A fall off the swing set yields a compound fracture of your 8-year-old's arm. A bee stings your toddler, whose breathing is now labored. Your little one has ventured too close to the campfire, and the burn is bad. Your instinct is to panic, but you know your next move may make all the difference. So, what do you do?
According to the U.S. Centers for Disease Control and Prevention, unintentional injuries – falls, drowning, burns, poisoning – make up the leading cause of morbidity and mortality among children in the United States. In fact, every year more than 12,000 people ages 0 to 19 die from unintentional injuries while more than 9.2 million are treated in emergency rooms for nonfatal injuries.
Informally known as "trauma season" among emergency medical professionals, summer is known to bring with it a marked increase in unintentional injury and death among children. Per the CDC, the season is responsible for 27 percent of the year's ER visits.
According to the latest Safe Kids U.S. Summer Safety Ranking Report, a study published by Safe Kids Worldwide, almost 60 percent of total child unintentional injury deaths from May through August involved drowning, biking, falls, motor vehicle occupant activities and pedestrian incidents.
Dr. Sandy Vieder, chairman and medical director of the Botsford Hospital Trauma Center in Farmington Hills, sees all of these injuries spike with the arrival of warm weather. He'd also add to that list allergic reactions to insect bites, burns, heatstroke, and bone fractures – all injuries that can turn critical fast.
911 or drive to ER?
When every second counts, it is crucial for help to be dispatched to the scene of an emergency as soon as possible. Medical professionals sometimes refer to the first hour after a serious medical emergency as the "golden hour," because it is during that time that prompt medical care is most crucial to save a patient's life or limit the extent of injury.
Joyce Williams is the public affairs manager for Huron Valley Ambulance, based in Ann Arbor, which provides health transportation services in an eight-county service area in southeast Michigan and south-central Michigan. She notes that while it is not always apparent how serious an injury may be, there are certain signs and symptoms that demand an immediate emergency medical response.
"If the child isn't breathing, is unconscious or is bleeding profusely, call 911," says Williams, also a former nurse. "You, the parent, will know when to call 911 because you know the child better than anyone else. When in doubt, call.
"If the child wakes up and is fine, paramedics can always get there and leave," Williams continues. "But it's always good to have an ambulance on the way in case the child gets worse. Ambulances are like ERs on wheels. Paramedics can start treatment of the child on the way to the hospital. If you're driving the child to the hospital yourself and he or she gets worse on the way, you can't do anything. You'll have to pull over and call EMS, and that wastes precious time."
Vieder, who is also the medical director of Lakes Urgent Care in West Bloomfield, acknowledges that it may be difficult for panic-stricken parents to wait the three to five minutes it will take the ambulance to arrive on the scene – but do so, nonetheless. "The paramedics can get to you faster than you can get to the hospital," he says. "And they can begin treatment immediately upon arrival."
As for moving an injured child, Vieder says don't. "The concern with moving an injured child is causing additional injury, especially to the head and neck," he explains. "If your environment is unsafe and you must move the child, get others to help you if possible. You'll stabilize the head while others stabilize the body, so you can move in concert. This is only to be done if, for example, the child is in water or you're in the middle of the expressway."
If possible, Williams encourages parents to use a land phone line to dial 911, as the caller's phone number, address and the nearest fire department and police station will automatically appear on the emergency dispatcher's computer screen.
"However, today, many people don't have a land line and must use their cell phones," Williams says. "That is why one of the first questions our dispatchers will ask is for a call-back number to use, should the call be disconnected. Unlike with a land line, a caller's number and address do not come through. The technology isn't there yet."
In the event that the emergency takes place away from home or in an unfamiliar location, Williams encourages parents to flag someone down for help. If unsure of their location, like if there is a car accident, dispatchers will ask questions until they can pinpoint a location.
"The dispatcher will ask you what exit you just passed or what exit you're coming upon," she says. "They will ask you what you see around you. But ultimately, when accidents happen on the road, dispatch typically gets more than one or two calls from passersby who can help provide location information."
Williams notes that in most cases, the first person with whom a caller speaks when they dial 911 will be a police dispatcher who will try to ascertain the nature of the emergency.
"Parents should expect the dispatcher to ask lots of questions," she says. "Parents need to answer them as best they can and know that the ambulance has already been dispatched. These questions are not holding up the dispatcher from sending out an ambulance. That happens immediately. The answers you provide to questions are being relayed to the paramedics as they're driving.
"We're also using that information to determine if we need the ambulance to proceed with lights and sirens," Williams adds. "When we go lights and sirens, it's very dangerous for everyone involved. We try to use those only when the situation is critical."
Emergency dispatchers will use a calming voice and encourage panic-stricken parents to take deep breaths and to focus, so they can help the child. To keep the child calm, parents should attempt to keep their own panic in check and use a soothing voice to reassure the child age appropriately, Williams notes. "Kids will pick up on the parent's panic," she says.
Despite temptation to call 911 and quickly get off the phone to tend to an injured child, parents need to stay on the line until the dispatcher says to hang up, Williams notes.
"The dispatcher wants you to share all of the information you possibly can before the ambulance arrives," she explains.
If possible, parents should send someone out to greet the ambulance.
"Doing so is especially helpful at night or when the weather makes visibility poor," Williams says. "If the emergency is happening outside, say in the backyard, this person can lead the paramedics to the scene if there is no obvious entrance."
Williams also notes that in medical emergencies, the local fire department is typically dispatched along with paramedics. Firefighters may respond first and are trained and equipped to begin administering treatment until paramedics arrive.
"Firefighters will have a defibrillator with them. They can start oxygen, and they can administer CPR," Williams explains. "They can do all the things the medics will do when they get there."
Once paramedics do arrive on the scene, they will begin or continue treatment – and in many cases, confer with the parents on what hospital to take the child to.
"Typically, parents can decide which hospital they'd like the child to go to – unless the situation dictates a particular hospital," Williams says. "For example, if there is a severe burn, the University of Michigan has a trauma burn center at Mott Children's Hospital. It depends on the severity of the situation."
In most cases, at least one parent is welcome to ride in the ambulance with the child. "If the situation is critical, two medics may be working in the back, and a firefighter may be driving the ambulance," notes Williams. "In that case, a parent may need to ride up front, as there is not a ton of space in the back." Another exception to this may occur if a parent is hysterical and is impeding paramedics' work.
"In that case, a neighbor or family member may drive the parent to the hospital to meet the ambulance," Williams says. "If parents can't or shouldn't ride in the ambulance and someone is not there to drive him or her, firefighters or police can drive the parent."
Likewise, police officers and firefighters responding on the scene will lock up the family's home, check the scene to make sure nothing was left behind and make sure that any other children in the family are left in the care of another family member or neighbor.
"The parent is often too distraught to think about those things," Williams says.
At the hospital
Unlike days past, when parents were confined to the waiting room with little knowledge of what was happening with their child, nowadays, parents are welcome – and encouraged – to remain with their child while treatment is underway.
"At Botsford, we always allow parents in the room where we're giving treatment – even in critical situations," says Vieder. "We want parents there to provide any information we may need. We want parents there to be part of the recovery. We want parents there to be aware of how critical the situation may be. And we want parents there to know we tried everything we could in the event of a death.
"If a child dies, parents sometimes feel guilt that they weren't there, that if only they'd been with their child they could have made sure something else was done," he says. "We don't want parents to have those regrets." An exception to parental presence in a treatment area: if a particular procedure requires a sterile environment.
"But ultimately, if the child is scared, a parent will be a source of comfort," Vieder says. "If the situation is not super critical, we may request just one parent in the room if space is limited or if one or the other parent is queasy. We don't want another patient on our hands. But otherwise, we welcome parents there to hold their child's hand and to talk to him or her."
At the hospital, parents should expect to be asked about any medications their child is on and any allergies the child may have. Medical providers will also ask for details about what happened, which parents may be hesitant or nervous to share.
"The best parents with the best intentions make mistakes," Vieder says. "Things happen beyond our control. We encourage parents to share any information about the accident that they can. It's important that they do so, as that piece of information may be critical."
Both Williams and Vieder stress that the best thing a parent can do to prepare for emergency situations is to plan ahead and get educated.
To help 911 dispatchers get the info they need and to the scene as quickly as possible, Williams advises parents of young children to have a land phone line and to post that phone number for it, as well as the house address, on or next to the phone. Similarly, she encourages families to make sure their house number is visible from the street and in the dark.
"Light your address if possible," she advises.
Williams also encourages families to post the number for poison control on their refrigerator and to make sure kids know how to dial 911 – and that they can recite their address and phone number.
"Have your child practice dialing 911 on a play phone or a cell phone that's turned off," she adds.
Vieder suggests parents write down the names of any medications their child is taking and any allergies the child has on a card to keep in their wallet. This will ensure they have that information and can quickly relay it to medical professionals during an emergency.
Both say that if parents do just one thing to better prepare for an emergency, it should be taking a CPR and first-aid course.
"You may never need to use what you learn," Vieder says. "But even if you remember only a portion of what you learned in a first-aid course, you're better off. You'll have at least a fighting chance to help the child in need."