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This is both a complex and controversial question to: what sort of
system is best to answer the emergency medical needs of children on a
regional basis.  One needs to consider not only the physical and manpower
capabilities of institutions, but the competency, experience etc. of their
staff (this included physicians, nurses etc).  Individual physician's
capabilities may vary based on training, ongoing experience, patient
population and general competence.  There are also economic, ego, and
political issues at stake.  The current reality is that the majority of
children in this country receive thir emergency care in general emergency
departments (usually community hospitals) and not in pediatric centers.
There are many opinions, and not much hard data.  The focus will need to
remain on the patient.
 
I am currently a member of a PEM ACEP Committee that is developing a
pediatric emergency care outcome tool.  We are looking at a multiple
variables, including diagnosis, type of hospital/ED, training/experience
of individuals, utilization of consultants, outcome, etc.  This study may
contribute, if only in part, toward the answer.  If anyone is interested
in participating (looking over the tool, serving as a test site, etc),
please eMail me.
 
I am residency trained in both Peds and general emergency medicine.  My
clinical time is spent in a variety of settings including a children's
hospital, a university hospital, and two community hospitals.  I train
both Peds and EM residents.  I would like to think that the care that I
render patients in all theses settings is equivalent, but it is not.  Such
variables as nursing, residents, equipment available, consultants,
transport issues, lab capabilities, result in differences.  I feel that my
own experience may not answer the question on a larger scale.  Individual
studies, such as the one I mentioned above, may help to tease out an
answer.
 
Zach
 
Zach Kassutto, M.D.,F.A.A.P                     eMail: [log in to unmask]
St. Christopher's Hospital for Children         Tel:   215-427-5369
Philadelphia, PA                                Fax:   215-427-4668
 
 
> Date:    Fri, 16 Aug 1996 23:31:27 -0500 > From:    Harvey Louzon <[log in to unmask]>
> Subject: Regionalization of Peds EM Care
>
> I would be interested to hear the opinion of others on the desrirability
> of setting up a regionalized system of pediatric emergency care along the
> lines established for trauma care in many cities.  Only children's
> hospitals or those specifically designated as 'approved for pediatrics'
> would then recieve pediatric ALS runs.
>
> I am particularly interested in the opinion of those who have chosen to
> specialize in the emergency care of children by virtue of working in a
> children's hospital, having done a peds EM fellowship or of being double
> boarded in peds and EM. (The opinion of those whose pediatric training
> consisted solely of what they recieved in a conventional EM residency has
> already been made abundantly clear to me. Many of them are also
> subscribed to this list and it is not my intent to precipitate a
> firestorm of controversy here as well.)
>
> I am interested in what you perceive, if indeed you do at all, what the
> advantages TO THE PATIENT are of this type of specialty training and
> whether any hard evidence, in the way of improved outcomes, has ever been
> demonstrated with this approach.
>
> If this subject has already been discussed please point me in the direction
> of how I may retrieve this information from the archives.
>
> You may respond to me by private e-mail or, if you feel that your
> comments would be of general interest, to the list.
>
>
> H. Louzon MD
>
> ------------------------------
>
> ***************************************************
>
 
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