When seconds count for injured kids

When Dr. Patti Paris flips on the lights, she ushers her pediatric patients into an exam room equipped to do two important things: heal bodies and calm spirits. While the room has all the daunting elements of a hospital — metal exam trays, paper lined beds, jars of giant cotton swabs and tongue depressors and florescent lights — that's not what draws the eye.

Across the room from the exam table, a mural fills the wall. A beluga whale (painted by the mother of an Alaska Native Medical Center doctor), all soft blues and purples, nods at a fuzzy otter with a stream of bubbles trickling past its whiskers. Above the oceanscape sits a hoard of seals lazing on the ice, looking up at an active aurora borealis display. It's just one of several tranquil storybook scenes on the walls of ANMC. And for the 13,000 children who visit ANMC each year, it makes the experience a little less scary.

From 2009-­2013, Alaska hospitals admitted and treated young patients — infants through age 14 — for a host of non­fatal injuries, including falls (854), ATV/snow machine accidents (182), poisoning (144), bicycle accidents (139) and burns (74).*

In 2015, ANMC was recognized as Alaska's first and only Comprehensive Pediatric Emergency Center.

While the recognition may still be news to some, Dr. Jay Butler, the State of Alaska's chief medical officer and the director of the Division of Public Health, said the distinction doesn't mean the hospital is doing anything new — it just validates the care they've always given.

"The important thing to recognize in pediatric care is that kids aren't just little adults," Butler said. "Even if a hospital has a trauma center, they might not be equipped to handle kids. ANMC was our first hospital in the state to achieve this designation and meet the national standards set for the best possible medical care."

Butler said for a hospital to meet the Alaska Emergency Medical Services for Children requirements it must have: a pediatric intensive care unit, professionals trained in pediatric intensive and emergency care, adequate staffing for the care units and consultations, devised protocols and ongoing quality improvement activities.

"It's important to have doctors specialized in pediatrics because children decompensate much more quickly than adults," said Paris, who is also the medical director of ANMC's Emergency Department. "Because of that, and their size, pediatric patients are completely different from adults in terms of care and challenges."

One important difference between adult and child care, Paris said, is the size of equipment used. A normal breathing tube for an adult wouldn't be suitable for the trachea of a 2-­year-­old. Similarly, a tube for an infant wouldn't be large enough for a 10­-year-­old boy.

"Kids come in different sizes, so you have to be mindful of that and adjust things like equipment or medication doses," Paris said.

To help, ANMC has a multi­colored ruler and color-­coded equipment drawers where providers can quickly find appropriate equipment based on the size of their pediatric patients. Because children get sicker at a faster rate, Paris said, every second they can shave off response time — like time spent finding the right equipment — counts.

Dr. Nate Hemmer, an emergency room physician, said another way ANMC increases the odds for trauma cases is activating a trauma response when an ambulance notifies the hospital of an incoming injured child. Before the child even reaches the hospital, a team of doctors and nurses has assembled, ready to provide care immediately.

"We have more hands, and brains, in and everyone is working at the same time," Hemmer said. "It gets done faster. In trauma, speed is important. If you're bleeding internally, for instance, the time is ticking. The hourglass only has so much sand."

While ANMC primarily serves as the principal care center for the Alaska Native and American Indian communities in Anchorage, it's also the referral hospital for the entire state. While smaller community facilities may be able to deal with most pediatric illnesses and injuries, Paris said about 10 percent of cases require pediatric patients be flown to ANMC.

"We really like taking care of kids across the entire state, and that's why this program is important to us," Paris said. "We want to provide the best possible care to our future."

*Statistics from DHSS, DPH, Section of Emergency Programs, Alaska Trauma Registry

This story was sponsored by Alaska Native Tribal Health Consortium, a nonprofit Tribal health organization designed to meet the unique health needs of more than 150,000 Alaska Native and American Indian people living in Alaska.

This article was produced by the special content department of Alaska Dispatch News in collaboration with ANTHC. The ADN newsroom was not involved in its production.

Correction: An earlier version of this story used an incorrect term to refer to a child's trachea.