Death of a Child in the Emergency Department

Debates about healthcare reform often emphasize profit, technology, and AI, yet crucial data, like child mortality rates, receive scant attention. When such discussions do touch on worsening inequity in child mortality, the conversation quickly shifts to buzzwords like "inequity" and "social determinants of health." This shift obscures a fundamental question: How can we claim to fix healthcare if we ignore its most tragic failures?

My focus on the death of a child isn’t arbitrary and continues my recent writings trying to gain attention to outcomes. Recent data indicates rising infant and child mortality rates in the US—increasing gaps based on race -- troubling trends that seem to barely make a ripple in public consciousness. This oversight challenges the integrity of our healthcare system, questioning our priorities and efforts in addressing real-life crises.

Over the next few weeks, I will explain why everyone should be concerned about child mortality. The death of a child creates profound and lasting devastation, impacting parents, siblings, friends, relatives, and the medical staff involved.

Imagine the scene in a pediatric emergency department when the EMS alarm sounds at 1 AM. Anxiety surges among the staff, uncertain of the impending crisis. With only one doctor and five nurses working through the night, each emergency call potentially brings a storm.

The radio, a basic yet crucial piece of equipment, crackles with urgency, announcing an ambulance en route with a child who is unresponsive and pulseless, undergoing CPR. The estimated time of arrival: five minutes.

Pediatric emergency physicians train rigorously for such critical moments. Despite our preparation, the grim reality is that the prognosis for a child in full cardiac arrest is often bleak. We know what’s at stake; the child becomes our sole focus, commanding all our skills and dedication.

Our emergency department, frequently criticized for long waits and high bills, is a complex operation requiring an extensive array of training, expertise, dedication, and equipment, all available 24/7. There's no time to waste; everything necessary must be immediately accessible.

Pediatric Emergency Medicine (PEM) doctors undergo a decade of training after college. ER nurses, equipped with years of experience, excel in CPR, IV placement, and critical support. Our teams are bolstered by respiratory therapists, pharmacists, in-house surgeons, anesthetists, critical care experts, and support staff such as chaplains or social workers who assist families during these crises.

Throughout my career, I have seen children die from a myriad of causes, each one a profound tragedy:

• Gunshot wounds: Whether accidental or intentional, these incidents are shocking and largely preventable.
• Drug overdoses: Increasingly affecting younger populations, both through accidental and intentional ingestion.
• Motor vehicle accidents: Often tragic results of momentary lapses in attention or reckless driving and children being struck on bicycles and while crossing the street.
• Physical abuse: A dark reality that emergency rooms too frequently encounter.
• Overwhelming infections: Despite medical advances, severe infections can rapidly become fatal.
• Respiratory disease: amazingly asthma and viral lung infections wreak havoc on far too many children.
• Head injuries: From falls, sports, or accidents, the fragility of young lives is starkly evident.
• Sudden Infant Death Syndrome (SIDS) and congenital heart diseases: Unpredictable and deeply distressing to families.
• Drowning and bleeding from tonsil surgery: Reflective of both everyday activities and medical procedures turned tragic.
• Cancer: A long, painful battle that some children unfortunately do not survive.

As the ambulance approaches, we prepare meticulously. The room is pre-stocked, roles are clearly assigned, and every protocol is double-checked to ensure we can take immediate action. The handoff from EMS to our team is not just a medical procedure; it is a critical, emotionally charged event. EMS personnel, despite their professionalism, often reveal their emotional strain once the child is in our care, a testament to the intense pressure and hope invested in each case.

This narrative extends beyond mere data. These are real patients, real lives at risk. What story will unfold today? How will the family cope? Can we save this child?

In the frantic world of emergency care, the ripple effects are profound, and every second counts. We strive for miracles in an environment where reality often dictates otherwise. We face these heartbreaking moments with the resolve that, just perhaps, we might change the outcome.

Outcomes

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree and have not intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes. Interested in all of my writings.. click here..