The Littlest Victims of The Recession - Part II

I wrote several weeks ago about the effect the economic crisis was having on our littlest ones. How 44% of children's hospitals were reporting increases in ER visits this year because people were avoiding insurance and doctor's office visits they couldn't afford, and delaying care until it was absolutely necessary. The message was clear: children and their parents, the people working night and day to care for them, were flooding ER's across the country. And the effect this was having on our children's health and wellbeing was starting to take its toll. http://ow.ly/g7yz

But this we knew. I'm not saying we accepted it, but at least in knowing there was a threat we could try and do something about it. I emphasize this because today we discover yet another threat to our little ones courtesy of the recession...and like the one prior, this too has the potential to be deadly if ignored.

The US has a single poison control hot line (800-222-1222) available 24 hours a day, 7 days a week for questions about possible poisonings. About two million people call the hot line each year. Half the calls concern children 5 and younger. And today, according to a report published in the NY Times, as part of an effort to close its $24.3 billion budget deficit, Governor Arnold Schwarzenegger has proposed eliminating the state’s $6 million contribution to its four poison control centers making California the only state without a poison control program. (by Sarah Arnquist, NY Times http://ow.ly/g7Ob)

I sit here and wonder how can that be the right decision. Often I won't question a budget until I can see all the numbers behind it, but there is a basic scenario here I have some difficulty coming to terms with and I can't imagine that anyone - especially our children - come out ahead:

One of the nation's largest poison control program closes - there are huge implications for some of the others since they are all budget constrained - but let's put that aside for now. Unfortunately it is not hard to predict what will happen next. It is highly likely that without a poison hot line, people will either go directly to the emergency rooms or call 911, and the dispatchers who are not poison control experts will send an ambulance. There is a cost associated with this which studies have shown equates to approx. $7 of savings to every dollar spent on poison control. Beyond that is the fact that I am not sure how this will help an already overburdened ER system. Everyone will need to wait longer to be seen. Now we get to where this really hurts.

Forget the cost savings, forget that in the late 1980's Louisiana eliminated its poison control program but later reinstated it after officials realized that it actually saved the state money. If you take nothing from anything else I've written here please remember these 2 points: Poisoning is the second leading cause of death from injuries after car accidents...and HALF of these calls are for little children under 5. Who is more frail...whose bodies are going to run that poison more quickly...who cannot afford to wait in a crowded ER?

Will $6M make a significant impact on a $24.3B budget deficit? Maybe...but is it worth it? I said it the last time I wrote about this subject and I say it again today: It is up to us to make sure this recession's littlest victims do not become its casualties. If not for us, then who??

Sugar makes kids hyper: fact or fiction

"Wait an hour after eating before going swimming." "Don't go out in the rain or you'll catch a cold..." We've all heard these before...mostly because our parents told them to us...but who told it to them? Sometimes their parents...sometimes even doctors...but is there actual science behind the myths that most of us believe - and will more than likely pass on to our own kids?

Pediatricians Andrew Adesman (author of "Babyfacts: The Truth About Your Child's Health From Newborn Through Preschool"), Aaron Carroll and Rachel Vreeman, (co-authors of "Don't Swallow Your Gum! Myths, Half-Truths and Outright Lies About Your Body and Health") all agree - many of the leading myths just don't have the scientific evidence to back them up. When in doubt, doctors often fall back on what their own mentors taught them without questioning the facts on which their advice is based. (Story by Liz Szabo, USA Today http://tinyurl.com/p6nmox)

So what are these wives' tales that parents believe and these pediatricians say are myths? Here are some of my favorite:

• Adding cereal to a baby's diet will help him sleep longer (...we really do so want to believe)
• Teething causes a fever (apparently no more so than anything else)
• Vitamin C, echinacea or zinc will prevent a cold (a number of studies to the contrary)
• You can catch poison ivy from someone else with poison ivy (only if they haven't washed off the oil )
• Birth control pills don't work as well on antibiotics (apparently no proof of this)
• Must stay awake with a concussion (not unless the doctor says so).
• Timing when you have sex will determine your baby's sex (even if it's not true - this one might be worth double checking...just for the fun)

In reality, there are infinitely more questions than there are answers when it comes to the many important medical decisions we often face. That is why I believe it all comes down to this. If you look at the heart of these "myths" there is one common theme...at the end of the day, their goal is to keep us and our children healthy and safe. And until we are inundated with good, credible scientific data to the contrary, it is highly unlikely we will ever give them up.

Truthfully, if I ask you right now do you believe sugar makes kids hyper - fact or fiction? ...what would you say???

...And Then There's the Joy

For those of you who watched Grey's Anatomy last night, there were some sad moments and some gut-wrenching unbelievably awful ones...and then there was one unbelievably beautiful one...the joy of a child who was given another chance at life. One doctor gathered several of her colleagues to witness it. Together they stood outside her room, quietly smiling and taking in the moment. There wasn't much more that needed to be said - the message was clear. Saving one childs life trumped everything.

Given the project I've been working on, it has meant that over the years most of the news stories I've captured have been the sad stories of the children involved in ambulance crashes. This blog gives me the opportunity to share all kinds of pediatric patient stories. Today, I am grateful to be able to share something incredibly uplifting...

(by Roni Caryn Rabin: NYT 5/13/09 http://www.nytimes.com/2009/05/14/health/14scorpion.html?_r=1&ref=us )

10 year-old Michael Moerdler-Green was stung by a scorpion during a recent family trip to Phoenix. At the emergency room, doctors offered his parents a choice of treatments: heavy sedation to help calm his symptoms or an experimental scorpion venom made in Mexico, but not yet approved for use in the US by the FDA. His father, Dr Moerdler-Green, chose the antivenom. His son was able to leave the hospital ONE HOUR AFTER RECEIVING THE MEDICATION.

No other antivenom specifically for scorpion stings is available in the US. A study published yesterday in the New England Journal of Medicine documents a small clinical trial of young children stung by bark scorpions - most given the drug recovered from most of their symptoms within 2 hours. Dr Leslie Boyer, director of a venom research institute at the University of Arizona College of Medicine in Tucson said wider use of the antivenom could make treatment much easier in rural areas and small towns in the state that do not have PICU's and usually have to helicopter children to hospitals for care.

I would like to thank everyone for sharing this with me today. I am grateful to have your company when the news I have is sad or scary and my hope is to raise awareness about some child safety issue. I am thrilled that the only message I have to pass on today is one of hope...and life. Welcome to the joy.

What I Remember ...by Jim Love

St. Petersburg, FL., the year was probably 1978 or 79. My partner and I had responded to a drowning in a large apartment complex at the north end of town. When we arrived we found a bunch of people doing or trying to do CPR. While we were getting into position to take over care a news crew arrived and began to film the action- the cameraman positioned right behind me.

The child was blue and just had that look and feel. The outcome was not going to change and it was not right that it was being filmed- solely for the benefit of the TV station. Somehow when I stood up I bumped into the cameraman and into the pool he went.

Fencing could have, would have prevented the death of this child. Parental oversight could have, would have prevented the death of this child. These were not the only mistakes to be made. We put the child on the stretcher and began the very long trip to the hospital.

We did not secure the child in any special way to the stretcher. We never had any means to do so and nothing bad ever happened. Each time we transported a child back then, we did so either using the stretcher or more commonly held the baby in our arms- as though we could hold onto a 30 pound baby in a high speed collision. But we did it time and again and nothing bad ever happened.

That's not to say that there could not have been a catastrophic outcome from the transport- it just never happened- to me. Back then we were not taught any better and frankly did not know better. Back then the world was a lot larger. We did not know what happened across the country or the world like we do today- only 'major news' received that level of exposure. And the fact that we did not believe anything bad would happen kept us from seeking change or improvement. As a society we have enacted universal laws that govern how we transport children in ordinary vehicles. We made these changes because bad things do happen. Emergency vehicles are the same as other cars- only riskier- they run red lights and go fast. We need to adopt the same laws as those that apply to all vehicles

How children are transported today is about the same as it was back then and largely for the same reason- we take a risk and nothing bad happens. There are those who advocate for safer transport of children and infants and some states have enacted legislation to require safe transport equipment for emergency vehicles. Most people just assume that EMS, 911 responders, know what to do and do the right thing.

So what is the moral to this story? We often get angry when bad things happen and lash out in the wrong direction. Hindsight is most often crystal clear but too often we fail to use this vision to change the future. Learn CPR. Insist that all states require EMS vehicles to carry and use approved child and infant transport equipment. Ask questions and get involved. No Excuses

Jim maintains a website about EMS safety. For more information about this topic please visit: http://www.emsafety.net/.

An EMT's Story

Below is a story told to me by a young EMT back in 1995 - what is truly amazing is how little has changed:

“On Tuesday, September 19, 1995 at approx. 4:00pm, while working on an ambulance, my partner and I were called to do a routine transport at Hugh Spalding Children’s Hospital, an affiliate of Grady Memorial Hospital in Atlanta, Georgia. We were dispatched to pick up a mother and her infant and bring them back to their residence. I informed my dispatcher that we were not equipped with an infant seat on the truck. I was told to follow usual procedures (strap the mother to the stretcher and have her hold the baby on her lap) and to transport them . I felt this was wrong, but did as I was advised. When I returned to the station I sat down with my supervisor and told him that what I had just done went against everything I believed in. My supervisor respected how I felt and said that what he could try to do was get an infant and toddler seat and keep it in his car and first respond to the scene with us from now on. While I appreciated his efforts, I still felt that this was not enough.

I thought about when I had worked at Egleston’s Children’s Hospital in Atlanta. We used infant and child seats for transport but they were always so difficult to attach to the stretcher. The seat is shaped to fit a car’s seat belts. To attach it to a stretcher meant adjusting the stretcher to an upright position and strapping it in. In doing so, the bottom of the child seat was suspended mid-air and needed to be held in place by sheets and blankets propped up underneath it. No matter how we attempted to manipulate it, it was still unsteady.

And attaching the child to the stretcher was simply not an option. The reality is they are just too small: the straps cover half of their body and can’t restrain them. The straps can’t be tied tight enough to keep them in place or it will hurt them, and when the straps are loose, the child slides all over the stretcher. This makes for a miserable trip for all involved: crying child, stressed parent and helpless crew.

Which brings to mind the dangers of the everyday baby seat being strapped to a stretcher. While working on the ambulance at Egleston’s Children’s Hospital, 9 out of 10 children transported were going from one hospital’s emergency room to the PICU (Pediatric Intensive Care Unit) at another because they were in severe danger (they were having seizures, their airways were compromised, they had head injuries or were intubated). If any of those children went into arrest along the way, there were approximately 6 time consuming steps that had to be taken before CPR could even begin:

1. The safety seat shoulder straps had to be removed from the infant/child
2. The infant/child had to be removed from the seat. (Remember that at this point in time, someone is standing up in a fast moving ambulance, holding a non-breathing infant in their arms, trying to support themselves and the child without falling over)
3. All of the sheets and blankets that were previously holding the seat in place on the stretcher have to be removed. (These get tossed on the floor and everyone involved keeps kicking them out of the way so that they can help during the trauma…in effect more time wasted).
4. The straps holding the child seat in place have to be found (under the bar of the seat) and released, and the seat has to be removed from the stretcher.
5. A short back-board must be placed on the stretcher so that heart compressions may begin
6. The baby is positioned on the board, and resuscitation can begin.

But that is not the end to this emergency. The infant/child is still sliding all over the place. The technician’s hands can easily be misplaced while doing compressions and there are many other dangers that can occur to this un-restrained child while racing to the hospital.

My partner and I conducted a run-through of this procedure using a doll as a prop Going as fast as we could, it took us 2 minutes and 4 seconds. According to the “Brady Emergency Care” book, “all cells in the body need oxygen for survival. Lethal changes will begin to take place in the brain within 4-6 minutes without a constant and adequate supply of oxygen. Brain cells begin to die within 10 minutes.” It’s clear that two minutes without air for an infant or child is way too long!"

The EMT went home and drew what she believed was needed to solve this problem. It is my hope that somehow, someday, I will help her do that.