Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, September 26, 1993 TAG: 9403170008
SECTION: EDITORIAL PAGE: D3 EDITION: METRO
SOURCE: DONALD N. MEDEARIS JR.
DATELINE: LENGTH: Medium
Unfortunately, too many children do not get the emergency medical services they need and deserve. Although the emergency medical system for adults has steadily improved in recent decades, the needs of children have been largely overlooked.
The scope of this problem is immense. More than 20,000 children die each year from car wrecks, drownings, poisonings and other injuries. Pneumonia, meningitis, asthma and other illnesses and disorders that may require emergency care take a similar number of young lives annually.
Hundreds of thousands of children are hospitalized each year for illnesses and injuries, and millions more are treated in hospital emergency departments.
Inadequate data make it difficult to quantify deficiencies in the care these children receive. But according to an Institute of Medicine committee I recently chaired, the deficiencies are serious and the results are tragic.
One serious problem is a lack of the special equipment that children require in emergency situations. Children differ from adults in their anatomy, physiology and psychology. Their care requires different-sized instruments, different doses and kinds of medications, and different psychological support.
Estimates suggest that equipping an ambulance for the needs of children costs less than $1,000, but many lack this equipment. Similarly, in hospital emergency departments, equipment suited for children should be immediately available but often isn't. Appropriate care for the most seriously ill or injured children may depend on timely access to specialty care beyond the resources of community hospitals.
Another major shortcoming in this country's emergency care for children is that health-care personnel, parents, teachers and others caring for children have not been trained to recognize and give first aid in pediatric emergencies. Because many life-threatening conditions in children are difficult to detect, health-care personnel require special training to recognize and treat them.
An example: When children are about to go into shock, blood pressure does not necessarily drop precipitously, as usually happens in adults. As a result, life-threatening situations in children can be missed easily when untrained providers are trying to help.
Finally, when an emergency occurs, communication is critical. This communication has many aspects, but the front line in the process is the 911 emergency response system. However, few states have complete 9ll coverage. Even in those states that do, the service often needs to be upgraded or enhanced so that dispatchers can automatically see the address and telephone number of the person calling.
If children everywhere in this country are to have available to them the emergency services they deserve and need, the federal government and the states must be involved. Our committee recommended several new government initiatives, including a federal center that would conduct, oversee and coordinate activities related to emergency medical services for children.
During a time of extremely tight budgets, paying for the reforms that are needed will not be easy. I am confident, however, that relatively small investments would pay for themselves many times over in reduced health-care costs as well as increased productivity from lives saved and disability averted. Moreover, these economic factors are not nearly so important as saving lives and avoiding suffering.
We should and must protect our children. They depend upon others for their care; therefore society has a special obligation to attend to their health-care needs. Since they have no independent political voice through which they can make their needs known, we must be their advocates.
You can help. Whether you are a parent, grandparent, health-care professional, or child-care advocate, you can learn how to use the emergency response system properly and how to give first aid to children. You can also ask whether the ambulances in your area are equipped for children's emergencies, whether the personnel are appropriately trained, whether the emergency department in your hospital is equipped to care for children, whether your area has an enhanced 911 emergency call system. If the answer to any of these is "no," you should advocate having what is necessary. For our children, we must not settle for less.
Donald N. Medearis Jr., a member of the Institute of Medicine, is a professor of pediatrics at Harvard Medical School and chief of the Children's Service at Massachusetts General Hospital.
by CNB