What You Need to Know about Emergency Rooms. Not all ER’s are the same.

by Audrey Paul, MD, PhD, FACEP , Karen Goodman, MD, and Catherine Verow, MS, CCLS

There are many options for places that take care of babies. It’s important for you to know what your local options are. These may include:

  • general emergency rooms
  • pediatric emergency rooms within general emergency departments
  • pediatric emergency departments within children’s hospitals

Although routine testing and evaluation of a sick baby is provided in all emergency rooms, experience with newborns and ready availability of services, specialties and even equipment can and do vary between emergency rooms.

Preparedness Tip:

Familiarizing yourself with all of your options for emergency care will help you make the best decision for your baby, should an emergency arise. Pediatric ER’s offer specialized services that may not be available in general emergency rooms.

Pediatric emergency rooms are staffed by physicians, nurses and other health professionals who are specially trained in treating children. In addition to general pediatricians, pediatric ERs often have doctors who have completed a fellowship in pediatric emergency medicine. This type of fellowship is an advanced medical training program, lasting three years, offered to physicians who have completed a residency in pediatrics or emergency medicine.

  • Pediatricians focus on the overall healthcare of babies and children.
  • ER physicians focus on birth to death healthcare for emergencies.
  • Pediatric emergency medicine physicians have specialized training in both pediatrics and emergencies.

Pediatric ERs may exist not only within a general hospital emergency department but also within a children’s hospital. In a children’s hospital, pediatric ER doctors are more likely to have access to other pediatric sub-specialists, including physicians who have received fellowship training in cardiology, neurology, and other subspecialty areas.

Preparedness Tip:

Investigate and make note of the types of services (pediatric or general care) available at your local hospitals. Make note of the location of the nearest pediatric ER. Not all Doctors practice at all local hospitals.

Another important consideration in deciding where to seek treatment is your pediatrician. Pediatricians are often affiliated with one or more hospitals that allow him or her to be more involved in your baby’s care. Along with you, your baby’s doctor is also your baby’s best advocate. Even if you go directly to the ER, your pediatrician can be helpful not only medically (by providing information to the hospital staff) but also emotionally, and also in an emergency. Your pediatrician knows you and your baby and can help you deal with a stressful situation.

Preparedness Tip:

Discuss with your pediatrician which hospitals they are affiliated with, whether this is a pediatric ER, and what their local ER recommendations are in the event of an emergency. The closest ER (general OR pediatric), is the best ER in a serious emergency. “My newborn is “burning up.” She must have a fever of at least 104°F and is having trouble breathing.” “My son fell from the kitchen counter after I bathed him.”

In these or any other situations in which your baby is in distress or has suffered an injury requiring immediate treatment, it is important to get medical care as quickly as possible. Try to be calm. Go to the nearest ER. If required, the emergency department can transfer your baby to a more specialized setting once your baby has received appropriate care and is determined to be in stable condition.

Preparedness Tip:

Familiarize yourself with the location of the ER that is closest to you.

When to call 911?

Of course you should call 911 if your baby has turned blue, cannot be aroused or is having trouble breathing. You should also call 911 if your baby appears seriously ill, and you are concerned about driving to the emergency room. The same applies if you cannot drive or have no means to get to the emergency room. If your baby is not in distress, you can drive your baby to the emergency room. Make sure that your baby is properly secured in a car seat, or if you take alternative transportation always also make sure that your baby is in a car seat. If you drive, it may be comforting to have another adult present to assist with and keep an eye on the baby, while you drive.

Preparedness Tip:

Map your route to the nearest ER and the nearest pediatric ER, in case of emergency. Even If you need to call 911 to get to the nearest ER, in the event of an emergency you may need this information for someone else to follow the ambulance and/or to share with friends and family who offer assistance.

CPR Training/ When to do CPR?

Many local hospitals and community centers offer potentially lifesaving CPR classes for parents. It is advisable to take one of these classes so that you can perform CPR as trained, in the event of an emergency. It is recommended that if someone is able to perform CPR, this should be started prior to calling 911 (or concurrent if someone is able to perform CPR while someone else calls 911). Current recommendations are to perform CPR for one minute prior to calling 911, if you are alone.

Conclusion

If your baby exhibits any changes or symptoms that appear severe or life threatening, go to the closest ER immediately. If your newborn does not have a fever, and does not appear to be in immediate distress, but something still does not feel right to you, trust your instincts! Call your pediatrician. An ER visit may or may not be necessary, or your pediatrician may recommend that you go to a pediatric ER. When speaking to your pediatrician, ask if your ER is staffed with pediatric emergency medicine physicians 24/7, since pediatric emergency physicians are often more comfortable managing pediatric emergencies especially in newborns.

Ultimately, you are your baby’s best advocate, and you know your baby best. If you have any questions trust your instincts and always call your pediatrician. In an emergency, if you do go directly to the ER, you should contact your pediatrician. Your pediatrician can be helpful not only medically (by providing information to the hospital staff) but also emotionally. Your doctor knows you and your baby and can help you deal with a stressful situation.

Remember, newborns show symptoms and signs of illness differently than older children, so staying attuned of and being aware of the best expertise and being prepared for the places to go for any potential newborn emergency can be life saving!

The preceding information is intended to empower and inform your decisions. Its development was funded in part of a generous grant from R Baby Foundation.

The R Baby Foundation seeks to save the lives of newborn babies by educating parents, supporting research, and providing emergency room equipment and training to medical professionals.

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