Research shows many hospitals in the U.S. aren’t fully prepared to deal with a surge of sick children. Research shows many hospitals in the U.S. aren’t fully prepared to deal with a surge of sick children.
“I was quite nervous going in, as a pediatric emergency physician,” he recalled.
“Frankly, am I gonna have to treat him myself? Are they even going to have the equipment?”
Many EDs are unprepared to care for kids
Auerbach had reason to be wary about taking his kid to an unfamiliar emergency department.
Auerbach stresses that most children do get good care – and parents shouldn’t hesitate to bring their kids in if there is an emergency – but the reality is that children “were not at the focal point ” of the country’s ED system as it developed.
In general, EDs treat far more adults than kids.
“We were seeing that a patient that might require time-critical interventions, was now waiting for those interventions, sometimes six, eight, 12 hours in that community [emergency department] setting,” Auerbach says.
“Adult care is often more complex, more chronic, might involve more medications…[and] might be more lucrative,” says Auerbach.
A surge hits after years of cutting pediatric beds
“That [financial] margin is higher [for hospitals] if you preferentially invest in adult health care,” he says.
“So while the adult health care community may benefit from that, the pediatric health care community is left behind.”
“But I suspect all of those viruses will continue to circulate and cause their own surges. And if they all happen at the same time, we will be pressed for beds again,” she says.
How bad will it get next time?
“Two- to three-years-old with RSV were doing much worse with that virus than they would have done in 2018 or 2019,” he says.
That could be because those toddlers hadn’t been exposed to RSV and other common viruses after a year or more of social distancing and pandemic precautions, says Bryant.
“We had a couple of years in which we didn’t see a lot of respiratory virus circulation.”
“I don’t see how our pediatric health care system can be sustainable without major financial reforms,” Kociolek says.
That includes changing how pediatric care is reimbursed, making it more affordable for medical students to choose a career in pediatrics and investing more hospital resources into caring for kids.
And emergency departments don’t have to invest in costly specialists or add pediatric beds in order to be better prepared to treat critically-ill and injured children.
Often the biggest improvement comes from designating a staffer to be the pediatric care coordinator — someone whose job is to make sure every aspect of emergency care, from disaster drills to equipment checks, is done with kids in mind.
To Auerbach’s relief, the hospital in rural New York where his son was treated had taken just these kinds of steps.
It had partnered with a big university hospital and had the right equipment, the right policies, the right staff training, to handle seriously sick kids.
“They rapidly assessed him, [and] began very appropriate breathing treatments and medical treatments,” Auerbach says.
“And after about six hours of observation, we were able to actually stop at Dunkin Donuts on the way home and come and see his mom and his brother.”