Surviving the ER

When Kirsty Elliot’s 23-month-old daughter, Coco, hurt her left leg playing on a neighbour’s trampoline, the Lasqueti Island, BC, mom was too late to catch the last ferry to Vancouver. So the Coast Guard sent a medevac ship to transport Coco and her parents across the Strait of Georgia.

However, that didn’t mean any less of a wait when the family reached Nanaimo Regional General Hospital. It would be 3 a.m. before the ER staff finished encasing Coco’s leg in a pink full-length cast. In that time, Elliot learned a lot about keeping an injured toddler calm and comfortable through a sometimes long and chaotic process.

Canadians make some 10 million visits to the emergency room each year, and few parents escape at least one visit with a sick or injured child. Worse, hospital closings and cutbacks have made Canadian ERs more crowded than ever, with average wait times of four hours in major cities, such as Toronto. 

There’s no sugar-coating the experience. But you can minimize the stress and maximize medical care. Read on for 10 strategies that will keep your next visit to the ER as painless as possible.

Map it out Before you need it, know the location of your community’s emergency room. If you have a choice of hospitals, ask your paediatrician for a recommendation, says Calgary ER physician Natasha Iyer. Where available, a children’s hospital is often your best bet. “Emergency room physicians are trained to work with patients of all ages,” Iyer reassures, “but those in a children’s hospital have a lot of experience dealing not only with young patients, but also their anxious parents.”

Make an ER mini-file and checklist Have a succinct medical record and ER checklist at hand so you’re ready should your child need help in a hurry. Consider posting a one-pager with crucial information — health conditions, allergies, previous injuries, vaccinations, doctor’s name and contact information — on a corkboard for quick access. Keep a copy of that information filed away and include a consent form authorizing emergency care if you have a babysitter or other caregiver.

With your file, keep a checklist of what to grab and throw in a bag before you head out the door (see Todaysparent.com/erchecklist for a printable list). At the top: Toss in any medications you’ve given your child in the previous 24 hours (prescription, over-the-counter, herbal or nutritional supplements) and note the dosage. “Having the bottles right there makes it easy,” Iyer says. In the case of suspected poisoning, definitely bring the container of whatever your child may have swallowed.

Other must-brings include your child’s favourite comfort object; small games, toys or books; money for parking and pay phone (for hospital areas where cellphones aren’t allowed); a bottle or sippy cup; and if you’re dealing with vomiting, a change of clothes for your child and an extra shirt for you.

Try to keep your cool No problem, right? “But this is really important,” says Iyer. “If mom is hysterical or looking like someone just died, the child is going to be traumatized. If dad goes speeding off into the night and gets in a crash, we’ve got multiple trauma patients. So take a deep breath, calm down and think.”

Reduce pain “Don’t hesitate to relieve your child’s pain or fever with acetaminophen or ibuprofen — these medications will not interfere with any ER treatment,” stresses Iyer. “If you suspect an infection, take your child’s temperature before giving her acetaminophen [Tylenol or generics] or ibuprofen [Advil or generics]. But by all means, make your child comfortable.” Just don’t give aspirin, as in rare cases it’s associated with potentially fatal Reye’s syndrome.

Other measures for making your child comfortable: Gently apply an ice pack wrapped in a towel to a suspected fracture (not if the bone is protruding). Remove blankets and heavy clothing from a feverish child.

Leave siblings at home Caring for your other children distracts you from the one who is sick or injured. Besides, ERs are neither fun nor healthy places to be. Try to leave other children with friends or family.

Call in reinforcements We all hope that we’ll be calm and available to focus on a sick or injured child in the event of a medical emergency. But let’s face it, that doesn’t always happen. So call for support from family, friends or a trusted neighbour. “It’s great to have another adult come along to help anchor you,” says Dylan Eybergen, a children’s psychiatric nurse in St. Albert, Alta., “or just stay with your child while you go talk with a nurse or leave the room for a few minutes to have a meltdown.”

In addition, many hospitals have Child Life specialists on staff. “We’re trained to provide emotional support during challenging medical events and procedures,” says Nancy Morphet, a Child Life specialist in the emergency department of the Children’s Hospital of Western Ontario, in London. “So by all means, ask if our services are available.” Such services can include helping you and your child cope by providing counselling and game playing designed to educate and reassure.

Be honest but reassuring “Is it going to hurt?” It’s a reasonable question for your child to ask about medical procedures. Resist the temptation to lie, Eybergen says. “Once you do, you lose credibility and have a trust issue.” Eybergen suggests a reassuring “Yes, but the pain will go away, and Mommy and Daddy will be right here with you.”

Age-appropriate explanations help normalize the ER experience, Eybergen adds. For example, “the doctor is going to take a picture of your bones” sounds less frightening to a four-year-old than “X-ray,” and young children may think “CAT scan” has something to do with cats.

Even better, lay an emotional foundation long before your child needs to go the hospital, advises Morphet. Use a doll or teddy to act out a successful visit to the ER or read an age-appropriate book, such as Franklin Goes to the Hospital.

Deal with germs As for avoiding ER germs, steer clear of obviously ill and coughing or vomiting patients. But masking and gloving your child is overkill and may prove frightening, says Janice Spivey, a Kingston General Hospital emergency room nurse in Kingston, Ont. “Unless your child is immune compromised, relax — but be sure to tell the intake staff [if] when you check in. You can be assured we’ll mask anyone who might be contagious.” And do use the hand sanitizer dispensers posted at most ER entrances — on your way in and out.

Keep checking in — nicely It’s OK to ask about waiting time, and it’s always important to alert the staff if your child’s symptoms worsen, the medical experts agree. “Just try to do it in the spirit of being on the same team,” Morphet says. “An us-versus-them attitude doesn’t help anyone, including your child.” (Also remember that you aren’t seeing the life-or-death cases coming into the ER through ambulance and helicopter bays.)

Other important questions to ask: Is it OK for my child to eat and drink? (Perhaps not, if surgery is needed.) Are there ouchless options? (For example, numbing gels for shots or stitches.) Also make sure you know what to do after discharge (for instance, if pain or other symptoms get worse or don’t improve).

Debrief You’re finally back home and ready to forget about the whole trauma. But at some point in the next few days, talk the experience over with your child. “It can be as simple as saying something like ‘My goodness, that must have been hard, but you were so brave,’” Eybergen says, “even if he was screaming the whole time. Remember, there may well be a next time and you don’t want your child to be terrified to go back to the hospital.”

For Coco, now three, “next time” came sooner than anyone imagined. Though Elliot steered her high-energy daughter clear of trampolines, last December Coco took an unlucky tumble off the family bed. Yep, broken arm. “Just a little white cast with that one,” Elliot says. “It was a cakewalk.”

ER checklist

Click here for a printable version you can post on your fridge or in your home.

Before you head out the door, grab a bag and throw in these items:
• in the case of suspected poisoning — the container and any packaging
• all medications and supplements given in last 24 hours (over-the-counter, prescription, herbal)
• health insurance cards, including supplemental coverage
• mini-medical record (previously completed list of allergies, health conditions, physician’s name and number, vaccination records)
• money for parking and pay phones (for hospital no-cellphone areas)
• favourite blanket and comfort object
• snack food and drinks or money for vending machines
• small toys, games or books
• pen and paper for questions and instructions
• if child is vomiting, change of clothes for child and clean shirt for you
• for babies — bottle and formula (if you’re not nursing); suction bulb for stuffed nose; Pedialyte (if baby is vomiting or feverish); measuring tube or syringe for any liquid medications you bring