As for many of us, addressing issues surrounding pain control for
children has been both an academic interest and passion of mine for
years. I share Bill Zempsky's and others' comments about the
continuing challenge of minimizing pain in general, and painful
procedures in particular, for children. I'm at a particularly
sensitive point, having just had yet another kidney stone this week,
on top of an amazingly painful ruptured appi a couple months ago. When
I see folks staple a scalp laceration with no consideration for
analgesia, when it's so simple to use LET gel, it makes me cringe.
It's clear we're making progress. I think most who have been
practicing PEM for many years have seen definite improvements in pain
management. One of my earlier papers, on IM DPT (Demerol-Phenergan-
Thorazine) vs IM Ketamine, no longer seems to be the kind of study
that would currently need to be done. That said, I think many of us
also know that pediatric pain generally continues to be handled less
well than adult pain in the ED setting- not that there aren't also
sometimes issues with adult pain management.
Lastly, while on this topic, my colleagues and I created the
CalmerKids Training Module, developed to train ED and urgent care
staff on how to help children and families cope better with their
experiences in these settings- especially when procedures are needed.
It relies heavily on child life techniques (it was developed by
myself, a child life specialist, and a pediatric ED nursing educator).
Specific Sections in the Training Module include:
Establishing Trust and a Sense of Control
Different Positioning Techniques for the Child during Procedures
Preparing the Child to Cope Better and Specific Distraction Techniques
Pharmacologic and Non-pharmacologic Approaches to Pain in Children
Putting it all Together: A Summary
A 45-minute professional training DVD or VHS course
An optional toolkit of distraction toys, books and music for different
One year of unlimited email/ phone guidance and support
One hour of accredited nursing CE credit for an unlimited number of
nurses in the department for 1 year
CalmerKids Certification for the institution and individual lapel pins
after training is completed
As we know, more than 90% of children are not seen in our great
children's hospitals, but are instead seen in the thousands of
community EDs and urgent care centers across the country. Basically,
this is a cost effective way to bring techniques for helping children
through procedures to these institutions. It is now in use in about 40
facilities around the country, with almost half of those now
More information is available at http://www.GoCalmerKids.com
Feedback on the anonymous evaluations has been overwhelmingly
positive. We recently lowered the cost (perhaps one day we will even
break even!), and are passionate about getting this out to places
where it will benefit children who present for emergency or urgent
care. Aside from considering this training module for your
institution, if anyone has thoughts about how to "get this out there"
more, please touch base by email or phone.
Emory Petrack, MD, FAAP, FACEP
Petrack Consulting, Inc.
16781 Chagrin Blvd., #249
Shaker Heights, OH 44120
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Enhancing Emergency Services
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