Research Saves Injured Kids by Dr. Alison Gardner

I always wanted to be a pediatrician. First as a pediatrician and now as a researcher, it’s my job to care and lobby for kids. 

Sometimes our kids are injured no matter how many precautions we take and it’s our job to find the best ways to treat these seriously injured children. The golden hour is where you can intervene and improve outcomes from issues like airway troubles, and blood loss, and that sort of thing. That's where, in the emergency room, I come into play. 

Dr. John Petty and I were talking and he brought up the fact that he sees many kids come to the emergency department after trauma with low blood pressure but they have not lost blood. In fact, oftentimes their primary and only injury is a bad head injury. 

In medical school we are taught through the American College of Surgeon’s Advanced Trauma Life Support (ATLS) manual how to respond during that golden hour. It defines the standards of care for trauma patients. It says that if we see evidence of low blood pressure, or shock, that hemorrhage is what we're supposed to think. They're losing blood somewhere. If it's not blood loss out of their body, they're probably bleeding inside their abdomen or internally somehow. There is a sentence in the manual that says isolated or intracranial injuries don't cause shock.

Dr. Petty and I discussed and decided this might be different for kids than adults, and we decided to investigate because it might change our care. Instead of giving them fluids and blood we might do something different to help their blood pressure. In fact, if you've injured your brain, more fluids could cause the brain to swell more and that would be detrimental.

We started a very small study of patients that were treated at our Level I trauma center. We reviewed the details of 31 kids with low blood pressure to see the final cause of their injuries when they were discharge. We found that in kids under 5 years old that came in with low blood pressure and evidence of shock, 50 percent of the time they had an isolated head injury. They didn't have injuries that cause internal blood loss.

The question then becomes, what is the problem? That's guides our treatment. We found it was age dependent. In kids 5 to 11 years old, we found that about 25 percent of those kids had a head injury. This phenomenon disappeared in our teenagers.

After discussion with colleagues at other institutions, we decided to expand our study to review cases from the National Trauma Database. We don't know all the answers to our questions yet, but more research is needed. We need to find better ways to help save more injured kids during the crucial golden hour of treatment. Head injury is a real problem in kids, and it's something that's not entirely preventable.

Our infectious disease colleagues began studying the causes of mortality in pediatric patients decades ago and were able to develop vaccines and improve antibiotics in the mid-1900s. We don't see kids dying a lot from infectious disease anymore. Now we see the same thing with cancer. Childhood leukemia is not a death sentence anymore, and that’s due to hard work in the mid-1980s and 1990s. Their work is impactful.

Now childhood trauma is killing more kids than all other causes combined. I’m involved in the care of these injured kids every day. Since we can’t completely prevent injuries, it's our time to take on this challenge and help save the lives of injured kids.

- Dr. AlisonGardner, Assistant Professor of Pediatrics and Emergency Medicine at Wake Forest Baptist Medical Center

Teen Driver Safety Week

During Teen Driver Safety Week, Discuss the “5 to Drive”

For many teenagers, getting a driver’s license is an important rite of passage. For parents, however, it can be a time of concern.

It’s no small matter to hand the keys of a two-ton vehicle over to a son or daughter who not that long ago was having their training wheels taken off their bike. It’s particularly worrying when you know that motor vehicle crashes are the number one killer of 14- to 18-year-olds. 

In 2012, there were 2,055 teen drivers involved in fatal crashes, and 859 (42 percent) of those teen drivers were killed in the crashes.

But rather than worry, be ready: use Teen Driver Safety Week, which starts on Sunday and runs through October 25, as a time to set some ground rules. We call these rules the “5 to Drive,” and they might just save your child’s life. We’re asking parents and guardians to discuss these five basic rules for safe teen driving:

·         No cell phone use or texting while driving

·         No extra passengers

·         No speeding

·         No alcohol

·         No driving or riding without a seat belt

We need parents to discuss the “5 to Drive” with their young driver because these dangerous driving behaviors are what is claiming young lives on America’s roadways. We need teens to take these rules seriously. That will only happen if parents establish these ground rules with their children—and back them up with a zero-tolerance policy. Unsafe driving means no driving. That’s a promise you should make to your child because it’s a promise that will keep them safe and that they will take seriously. After all, no teen with a driver’s license wants to end up back on the school bus because mom or dad took away the car keys.

Whether it’s drunk or distracted driving, not wearing seat belts, or speeding, we need to redouble our efforts to help our nation's young people make the right choices—as drivers and passengers. So let’s get the safety conversation started. Use the “5 to Drive” and set the rules before your teens hit the road.  And then keep the conversation going.

Adults, control the keys. “5 to Drive” is a message that needs to be reinforced again and again.

- David Friedman, Deputy Administrator of the National Highway Safety Administration

Fire Safety Saves Kids' Lives by Pamela Elliott

Life-saving fire sprinklers should be more prevalent

While on my flight to speak at a fire safety event, an article caught my attention. It was titled “U.S Requires New Cars to Have Backup Cameras.” My first thought was there must be a huge problem if the National Highway Traffic Safety Administration is requiring new cars to have backup cameras. Then I was somewhat surprised to read that there are nearly 210 backover deaths each year. About a third of those deaths are children, and many of these accidents are caused by parents. The article stated that rear-facing cameras would save between 59 and 69 deaths a year.

By contrast, the United States Fire Administration reports that fire kills 3,400 and injures 17,500 people each year. I was burned as a young child in a house fire. As such, I am acutely aware of the number of people who needlessly die or are injured in fires.

I sat on that flight with many mixed feelings. As a fire safety advocate, I’m excited any time a safety measure that will save even just one life is enacted. However, as a burn survivor, I felt frustrated and angry that similar safety measures haven’t been implemented in homes to prevent fires. What makes me even angrier is that the technology to prevent these deaths and injuries exists—they're called fire sprinklers. It’s taken quite a few decades to install them in new homes at a very slow rate.

NHTSA is to be highly commended and applauded for their public safety efforts. Since its inception, seatbelts have saved 280,000 lives and air bags have saved 28,000 lives. Now another safety device will be added to cars to prevent even more deaths.

Because of my past, I investigated how many children die in fires. I looked at the FEMA report “Fire Risk to Children 2010.” In 2010, 357 children died in fires. That’s about five times more children than those killed in backover deaths annually. The children most likely to die or be injured are newborns through age four -- those who can’t escape by themselves. If those statistics don’t grab at your heartstrings, I don’t know what would.

Anthony Foxx, United States Secretary of Transportation, said in the article, “Safety is our highest priority, and we are committed to protecting the most vulnerable victims of backover accidents—our children and seniors. As a father, I can only imagine how heart-wrenching these types of accidents can be for families, but we hope that today’s rule will serve as a significant step toward reducing these tragic accidents.”

Sometimes when children die in fires, no body is found. I can’t imagine having to bury a child, but I certainly can’t comprehend not having a body to bury. 

According to the FEMA report, 87% of fire-related casualties to children occurred in homes. That’s 87% of 357 children — 310 children who die in their own homes. We have the capability of saving 310 children a year. The technology exists — it’s a scientific fact that fire sprinklers save lives, reduce property loss and decrease injuries.

There’s no way to comprehend the devastating effects of burn trauma unless it happens to you or a family member. Why do we wait for a horrific event that warrants litigation before we’re compelled to change? Unless prevention becomes the highest priority of the fire service and its advocates, we can expect to continue to see these horrific statistics; this makes me very sad and irate at the same time.

I can only hope that comparing these statistics will somehow motivate fellow safety advocates and the fire service to take action. We need to stand united in the message that fire sprinklers save the lives of both citizens and firefighters.

- Pamela Elliott, RN and fire survivor

Are we prepared for injured kids?

How many of you are parents, aunts, uncles or grandparents with children around you?

We all know that illnesses and injuries are going to happen even with the best prevention and care. The CDC reports that North Carolina has higher than average death rates for injured children. Patient-related injury accounts for the highest death rate among children birth to 19 years old in North Carolina. Currently, there are only 124 pediatric intensive care beds in the state to care for those children and very few of them are vendor specialized pediatric intensive care beds. Therefore, there are very few special care beds for children in the state with dedicated physicians and nurses to take care of those patients. 

To help explain the issue from the medical professional’s perspective, we wanted to share a few numbers and ask some questions.

• What percentage of EMS calls involve kids?  5%
• What percentage of medical education time is typically devoted to trauma for children? LESS THAN 5%

The critically-injured pediatric patient produces more anxiety in caregivers because there is a lack of preparedness. We have found that when medical personnel are properly trained, children’s lives are saved. Unfortunately, budget cuts and financial restrictions result in many hospitals, EMS agencies and medical caregivers focusing on general training for continuing education instead of specialized courses for treating critically injured children.

• How comfortable would you feel caring for a child in an emergency?

The bottom line is that we all feel unprepared to care for injured kids because we don't care for them that often. When an emergency occurs, there is no time to travel long distances for care. We have to trust that the people caring for our children are prepared and know the best way to save and care for them, but more can be done to help support and prepare these first responders and emergency care providers. That is why we deliver evidence-based care for providers at all levels – from EMTs to nurses and physicians.

• How many of you watch reality TV?
• How many of you have been on a plane before? 

Simulation is reality-based learning – training in situations that are very close to reality. The aviation industry has used simulation technology for years by using flight simulation for pilot’s initial and ongoing training.  Experience shows you will react the way you are trained.

Simulators make learning fun and interactive. In recent years technology has allowed us to take advanced patient simulation into the classroom. Now we can go to the smaller hospitals, the EMS agencies, or the classroom and take this simulation technology to the student, instead of making them come to a simulation center.

Using advanced simulators in the classroom definitely benefits the student – whether that student is a paramedic, nurse or doctor – by giving them the chance to practice caring for a child and performing life-saving skills before they have to do it on a real patient. The pediatric trauma course supports critical thinking skills and gives access to the different equipment a medical professional might use when caring for a patient, whether it’s a ventilator or the different medications used.

We work hard behind the scenes to make sure your child receives the right care at the right time and gets to the right place for treatment. We hope you will learn more and share how we can all improve care for all injured children in the U.S.

- Dr. Dennis Taylor is an acute care nurse practitioner that works at a Level I trauma center in North Carolina, and has been a paramedic for over 30 years

- Gail Kluttz has been a nurse for 24 years and is the regional trauma systems nurse coordinator at a Level I Trauma Center in North Carolina

- Dale Hill works as the regional trauma outreach coordinator at a Level I trauma center in North Carolina and has been a Paramedic for more than 25 years, working in the pre-hospital, hospital and academic settings