Pediatric Emergency Contact Notifications Made Easier

For the head of the trauma department at one of America's top pediatric facilities, Chicago's Children's Memorial Hospital, having to notifying parents that their children have been the victims of trauma or identify pediatric Jane Does, is an every day occurrence. But just because they look like they're handling it well, doesn't mean that it ever becomes routine.

When a child comes into the ED without a parent, it's usually the result of an accident or traumatic event. Even though their first priority is to tend to the child's medical needs, their next priority is to identify the child. They need to get his parents or guardian down to the hospital, to give consent for his treatment, provide vital medical history and most importantly, to be at their child's side when he needs them most.

You'd be surprised how often a child is brought into Children's Memorial without anything pointing to his or her identity. Many times it's the result of a car accident, where the parents are injured as well as the child, and are taken to another hospital, while the child is brought to Children's for specialized pediatric treatment. Since children don't have driver's licenses or checkbooks, identifying a child can be challenging.

Just the other day, three children ranging from 8 months to 3 years were brought into the ED after a serious automobile accident.

Their parents, who were in bad shape, were taken to another hospital and the paramedics had no clue about their names, ages or medical history. The trauma team began their medical evaluation and as they always do when dealing with an unidentified child, opened a trauma pack for each, using a patient number to identify them. We estimated their ages, did a full physical description including any identifying marks and clothing, then ordered a full set of x-rays, which helps to identify any conditions or injuries that aren't readily apparent.

The team's biggest asset in this situation was the solid relationships that they've built with police, fire department, and other local hospitals ? as they work together to get the children identified as quickly as possible. After a major accident like this, the police and fire department were already in the ED coordinating efforts. With their special emergency landline system they're instantly linked by phone with any local hospital they need to reach. As the team began calling to find out where the children's parents were taken, hospitals began to call them, to say, "I know you're looking for the mom and dad of the accident victims. They're not here," saving them precious time. In this case, we found the hospital relatively quickly and found out that even though the children's parents had been seriously injured, the children's caregiver who had also been in the accident, was fine. The hospital sent her over to Children's and she ? and later on the parents ? were able to give them all the information theyneeded to identify and treat the children.

In the case of a completely unidentified child, especially babies, they depend on our procedures. Usually the fire department, police or DCFS dropped the child off, so they are already aware of the situation and have already begun going through the child's clothing and personal effects to gather evidence and identify the child. The trauma team will send the police or paramedics right back to the scene to gather additional information, medicine bottles, names, and to canvass the area. There is almost always someone who saw something. Someone from pastoral care automatically comes down and a social worker will get involved if it looks like any abuse was involved. Together, they take care of figuring out where to go from here, while the team takes care of the child medically.

If these steps don't elicit any clues to the child's identity, the hospital will get media affairs involved. Children's will never show the face or reveal the name of any child. Instead, they photograph the child's clothing and personal effects and release it to the media along with the child's estimated age, description and the vicinity in which she was found. They work closely with detectives and DCFS to give them all the details they need to chase down any leads they get from the public. Many times just calling DCFS or the police will locate parents or bring about an identification. In the case of severe trauma, abuse or inflicted injury, Children's always balances treating the child, with carefully gathering as much evidence as possible, to help the eventual police investigation. They had a young girl a few years ago, whose brutal attacker was convicted mainly on the evidence gathered and catalogued in the trauma room.

When it comes to providing emergency contact information, kids aren't always the best source. They have seven or eight year old kids come in everyday, who I'm sure are sophisticated in every other way. But get them in a trauma situation and ask them what their mom's name is and they'll say it's "mom". In this case, the first thing they'll do is look at whatever they brought in with them. School-age kids almost always have a backpack. If they don't find anything there, they'll check our records to see if the child is in the system and begin to gently probe the child for information. They ask them where their house is, what their school looks like, information about their friend's houses, maybe a familiar landmark on the corner like a 7/11 or the name of a park. If you can't find their contact information right away, try to find the name of their school. Their books will probably have the name of their school stamped inside.

Schools are also a great source for emergency contact information. They'll often even list alternate people to call in an emergency if the parents are at work or hard to reach. In an emergency, schools will usually send someone directly down to the hospital with the child's emergency card and emergency consent forms. If the injury occurs at school, most schools will send someone from the school along with the child to the hospital, while someone else is calling the parent. For parents, I would suggest that every parent name someone else on the child's emergency card, who knows the child well and would be able to step in to help out during an emergency if the parents can't get there right away.

So once you identify a child, how do you know if the person who comes to the hospital is really his parent or relative? It's not always easy. Remember that the parents didn't expect to have to come to the hospital today, and probably won't be carrying three forms of ID and their child's birth certificate. For people that come in and say they're related to a child who's been in the media, they get as much ID as they can, be it a driver's license, pictures or other proof. With kids, the biggest test is to watch their response when that person goes in the room. Usually you'll here a resounding "Mom!" or "Daddy!" and you know you've got the right person. If there's no response from the kid, or if they're not sure of the adult, it's probably not the right person. Or worse, the child might recoil from the adult, which could indicate an abusive situation.

Treating kids also means caring for their parents. When Children's has to make a notification call they'll begin by telling the person on the phone who they are and ask them how they are related to the child. If it's the mom or dad, they'll tell them that their child has been brought to Children's Memorial Hospital. Of course the parent will immediately ask how the child is. This is always the hardest part of the call. If the child is clearly fine, they'll say "Don't worry, they're fine, we just need you to come down here." But if there is a more serious injury, or if the child hasn't survived, they say that the child has been in an accident, that they need to come down, and if necessary, that they need to get their medical history. If they refuse to get off the phone until they find out what's wrong, the trauma coordinator will say that they're very concerned about their child's health and that they need to come down right away. They'll always try to calm the person down as much as they can ? tell them to go and get a pencil and paper to take down the address of the hospital, to take down the hospital's name and they're direct number. They tell them to ask for them right away when they get here so they don't have to waste any time at the desk and then try to make sure they have someone to drive them over. And they finish by reminding them that they need to drive carefully and slowly and to make sure that they get there in one piece!

At Children's the top priority is the restoration of the health of every child who comes through our door, no matter who they are and where they come from.

For tools you and your staff can use to facilitate pediatric notification, identification and communication, download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

Laura Greenwald, CEO/The Next of Kin Education Project nokepinfokit@juno.com

The Seven Steps Information Kit can be downloaded free of charge at http://clik.to/7steps The Reminder Products can be purchased at our NOKEP store http://www.cafeshops.com/7steps

---

Could This Be Arthritis In My Hands

Hi Rusty. A few days ago, I slightly injured a... Read More

Polysomnography: One Tool in Helping in the Diagnosis and Treatment of Fibromyalgia

Stop! and imagine for one moment that your body is... Read More

Thalidomide

Thalidomide is responsible for causing more than 10,000 children to... Read More

What You Should Know About Mixing Medications and Diet...

I had a call the other day from a potential... Read More

Melatonin, Sleep Enhancement, and ADHD

Overview Melatonin is a natural hormone, which is produced and... Read More

Take Control of Your Doctor: Ten Actions To Get What You Need At Your Next Office Visit

Michael Richardson, MD has some suggestions on maximizing your next... Read More

Talking Money with Your Doctor: Drugs and Tests for Less

Would you buy groceries without knowing their prices? I suspect... Read More

Lipitor Side Effects

Lipitor is a drug intended to help lower cholesterol. The... Read More

First Step To Addiction Recovery

The first step to over comming any addiction is to... Read More

Medical Malpractice Suits: Death By Medicine

A recent report has found that Americans are more frightened... Read More

Bextra and Vioxx Withdrawal Spawn Advertising Pause from Bristol Myers

Pharmaceutical giant Bristol Myers Squibb has announced that they will... Read More

Study Confirms IBS Improvement

Irritable bowel syndrome is a debilitating and distressing condition, which... Read More

Arizona Drug Rehab: Finding Help in Arizona

The state of Arizona has one of the worst drug... Read More

Alprazolam/Xanax ? A Habit Forming Drug

Xanax is a Prescription Drug which is habit forming. You... Read More

7 Tips to Keep Your Fluid Down on Dialysis

As any dialysis patient will tell you, keeping your fluid... Read More

Bextra, Some Facts To Consider

For those who take Bextra, there are many warnings out... Read More

Serzone Side Effects Lead to Serzone lawsuits

Serzone is a prescription medication that is given to patients... Read More

Lunesta Dependence

Lunesta is a newly released sleeping pill. Marketed as a... Read More

Medical Tests: What Does a Normal Range Mean?

We have a marvelous array of medical tests available to... Read More

Lunesta Side Effects

Before you decide to buy Lunesta, make sure you have... Read More

Which Drug Addiction Treatment is the Best?

The answer is simple: there is no such thing as... Read More

Health Needs of Survivors of Domestic Violence

Domestic violence is not over when the victim is safe... Read More

Parasites In Your Colon

Your colon is a place for other parasites and organisms... Read More

Treating Neuromas - Ten Tips

A neuroma is an inflamed nerve. In the foot, the... Read More

4 Reasons Why You Should Use Canadian Pharmacies

Let's face it: purchasing prescription drugs in the U.S. can... Read More