No typical day for emergency medicine

The caregivers in UNC's Division of Pediatric Emergency Medicine have to be ready for just about anything, from the common cold to complications of rare diseases.

Always be prepared. The Boy Scout motto is particularly suited to UNC’s Division of Pediatric Emergency Medicine. When an ill or injured child arrives at UNC Hospitals, the pediatric emergency team is at the ready to address a full spectrum of unique needs.

There’s no such thing as a typical day or a typical patient. Patients are a range of ages from newborn through adolescents and even into early adulthood. Emergent conditions range from common childhood conditions like colds, fevers and earaches to acute complications of rare disorders. Caregivers are also trained to evaluate and treat children with special needs such as those with complex diseases or mental health disorders and victims of physical and sexual abuse.

“The right treatment at the right time for the right patient,” says Cheryl Jackson, MD, chief of the division. “We recognize that the care needs of our patients have to be differentiated not only in terms of equipment and medication, but also by recognizing and responding to the development needs of patients and their families.”

Caring for Patients and Families

Established in 2007, the pediatric emergency department is a relatively new unit in a relatively new specialty. The pediatric emergency team works in a 10-bed unit within the larger adult emergency department, offering a child-friendly environment with bright wall murals, open 18 hours a day.

Although based in Chapel Hill, the impact of the division is wide spread.

  • Number of Pediatric Emergency Patients Annually: Between 13,000 and 14,000
  • Patients come from all 100 counties throughout North Carolina, and many from out of state.  
    • 82% from central N.C.,
    • 15% from eastern N.C., and
    • Around 1% from western N.C.
    • About one-third of all admissions to N.C. Children’s Hospital occurs through the emergency department.
    • An average of 18% of all patients seen in the emergency department require admission for further care.

Easing pain and distress that can come with medical and surgical emergencies is a high priority in the pediatric emergency department. Pharmacological tools like intranasal medications and moderate sedation are used in tandem with distraction tools, with the goal of providing relief without needles.

“We’ve had great success with the Carolina Cares program,” says Dr. Jackson. “The program uses distraction tools and parent education cards to help children and their families deal with the anxiety of an emergency room visit.”

One of the techniques explained in the kit is to have the young patients blow bubbles or blow into pinwheels to encourage the deep breaths needed for an exam, which also helps relax the child. Kits also include stuffed animals and coloring activities to calm and comfort through distraction. 

Improving Care through Research, Collaboration, and Education 

The Division of Pediatric Emergency Medicine sponsors several initiatives in quality improvement, education and innovation to improve the quality of emergency care not only at UNC but in hospitals around the state. These efforts include:

  • Timely administration of antibiotics to patients at risk for overwhelming infection
  • Asthma initiatives
  • Timely and effective pain management
  • Education of EMS providers on the approach to evaluating and stabilizing pediatric patients

Collaborative research efforts include:

  • Hi-fidelity simulation and teamwork training to enhance provider comfort in handling acutely ill and injured pediatric patients at small hospitals (with Johns Hopkins)
  • Evaluation of remote simulation as a tool to improve pediatric preparedness in the critical access hospital emergency department (with Johns Hopkins)

The pediatric emergency team also has a mission to educate, providing instruction to:

  • Medical students;
  • Resident physicians from a wide variety of specialties including pediatrics, family practice, and anesthesia; and
  • Emergency medical technicians across the state on the approach to evaluating and stabilizing pediatric patients.

Learn more about the Division of Pediatric Emergency Medicine >>

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