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Trauma Won

How to Avoid the Emergency Room and When to Go

Kids are breakable. That horrible knowledge creates a mental static that parents have to manage, if they’re lucky, until they die. Fathers and mothers work actively to make sure that abstract idea doesn’t become a pressing reality, but there is only so much that can be done. Kids are gonna kid and that sometimes means a header off the couch, a swerve into a ditch or a fastball to the face. Keeping a child alive, after all, is not just about minimizing risks, but reacting to worst-case scenarios. That’s why it’s critical to understand both how to keep a child out of the emergency room and when it’s time for a hasty visit.

Dr. Sarah Denny, who works at Nationwide Children’s Hospital Level One trauma center in Columbus, says it’s critical for parents to understand that the events most likely to lead to emergency room visits are not easily avoided. What is possible, however, is to mitigate the danger represented by possible disasters by actively considering what would happen if things took a turn for the worst.

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“Motor vehicle crashes are one of the leading causes of death or injury in children” she explains. “Babies should be rear-facing until two, in the back seat. Children should not ride in the front seat until they’re 13. Everyone in the car should wear their seatbelt every single time.”

Also on her prevention list is the making sure a kid wears a helmet if they plan to ride “anything with wheels” and keeping kids off trampolines because that’s where fractures come from–lack of padding isn’t the issue, multi-kid pileups are. And there are more situations that can lead to emergency room visits as the weather warms and people head to pools and lakes. She stresses that kids require direct adult supervision if they’re in the water.

“If your child can’t swim, they need to be at arm’s length,” Denny explains.

No matter what the emergency, Denny is keen to remind parents that their reaction will dictate what happens next. The decision whether or not to seek emergency medical attention is important, but before that even takes place there’s the moment of realization.

“Kids take their cues from their parent’s reaction,” Denny says. “Try and stay as calm as you can.”

For parents trying to calmly decide whether or not to call an ambulance, Denny says that pediatricians can be the most important resource. In all but the most pressing cases, pediatricians can offer some meaningful context and advice. “Almost all pediatricians have someone on call,” Denny says. “That’s your best resource and that’s true across the country.”

Still, some injuries are severe enough that parents should call 911 or head immediately to the ER instead of having a phone consultation. There are very specific signs that indicate a more drastic response is warranted: loss of consciousness, uncontrollable bleeding, visible warping or breakage of a bone, dehydration, dry mouth, or confusion. The last few relate more to illness, but the confusion is a sign of many different kinds of distress. When these warning signs are in clear evidence, it’s time to get to the hospital.

What happens at the hospital and, in particular, within the emergency room, is a different matter. Parents (and patients generally) complain about the lack of immediate care provided by ER doctors. Denny is sympathetic but also supportive of the overall system that leads to complaints. The national standard for triage, called the Emergency Service Index, allows doctors and nurses to prioritize patients based on the severity of the medical concern and resource needs. Individuals are assigned levels that denote their priority. Those assigned Level 1 will receive care first, while Level 5 will receive care last.

The important thing to understand is that injured children are safer in an emergency waiting room than they are at home. Decisions about whether or not to visit a hospital shouldn’t factor in whether or not that visit will be a pain in the ass. When it comes to both hypothetical and real injuries, the key is to always imagine that things could get worse, then try to make sure they don’t.

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