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Pediatric Emergency Advice

Meg Falciani has nothing but respect for the community hospital near her tiny town of Malaga, N.J. After all, her husband's grandfather was one of the founders, and she's gotten great treatment there. But when her 4-year-old daughter, Celia, gashed her chin open, Falciani drove right past her ER, which is only minutes away, and traveled nearly an hour to reach Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.

"Our local hospital is great for adults," says Falciani. "It's just that they have no pediatricians on staff, they don't have a lot of pediatric-size equipment, and they don't admit children. If you have a seriously ill or significantly injured child, they'll stabilize her and transport her to another hospital."

Falciani had already gone through that when her oldest son, Luke, now 10, was a toddler. She took him to the local ER after he developed a high fever and became dehydrated. He needed intravenous fluids, but the hospital didn't have a small enough catheter to easily insert the IV line. When they finally managed to get in a larger one, the staff had to tape tongue depressors together to form a child-size stabilizer to prevent him from pulling it out. After that, an ambulance took him to duPont for further treatment. In the years since then, the mom of four says she hasn't seen much movement toward a more kid-friendly approach.

"It's not a very confidence-inducing thing," she says.

And given that Celia has chronic health problems, Falciani has decided that, in many cases, the local hospital won't work for her daughter.

Falciani's situation may seem more the exception than the rule. After all, she lives in a rural area and her daughter has special medical needs. But the truth is, her family's experience is far more common than anyone might think. Although children make nearly a third of all ER visits, a mere 6 percent of hospitals have all the pediatric supplies they need, according to a report from the Institute of Medicine, an independent research organization that advises the government. What's more, only a quarter of hospitals have access to doctors board-certified in pediatric emergency medicine, and more than a third have no pediatric specialists on call at all. Without their specialized knowledge, kids' care can be seriously affected.

Take the results of this Johns Hopkins and Duke sponsored mock drill, which tested 35 North Carolina emergency departments, including five trauma centers: Nearly all failed to stabilize injured children properly, to correctly treat kids with a life-threatening drop in blood sugar, or to order proper IV fluids. The report, which was published in Pediatrics, was so troubling that Parenting reached out to doctors and moms nationwide to learn about their experiences, and their stories offered only more of the same. The lack of expertise is not a North Carolina problem (or a New Jersey one); it's nationwide in scope.