After 14 years of the terrifying asthma attacks that have plagued her son since infancy, Patricia Wooten, 31, of Dorchester has become a pro at triage – the fine art of distinguishing between life-and-death emergencies and scary, but less urgent, medical problems.
She has learned how to listen to James’ wheezing through a stethoscope and determine, with help from a doctor on the phone, whether it’s safe to increase his medications and handle things at home.
And she knows when to call 911 or to rush James to Boston Medical Center’s emergency room herself, zooming through traffic in 15 minutes flat.
But many parents, especially those with less experience than Wooten, aren’t sure which emergencies – from asthma to epileptic seizures to high fevers to bad falls – require a fast trip to the ER, and which ones can be handled by phone, in the doctor’s office or in the urgent care unit of a health maintenance organization.
And new research suggests that guessing wrong may be more dangerous than you may think. Pediatricians’ offices are often not equipped to handle emergencies because doctors think emergencies are rarer than they really are.
In a recent survey of 52 pediatric practices in Connecticut, for instance, researchers found that the average pediatric practice faces one emergency every other week – and that one quarter face an emergency every week.
Yet few pediatricians or their staffs are certified in basic or advanced life support techniques. And they often lack the necesssary equipment – oxygen, intravenous tubing, masks and bags to pump air into the lungs, says Dr. Glenn Flores, a Boston Medical Center pediatrician who was the study’s lead author.
While most pediatricians’ offices can handle a typical asthma crisis, Flores says, a third or fewer are prepared for other emergencies, such as upper airway obstruction, shock, trauma, epileptic seizure, cardiac arrest or a diabetic crisis.
Dr. George Foltin, director of pediatric emergency medicine at Bellevue Hospital in New York, emphatically agrees, noting that one third to 40 percent of all pediatricians and family practitioners are not ready for respiratory emergencies.
“And maybe 50 percent are not ready for other kinds of emergencies,” adds Foltin, a member of the pediatric emergency medicine committee of the American Academy of Pediatrics, which is holding its annual meeting this week in Boston.
Granted, it makes little sense, especially in or near a big city, for every pediatrician’s office to be as prepared for an emergency as a big hospital pediatric emergency unit.
“The average city police department doesn’t have a tank and an F-18, because they don’t usually use them,” says Dr. Gary Fleisher, chief of emergency medicine at Children’s Hospital. He argues that at least for urban pediatricians, often the best preparation “is to have a telephone so he can call 911.”
Still, there’s a lot that parents themselves can do to make sure their child gets the right care fast in an emergency.
The key is to discuss with your child’s pediatrician – before an emergency arises – when you should call 911 or the police emergency number to have the child rushed to a hospital, when to drive the child to an emergency room yourself, which hospital to go to – and when to triage problems by phone with the help of a doctor or nurse.
All this can get rather tricky, but a rough consensus emerged from interviews with several leading pediatric emergency specialists, among them, Dr. Martin Horowitz, director of pediatrics for the health center division of Harvard Pilgrim Health Care; Dr. Bob Vinci, director of the pediatric emergency department at Boston Medical Center; Dr. Suzanna Steinbach, director of the pediatric asthma clinic at BMC; Flores of BMC and Fleisher of Children’s.
Here’s what they said: