Not to drag up too many old issues, but PEM's are emergency physicians first. Yes, everyone who came up the peds track did only four months of adult time and that won't make you an expert in figuring out whether to start TPA on that 52 year-old who is having an evolving stroke or not. However, I think doing a laceration repair on a relatively healthy 40 year-old isn't that much different than a 15 year-old.
That said, the only "legal" issue is what services you are credentialed by the hospital to perform (other than the occasional emergency surprise that may so up at your door). If you work in a dual ED (adults and kids in the same basic area), then the hospital is responsible for making sure you are qualified to perform/provide services to certain patients. The breakdown of peds care ending at 15, 17, 20 or 25 is purely artificial and based on your specific hospital's policies. In fact the AAP recognizes "young adults" (to age 26) under the purview of pediatrics (Guiding principles for managed care arrangements for the health care of newborns, infants, children, adolescents, and young adults. Pediatrics 2013;132;e1452).
So with that said, as long as the hospital has said your are qualified to perform a service (and your malpractice carrier agrees) than you can go ahead and provide the service.
Just my 2₵
Jeffrey Linzer Sr., MD, FAAP, FACEP
Associate Professor of Pediatrics and Emergency Medicine
Emory University School of Medicine
Associate Medical Director for Compliance
EPG/Division of Pediatric Emergency Medicine
Children’s Healthcare of Atlanta
[cid:[log in to unmask]]
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Lisa A Drago
Sent: Monday, April 21, 2014 3:13 PM
To: [log in to unmask]
Subject: Adult patients in the PED
Recently our adult colleagues have been requesting the PEM docs see young adults ( under 30) when their volume becomes unbearable. Any PEM docs seeing young adults in your practice and legally how are you handling this (separate hospital privileges?)
For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
This e-mail message (including any attachments) is for the sole use of
the intended recipient(s) and may contain confidential and privileged
information. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution
or copying of this message (including any attachments) is strictly
If you have received this message in error, please contact
the sender by reply e-mail message and destroy all copies of the
original message (including attachments).
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: