that will help?
The Rbaby Foundation - founded by Phyllis and Andrew Rabinowitz after the loss of their daughter 10 years ago - works to improve the quality of pediatric emergency care and to make sure parents understand that medicine is not one-size-fits-all. RBaby offers tools for parents as well as training for medical staff and equipment for hospitals. Also, Mass General Hospital is launching an app in the next year that will allow parents and caregivers to quickly identify the closest location for pediatric medical care.