Responding to the remarks re:EDAPS,
I am boarded in PEM and have been in practice of emergency medicine since
1986.. I have worked in mixed ED's and most recently in a children's
hospital emergency department.
From my vantage point , I have been amazed at the number of times a
pediatric patient is sent to me after having been handled in a less than
For instance, we routinely receive babies who are severely dehydrated, who
have no IV or an IV running D5W at KVO ( 20 cc/hr) , Respiratory distress
with no O2 and more importantly arriving after getting diazepam for a
seizure and no airway support.. Head flopping off to the side, tongue
obstructing the airway etc..
I get called frequently from ED physicians ( who are supposedly ED trained)
who want to transfer kids with pneumonia by private auto, kids with
roup,( who by the way they claim have epiglotitis ) by car or ambulance
this always confuses me, because the referring doc really believes the
kids has epiglotitis , and yet will not intubate the kid...!) Fortunately,
the incidence of epiglotitis is really low ! BUT even so, I am not so sure
that what one experiences in Los Angeles is going to translate to the more
suburban or rural areas of America..
What is this about the nature of ambulance transports for kids being less
significant that the ambulance runs for adults? I have received many a
ambulance run for some adult that was drunk, had a headache for 2 weeks,
abdominal pain from constipation etc.. I would bet the percent of
inappropriate runs are about the same, when the social -economic level of
the population being compared is equal.
Trauma transports should be equally important, and perhaps more important
in kids because it does not take much to knock down a kids respiratory
effort ( simple head bonk resulting in anoxia) and a simple intervention by
a trained responder can avert injury ( jaw thrust/chin lift)
Anyway, it would be great if every ED was staffed by MD's who were familiar
with kids, but I am afraid that we are still not there in my area of the
PS, I was irritated by Bukata and Hoffmans remarks on the last issue of EMA
They have not seen the pitiful care kids are getting by their ER colleagues.
We can all do better and should strive for that..
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