James P. Moises, MD, Assistant Clinical Professor of Surgery, Department of Emergency Medicine, Clerkship Director of Emergency Medicine, Tulane University Hospital and Clinic, discusses pediatric emergency care.
Dr. Moises,
I agree that it's imperative that children receive optimal emergency care. This has been debated off and on for many years, with pediatricians generally accusing the rest of emergency care providers of being inadequately trained.
In my experience, the overwhelming majority of specialty trained emergency physicians are excellent at providing pediatric emergency care. In fact, I believe they handle pediatric crises better than many pediatricians, who seldom see airway issues, overdoses, trauma or other such problems in their daily office or hospital practice.
Those times when I have contacted a pediatrician in my community hospital to come and assist with a true pediatric emergency, they have almost always hesitated and said 'well, maybe you should transfer them to the pediatric ICU.' That's all well and good, but it's an hour away and stabilization is a priority. My gut feeling is that this situation exists in hospitals all across America. I doubt if any mandate by the federal government or the IOM will help to fund or staff rural, semi-rural or poor inner city hospitals to the level that pediatricians and the government would consider theoretically 'optimal.'
So, we'll be relying on emergency physicians who have been doing the hard stuff, intubating, IO lines, toxic exposures, sepsis, etc. all along; without typically having 24 hour pediatric specialists available to 'save the day.'
I hope for my children, and theirs, that care improves everywhere. But we need to support the existing care, rather than assume it is all inadequate and dream of some unattainable ideal.
Thanks for your insights,
Edwin Leap, MD, FACEP
