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I work in a city with 5 hospitals.  2 of these hospitals are trauma centers and have pediatric intensive care units and pediatric subspecialists on staff.  The other 3 hospitals have general pediatricians and would like to continue to see children in their emergency departments and admit children to their general pediatric floors.  The question has recently been brought up by EMS directors as to whether it would be better for critical pediatric patients if ambulances bypassed closer hospitals that do not have pediatric ICUs to go to one of the other 2 hospitals that have this capability.  All 5 hospital's emergency departments are staffed by board certified EM physicians with the capability of stabilizing critically ill children.  However, these children then have to be transferred by ambulance to one of the 2 hospitals with a PICU if they are found to be to sick to be admitted where they are.  Pediatric trauma patients are already diverted
directly to one of the trauma centers.  Is it best to divert critically ill medical patients to a hospital with a PICU?  This would meet with a lot of resistance from the hospital administrations of the smaller hospitals.  However, I believe this might be in the patient's best interest.  Any thoughts?

Susan Frayer
Medical Director 
Lutheran Children's Hospital Pediatric Emergency Department
Ft. Wayne, IN

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