On a scale of 1 to 5: children’s emergency rooms

Bringing your child to an emergency department is traumatic for parents, but knowing what to expect can help lessen the stress

Tue, Jul 8, 2014, 01:00

No parent has really earned their stripes until they have been through the ordeal of arriving at a hospital emergency department with a sick or injured child.

If they’re lucky, there will be lots of waiting around. Yes, lucky. A real emergency will be seen to very quickly.

But we parents don’t always see it that way. For us, being there with our child is, by definition, an emergency.

“Where am I in the queue?” is a question parents often ask and, while not unreasonable, it’s one the staff can’t really answer. It all depends on the severity of cases coming through the doors behind you, and there’s no way of predicting that.

There are more than 23 hospitals in the Republic in which acutely ill or injured children are seen, according to the HSE. Nearly all will admit cases if necessary, although some, such as Naas General Hospital in Co Kildare, will only see children and not admit them.

In Dublin, children are taken to one of the three specialist paediatric hospitals, while outside the capital, where hospital emergency departments (EDs) see both adults and children, about 20-25 per cent of attendances are children. Yet, “with few exceptions”, the 2012 “National Emergency Medicine Programme” noted, those hospitals “lack the necessary infrastructure, ie they lack adequate, child-friendly and appropriate audio-visually separated areas within EDs”.

Calm atmosphere

Passing through the ED of Our Lady’s Children’s Hospital, Crumlin, on a recent Friday afternoon, all seems calm. The resuscitation room with three beds, one designed for small babies, is empty and fewer than a dozen people are sitting in the waiting room.

Out in a treatment bay, one cheerful little boy with a blue bump on his forehead, who is being kept in for four hours of observation, is chatting while a nurse does one of the periodical checks to make sure there are no signs of deterioration.

There’s a seasonal nature to both the pace and the nature of work in the ED. While the number of children coming in reduces during the summer, it’s also the time when trauma injuries, both major and minor, are most common.

“As soon as the sun starts to shine, boys and girls fall out of trees,” says Dr Carol Blackburn, one of three ED consultants at Crumlin. “It is when kids get up on buildings and jump off roofs and things.”

Water-related incidents also spike, with drownings and near-drownings, coming in. Across the city, the ED of the Children’s University Hospital, Temple Street, has had two such headline incidents to deal with within 10 days.

It’s a reminder of the old cliche that emergency doctors never know what’s going to come through the door next, and illustrates why waiting times for less ill patients can be an issue.

“A big emergency coming into the department will slow everything down,” says Dr Róisín McNamara, ED consultant at Temple Street.

A drowning or a child in cardiac arrest will take up quite a few of the senior doctors, she points out, and, on occasions, she has had to go into the waiting room and explain that for the past hour and a half they have been working on a very sick child and that others will be seen as quickly as possible but, in the meantime, she requests parents to bear with them.

In her experience, there is never an issue with parents in those situations – or even generally, as their prime focus is the welfare of their child.

“It’s not like an adult hospital where you need a fairly serious security presence,” she says.

Keeping parents informed

Both she and Blackburn did their specialist paediatric emergency medicine training in the Royal Children’s Hospital in Melbourne, Australia, where the consultants emphasised the importance of keeping parents informed.

“I think that makes a difference,” says McNamara, who believes that, for the most part, what parents experience in Irish paediatric EDs is reasonable.

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