Emergency Medical Services for Children (1993) / Chapter Skim
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2 RISKING OUR CHILDREN'S HEALTH: A NEED FOR EMERGENCY CARE
2 RISKING OUR CHILDREN'S HEALTH: A NEED FOR EMERGENCY CARE
Pages 38-65
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From page 38... ...
Infants and very young children are more susceptible to serious illness than older children are, and until children approach adolescence, respiratory diseases lead to more hospitalizations than do injuries. This chapter discusses differences between children and adults and the need for special attention to those differences in emergency care.
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From page 39... ...
In situations where a specific age is set for adult patients, children may be defined by default. The survey of state EMS agencies found that 19 of 27 states that specified a minimum age to define adult patients use age 18 (Seidel, 19911.
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From page 40... ...
as specialized care, provided by physicians, nurses, paramedics, emergency medical technicians, allied health personnel (e.g., respiratory therapists, physical therapists) , and others, that covers a wide range of services including prevention, prehospital care, stabilization and definitive care in various inpatient settings, and rehabilitation.
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From page 41... ...
Successfully performing procedures such as endotracheal intubation and intravenous injections in children requires equipment sized appropriately for smaller airways and blood vessels. Accommodating a child's shorter trachea and higher larynx also requires special care during intubation.
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From page 42... ...
Emotional and Behavioral Development Children progress through recognizable stages in emotional and behavioral development that affect their risk of injury and illness and their responses to the people and procedures involved in emergency medical care. During the first year of life, infants develop early motor skills and an awareness of their surroundings.
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From page 43... ...
Among injured children and adults, children are more likely to have experienced a head injury. In 1985, it accounted for about 30 percent of children's and about 12 percent of adults' hospitalizations for unintentional traumatic injury (MacKenzie et al., 1990a,b)
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From page 44... ...
Many of those with training may, however, have little opportunity to use their skills because they encounter few seriously ill or injured children; they may lack confidence in their ability to perform even simple, noninvasive procedures (Gausche et al.,
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From page 45... ...
Moreover, their emotional responses to seriously ill or injured children can be strong. Helping Children with Special Health Care Needs Although the vast majority of children in this country are fundamentally healthy, an increasing population has serious ongoing health conditions.
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From page 46... ...
In a survey of this sort, however, underestimates are likely; respondents may forget to report visits or may not know about visits by other members of the household. No national data are available on prehospital care, but 29 states collect at least some data on these services (Emergency Medical Services, 1992~.
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From page 47... ...
About 24 percent of all injury deaths in infants were attributed to homicide compared to 10 percent among children ages 1 to 14 and 16 percent among 15- to 19-year-olds. At every age, more boys than girls die from injuries.2 Injuries associated with motor vehicles account for the largest number of deaths of any given cause.
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From page 48... ...
. Intentional Injuries Homicide16416481110392911 Suicide00161391453 Other injuries1429783492 All injuries5841,3238498423,0846,682 TOTAL INJURIES1,2933,2942,3092,68112,84921,133 NOTE: The following ICD-9-CM codes were used to define specific categories of injury: unintentional injuries, E800-E949; motor vehicle injuries, E810-E825; homicide, E960-E969; suicide, E950-E959; and other injuries, E970-E999.
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From page 49... ...
(NCHS, 1990~. Data from the National Hospital Discharge Survey show that in 1990 injury was associated with about 468,000 hospitalizations among children under the age of 15 (NCHS, 1992a)
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From page 50... ...
The more serious injuries occur particularly to pedestrians, bicyclists, and motor vehicle occupants and in falls (Gallagher et al., 1984; Tepas et al., 1990~. In infants, falls account for many injuries but child abuse is the cause of some of the more serious cases (Luerssen, 1992~.
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From page 51... ...
Recent NPTR data show that about 32 percent of the children had some degree of activity limitation at the time they were discharged from the hospital (NPTR, 1992~. In another study of ~ group of seriously injured children' 54 percent had some remaining [unct~onal I~mitat~on as long as six months after the injury (Wesson et al., l989~.5 Head and spinal cord injuries were responsible for half of these cases; lower extremity injuries accounted for another one-quarter.
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From page 52... ...
52 EMERGENCY MEDICAL SERVICES FOR CHILDREN TABLE 2-2 Deaths from Specified Categories of Illnessa Among Children and Adolescents Ages O to 19, by Cause, Age, and Sex, 1988 Age Categories of Males Infectious diseasesb53230092771071,108 Neoplasms723173783155101,592 Endocrine, Metabolic Nutritional19271403465402 Immunologic12834229 Cardiovascular504180831192731,159 Neurologic3402541281733381,233 Respiratory73622696991451,302 Digestive21679353350413 Urologic129144825180 Congenital anomalies and birth-related conditions14,66459017312913915,695 Sudden infant death syndrome3,295nananana3,295 Other illnesses60621182772681,244 All illnesses21,2982,2501,1141,0681,92227,652 Females Infectious diseasesb428239985994918 Neoplasms772942622443421,219 Endocrine, Metabolic Nutritional18172815769460 Immunologic81111122 Cardiovascular4051766964134848 Neurologic263209139109148868 Respiratory5281966584105978 Digestive16564252039313 Urologic113158916161 Pregnancy-related conditionsnanana03434 Congenital anomalies and birth-related conditions11,5134521259410312,287 Sudden infant death syndrome2,181nananana2,181 Other illnesses4571576178175928 All illnesses16,3191,8859348191,26021,217 TOTAL ILLNESSES37,6174,1352,0481,8873,18248,869 continued
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From page 53... ...
aDeaths attributed to illness as the underlying cause of death. bIncludes a total of 278 deaths attributed to human immunodeficiency virus infection; diagnostic codes *
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From page 54... ...
. aIncludes discharges for hospitalizations attributed to human immunodeficiency virus infection with the diagnostic codes *
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From page 55... ...
. These children, who may require the same medical and surgical care that other ill or injured children need, also require the care of mental health professionals.
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From page 56... ...
Furthermore, to the extent that child-abusers are themselves children, the issue poses extraordinary challenges in the EMS-C arena. Settings for Emergency Care Emergencies Encountered in the Pediatrician's Office Discussions of emergency care tend to concentrate on the principal providers of such care prehospital services, EDs, and hospital inpatient settings but office-based physicians and nurse practitioners also encounter emergency conditions among the children that they see.
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From page 57... ...
Seizures and respiratory distress are among the more common illness-related conditions encountered; the two most frequent causes of injury are motor vehicle crashes and falls (Seidel et al., 1984,1991b; Tsai and Kallsen, 1987; Johnston and King, 1988~. The distribution of prehospital cases with injuries or illnesses varies as expected with age; the youngest children experience more illness and the oldest ones, more trauma.
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From page 58... ...
, although it may be less than 1 percent in some areas (Arkansas EMS-C Project, 19911. Among more seriously ill or injured children, the proportion is generally believed to be higher, but not necessarily equivalent to that for adults.
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From page 59... ...
Some seriously ill or injured children are admitted directly to inpatient units without any preliminary care in the ED. As noted earlier, motor vehicle crashes, falls, and burns (which include fire and scalding)
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From page 60... ...
Pediatric trauma centers (PTCs) , with specialized services and skilled surgical teams for care of seriously injured children, have begun to develop as part of regional trauma systems (Hailer and Beaver, 1989~.
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From page 61... ...
Motor vehicle crashes accounted for the largest share: $4.1 billion for children under age 15 and $16.1 billion for the 15- to 24-year-olds (Rice et al., 1989~. The initial cost of ED care for the many injured children who are treated without hospitalization has been estimated at about $2.5 billion per year (1987 dollars)
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From page 62... ...
About ~ percent of children admitted -~or-trauma were judged to have needed advanced trauma care;8 these children accounted for 21 percent of hospital charges for children (MacKenzie et al., 1990b)
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From page 63... ...
Nationally, motor vehicle-related injuries account for the largest number of deaths, but in some states drowning and burns are more deadly, especially among younger children. Homicide and suicide are more frequent among adolescents than among younger children, but child abuse is a particular threat to children under 5.
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From page 64... ...
6. Sudden infant death syndrome has been defined by tale National Institute of Child Health
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From page 65... ...
Advanced trauma care was defined as that available at a Level I or Level II trauma center.
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