Emergency Services for Children: What are my options and what do I do?

 

I remember a few years back, I was speaking to another mother at the park when I mentioned, laughingly, about how at one point I had asked Terem [medical emergency clinic] if they had a monthly membership fee. She looked at me funny and explained that she had never visited the ER (or Terem) with any of her three children! And she had two boys! I hadn’t even known that was an option. Each one of my five children has been stitched, glued, or casted, at one, or many points, in their early childhood. This is either a testament to my bad parenting, their overactiveness, or just the necessary pitfalls of raising children. Whatever the reason, through personal, and professional, experience, I have learned the many options of what to do in an emergency situation with a child.

POSSIBILITY 1: CHOKING

Years ago, I went to visit a friend so our daughters could have a playdate together. I apparently arrived 30 minutes after one of the most stressful events to happen to a mother. Her 1-year-old son had grabbed hold of a grape, shoved it in his mouth and proceeded to turn blue. Luckily, she had the wherewithal to call MADA (Magen David Adom, Israel’s Emergency services) and they came immediately and saved her son.

In the event of choking (when the child’s face turns red or blue), not breathing, sudden loss of consciousness, call 101 (MADA), 1221 (Hatzala) immediately.

POSSIBILITY 2: PROFUSE BLEEDING

When I say profuse, I mean that the child runs in from the outside where they were playing with a ball, and their shirt front is covered with blood and dripping down their head, because they slipped and hit a fence (true story). This is perhaps one of the most challenging events that happen in parenthood, because, face it, blood is scary, and your child, screaming, is scary too. Here is when that artificial parental calm needs to kick in.

Because we have so many blood vessels (and nerve endings) in our face, scalp, and hands , even small cuts can bleed profusely; we need to know what we are dealing with. This is the time to lead your child calmly to the sink (or bathtub) and rinse away the blood, to see what the cut actually looks like. (obviously, if an appendage is dangling then I don’t need to tell you to go right to the ER).

If the cut looks deep, you can see underlying tissue, or the edges are very far apart and/or ragged, it’s time to take the child to a Terem- like facility. You can also take your child to the local kupah clinic office if they have nurses’ hours , to take a look, before hauling off to emergency services.

Terem is a stop before the ER, which handles all sorts of emergency situations that are not severe enough for the Emergency Room. Most of the kupot have arrangements with Terem (located in ~7 cities in Israel), but check first with your kupah to see if they work with a Terem or not. Depending on your location, the kupah may require that you visit one of their 12-24 hour emergency clinics, so have this information on hand, when it’s not an emergency. If the wound is on the face, try to contact the Terem/kupah clinic beforehand, (have your spouse or a friend call, while you are preparing yourself to go) because not all clinics have a surgeon on hand who will stitch on the facial area (if stitches will be needed).

You never need a referral to go to your kupah’s open clinic. You may sometimes need a referral to go to Terem; it’s important to know this information prior to an emergency.

POSSIBILITY 3: BURNS

Despite even our best planning, safety features, and making sure hot soup is never placed next to an infant or holding a cup of hot coffee when we hold our child on our laps, accidents do happen. I was sitting two feet away from my three-year-old when, somehow, hot tea got knocked onto her lap, and now she has the scar to prove it.

In case of a burn, make sure first you keep it wet. I rushed my daughter to the sink and immediately put cold water on the burn.

If you see blisters rise immediately, that’s usually a sign to get medical attention. If the burn is small, like the size of a quarter, cold water and eventually aloe and/or silverol can do the trick. In this case, because her whole thigh was blistering, I knew we were off to Terem.

Keep the burn wet (a wet towel, applied on the skin is good) and get yourself to the nearest emergency clinic for treatment. If the burn is covering a large part of the child’s overall skin, or the child is unconscious, then proceed directly to the ER.

POSSIBILITY 4: FRACTURE

When my five-year-old son was brought in from the park, quiet, with a serious expression on his face, and holding his arm, I knew he had probably broken something. Pain is expressed differently in children, and many children, when they are in serious pain, don’t cry, but rather, become very quiet. So look at your child. Is he refusing to use the arm or leg? Is he holding it? Does he just want to go lie down and not move? In addition to the obvious, (limb at a funny angle), these could be signs of a fracture.

If there is bone sticking out of the skin, go directly to the ER. Otherwise, this is a visit to Terem or the emergency clinic. They will give you a referral if they feel the injury warrants a hospital visit.

Atthe initial visit to Terem, they will do an x-ray, and make a decision about treatment. I then recommend you set up an additional appointment with an orthopedist specialist, because not all fractures are clear, and treatment may vary. With children, incorrectly set fractures can affect bone growth and development, so it’s always good to get a second opinion.

POSSIBILITY 5: FALLS

I was driving home one afternoon a few years ago when I got a call from a friend. “You have to come right away. My son has a huuuge bump on his forehead. He ran into the sofa. It’s huuge! I think we need to go to the hospital.” Like bleeding, the forehead and skull are wonderful places for extremely large swelling bruises. I took one look at the bump, and said, “that’s it?!  That’s not so big.”

A bump in and of itself is not a reason to rush off to the ER. However, if the child has fallen from a height (more than his own), is dizzy, thrown up, or keeps complaining of a bad headache, keeps falling asleep, these are all reasons to go right to the ER. If the child is interactive, but you feel the bump is really large, go to your local clinic first.

In all of the cases I’ve mentioned above, your child will often be in pain. Before dosing your child with pain reliever, however, I recommend waiting till you get to emergency services. They are quite good, now, at offering pain relief at these clinics, upon admission, and they know the correct dosage and type to offer children, depending on age, weight, and circumstance.

If your child will need antibiotics, special dressings or ointments, make sure these are all written clearly on the discharge letter, and that you understand what is written. If you are in a non-kupah setting, you may have to bring these prescriptions to your kupah family doctor to get a kupah prescription before you can have them filled, so be prepared for that. Go right to your family doctor with the paper.

Although it does sound like I should be reported for child abuse, all of these events with my child were accidents, and they will happen. Take a look at the list below for good recommendations for when and where to go when your child gets injured.

Terem?

  • A wound that won’t stop bleeding (requires stitches/glue)
  • Fracture
  • General symptoms
  • Dehydration
  • Unexplained pain
  • Really not feeling well at night

ER?

  • Unconscious
  • Referral from Terem
  • Referral from the family doctor
  • Newborn with fever/breathing difficulty/nonresponsive
  • Car accident with a police report
  • Between 1-6 a.m.

Kupat Cholim’s 24-hour telephone information centers:

  • Clalit:          *2700
  • Maccabi:     *3555
  • Meuhedet:  *3833
  • Leumit:        1-700-507-507

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