The Pediatric Emergency Care Crisis: Young Patients Dying

The Pediatric Emergency Care Crisis: Young Patients Dying

Edited by: TJVNews.com

Each year, hundreds of children across the United States suffer tragic outcomes due to the inadequacy of emergency rooms in handling pediatric cases. Shockingly, only approximately 14% of emergency departments in the country are certified as being prepared to treat children, or are specialized children’s hospitals, according to an investigation by The Wall Street Journal.

The critical issue at hand is that many emergency doctors lack the experience and expertise to effectively diagnose and treat children. According to the WSJ report, they may miss life-threatening conditions hidden by common symptoms or illnesses more common in children. In some cases, medical professionals resort to using adult-sized equipment and protocols, often without knowing where to locate child-sized gear in an emergency.

The consequences of this unpreparedness are dire. As was reported by the WSJ, research indicates that between 2012 and 2017, about 1,440 children lost their lives due to inadequately prepared emergency rooms. Studies have found that children are four times more likely to die in less-prepared emergency rooms.

Despite awareness of this issue among doctors, health authorities, and policymakers for decades, most hospitals have failed to take action. The investigation by The Wall Street Journal revealed that over 70% of emergency departments have undergone assessments to determine their readiness for pediatric cases, but the results are confidential. Furthermore, 25 states do not even assess pediatric preparedness in emergency rooms, and those that do often do not disclose the names of hospitals that are adequately prepared,  the WSJ report added.

The WSJ’s investigation has produced the first comprehensive list of hospitals across the nation that have received state certification for pediatric emergency readiness or are recognized as children’s hospitals or pediatric trauma centers. However, the standards for certification vary, and some hospitals have merely identified weaknesses without implementing substantial improvements.

The lack of preparedness in emergency rooms leads to avoidable deaths and leaves many children with severe, long-term health conditions. This crisis is compounded by a lack of incentives for hospitals to improve care for children. As was noted in the WSJ report, emergency departments often lose money when treating children, particularly those covered by Medicaid, as the reimbursements are insufficient to cover costs.

“All E.R.s are not created equal,” said Phyllis Rabinowitz, who started a foundation to improve emergency care for children, as was reported by the WSJ. Her infant daughter died of Coxsackie B virus in 2006 after an E.R. sent her home. “This is a real crisis. I am living proof.”

 

Also speaking the WSJ report was Dr. Katherine Remick, co-director of the federally funded Emergency Medical Services for Children Innovation and Improvement Center. She said,  “Our emergency care systems were never designed with children in mind.”

Although hospitals have made some efforts to address the issue, such as training staff and ensuring the availability of pediatric supplies, most have not done enough. The WSJ report stated that a study published in JAMA Network Open in July 2021 found that hospitals nationwide scored a median of 69.5 out of 100 on a test measuring pediatric readiness, with a score of 88 considered well-prepared.

Experts in pediatric emergency care emphasize that hospitals do not need the resources of children’s hospitals to provide adequate care for kids, as was mentioned in the WSJ report. Simple steps, such as designating specific staff for pediatric coordination, maintaining appropriate supplies, and training emergency personnel, can significantly improve outcomes.

Dr. Chris DeRienzo, chief physician executive of the American Hospital Association trade group, said hospitals are committed to treating young patients well, and the doctors who most often staff E.R.s have some pediatric training, as was reported by the WSJ. He said it is unreasonable to expect every emergency room to have the pediatric expertise of a state-of-the-art children’s hospital.

Despite the challenges, there are signs of progress. Some hospitals have taken steps to enhance their pediatric readiness by training nurses to use child-specific equipment and color-coding pediatric supplies for easy identification.

On the other hand, the WSJ also provided details of seriously ill children who did not receive the appropriate care at the hospitals that their parents brought them to. As such, the WSJ highlighted a tragic incident involving a young girl named Avery Guzman-Mendez. Avery’s case serves as a stark reminder of the difficulties that can arise when doctors who infrequently treat children must perform procedures on pediatric patients.

Avery, a three-year-old girl with epilepsy, found herself in a life-threatening situation when she suffered a seizure in March 2020. According to the WSJ report, she was rushed to the emergency room at Ascension Seton Highland Lakes hospital in Burnet, Texas. The attending doctor needed to intubate her to ensure that her seizing or the medication administered did not compromise her ability to breathe. However, this seemingly routine procedure turned into a harrowing ordeal.

Intubating a child is notably challenging, especially for doctors who lack experience in treating pediatric patients, according to the WSJ report.  Children’s airways are smaller and differently positioned than those of adults. Furthermore, the need for quick action is crucial, as children lose oxygen more rapidly than adults.

Tragically, the hospital where Avery received treatment had not obtained certification under a Texas program aimed at improving crisis care for children, the report added. This lack of certification could have contributed to the difficulties encountered during Avery’s treatment.

According to accounts from Avery’s family, medical records, and court records from a lawsuit against the hospital, the doctor initially received an adult-sized breathing tube. Despite repeated attempts with smaller tubes, the doctor struggled to locate Avery’s airway, resulting in a critical decline in her oxygen levels and ultimately leading to cardiac arrest, the WSJ reported. The medical team attempted CPR multiple times while using adult drug dosages due to the absence of pediatric records, further complicating the situation.

Although the team eventually managed to stabilize Avery, her oxygen levels had dangerously plummeted multiple times during the ordeal. Avery was subsequently transferred to a children’s hospital approximately 50 miles away in Austin, where doctors were able to successfully intubate her. Tragically, by that point, her brain had already sustained significant damage, and she passed away six days later, the WSJ report said.

This heart-wrenching incident underscores the importance of pediatric readiness in emergency departments. Most pediatric-readiness programs mandate that hospitals possess the necessary equipment, training, and protocols to handle procedures like intubation in pediatric patients. Ensuring the availability of pediatric-specific supplies, proper training, and protocols for emergency staff can make a significant difference in providing effective care for children in critical situations.

Despite longstanding awareness of these challenges, the incentives for hospitals to improve pediatric care have been limited. While Congress began allocating funding to address pediatric emergency care deficiencies in 1984, the lack of strict requirements from government agencies and professional groups has hindered progress, according to the WSJ report. State efforts to assist hospitals in improving child emergency care have been constrained by limited federal funding, as child emergency care is not as lucrative or in as high demand as other medical services.

The tragic case of Avery Guzman-Mendez serves as a somber reminder that there is much work to be done to ensure that emergency departments are adequately prepared to handle pediatric cases. Pediatric patients deserve nothing less than the highest standard of care, and it is incumbent upon healthcare institutions, policymakers, and medical professionals to prioritize the development of pediatric readiness in emergency settings. Only through concerted efforts and increased awareness can we prevent such heartbreaking incidents in the future and ensure that every child receives the care they need during emergencies.