Spotlight on Pediatric Emergency Care Volume 2, Issue 6, November 2004 Perhaps Kids Really Are Small Adults!? It's true -- kids really are just small adults. This according to a prominent lecturer who spoke last month at the national meeting of the American College of Emergency Physicians (ACEP) in San Francisco. His lecture topic: how to approach the critically ill child in the community emergency department. In the middle of an excellent discussion, he claimed that emergency physicians simply need to apply their basic knowledge of handling critically ill adults to the task of caring for children presenting in need of such services, emphasizing the lack of differences in knowledge and skills between adult and pediatric emergency care. Two days later, I attended yet another lecture, this time an excellent overview of rapid sequence intubation (RSI). The RSI technique is used to secure the airway in critically ill patients -- clearly an essential component of the skill set for taking care of the critically ill child. This lecturer, however, emphasized the differences between caring for the child who needs RSI and the adult. He noted that while an adult given a paralyzing agent can tolerate as much as eight minutes of not breathing before significant oxygen desaturation takes place, a 14 month old can only tolerate apnea for three minutes due to differences in an infant's lungs' residual capacity. So who's right? I suspect the first lecturer was attempting to ease the anxiety that we all feel when a critically ill child presents to the emergency department -- an anxiety felt perhaps even more acutely by those with relatively less experience with sick children. But I believe we do children a disservice when we emphasize the lack of differences between children and adults. Kids truly are different. They are different anatomically, physiologically and psychologically. And these differences translate into specific needs that we must meet if they are to get adequate, let alone optimal, care. If you are receiving this newsletter, I assume that in some way, you view yourself as an advocate for children. Whether you are a physician, nurse, physician assistant, nurse practitioner, administrator or in another role I left out (sorry about that!), advocacy for children means translating their unique needs into knowledge, skills, policies and an environment that ensure those needs get met. And a starting point for such work involves a deep appreciation of how a child's needs are different from those of an adult. Only after we distinguish between the two can we look at the financial and other ramifications, and explore how competing needs can get met in a fiscally responsible manner. On a different note, I wanted to take a moment in this Thanksgiving season to extend my deepest appreciation and thanks to the many of you who came by to chat at our booth during the ACEP meeting. It's humbling to witness your enthusiasm and work on behalf of children. We all have much to be thankful for, and the children in our country (and those of several other countries, represented by a number of international physicians who came by) are fortunate for your passionate advocacy towards improving emergency care for children. Thank you, and have a great Thanksgiving holiday! About Our Organization Created in 2003, Petrack Consulting is dedicated to helping physician and hospital leadership bring excellence to emergency services for children. We work collaboratively to fully understand our client’s needs, and then address programmatic initiatives with measurable outcomes. Our unique background in pediatric emergency medicine, administrative medicine, and organization development allows us to create uniquely effective solutions for enhancing emergency services for children.