Sorry it took so long to reply:
At 03:16 PM 5/13/98 -0700, you wrote:
>Need help from the group regarding a huge area of controversy in L.A.:
>15 years ago, a process was developed by the Pediatric Emergency Medicine
>community in Los Angeles whereby Emergency Departments in Los Angeles county
>are "certified" in order to receive pediatric 9-1-1 patients (Emergency
>Departments Approved for Pediatrics).
>Now 15 years later, we, in L.A., are re-looking at all of these EDAP's and
>PCCC's to see if they continue to meet the requirements to stay certified.
>And the question that comes to mind is: are we making a difference in the
>care of kids by having ED's meet these requirements?? Should this be
>something that is mandated by the county? Emergency Medicine and ED's are
>totally different animals than 20 years ago when these requirements were
>being developed. We now have residency programs, board certification, and
>re-certification requirements. Years ago there were more moonlighting (you
>fill in the sub-specialty doc who was moonlighting to make more money) who
>may not have cared for a child since medical school. ED's, at the time,were
>found not to have appropriate sized equipment for children and that is why
>the requirements were developed.
>This can-of-worms has recently opened in Los Angeles, and is making for
>fascinating discussion. Those of us in the review process feel we are
>making a difference in the care of kids, but maybe our focus needs to change
>slightly now in 1998, like focusing more on the continuing education of the
As a residency trained and board certified emergency physician with 19
years in practice, I have often taken issue with the assumption that
children are at some increased risk when seen in a community hospital
My partners and I are all board certified emergency physicians who practice
excellent emergency medicine to the benefit of patients of every age.
20-25% of our practice involves the care of children. We
have a supportive hospital and medical staff. We live in an area of over 1
million people with an extraordinarily high percentage of board certified
emergency physicians in every ED.
Children's hospitals are essential, and we have a good one in our area.
I value the ability to transfer appropriate patients there, and my practice
is immeasurably enhanced by that availability. Our 48,000 volume ED takes
advantage of that service several times a week.
Hopefully, the improvements you noted in emergency medicine
"Emergency Medicine and ED's are
totally different animals than 20 years ago when these requirements were
being developed. We now have residency programs, board certification, and
will prevent a recurrence of the media (with the assistance of some vocal
pediatricians) scaring the public about taking their children to community
I am reminded of the letter one mother wrote in reply to the U.S. News and
World Report cover story of January 27, 1992. The cover read "The shame of
emergency medicine: KIDS AT RISK". She wrote:
"After reading your article, I became aware for the first time of the
importance of competent pediatric emergency care. As parents of four
children, my husband and I were often upset about the inconvenience of
traveling into Boston to receive emergency care for our children instead of
going to a local hospital. New, we thank God for our pediatrician's
insistence that we do so, even in snowstorms, ice and severe
thundershowers. I hope others reading your article consider the importance
of what was reported. It could save their child's life."
Given the nature of most pediatric ED visits: Is this woman making her
children safer on those wintery nights, or asking for a visit to the trauma
center? Is her child better off seeing a competent emergency physician
locally, or the second year pediatric resident at the children's hospital?
I would urge the citizens of California and other states looking into this
issue to understand that competent emergency physicians can diagnose and
treat patients of all ages and appropriately refer those needing
specialized care. Specialized children's services, like specialized care
for neonates and trauma patients are important to every community, but not
to every patient.
Kenneth Frumkin PhD, MD, FACEP
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"Of course, that's just my opinion, I could be wrong." - Dennis Miller
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