Where Do I Take My Injured Child?

This is a question that every parent faces at some point. The problem is that there are no good guidelines available. Although most parents are aware of the hospitals in their area, they are not familiar with hospital capabilities.

To figure out the best place to take your child, there are two questions that need to be answered:
1. How badly is my child hurt?
2. What services do the medical facilities in my area offer?

How badly is my child hurt? There are several different degrees:

• Minor injuries. These include sprains, mildly painful body parts, bruises, cuts, etc. that you are not comfortable taking care of at home without professional evaluation.
• Moderate injuries. These are injuries that you think may require hospitalization, and include concussions, broken bones, or any condition that causes serious pain. This category also includes kids who do not seem to have significant injury but have been involved in a major event like a higher speed car crash of fall from more than 10 feet.
• Severe injuries. These injuries obviously require hospitalization, and are usually caused by major trauma like a high speed car crash, shooting, stabbing, or being struck by a car. Events that cause prolonged unconsciousness (more than 5 minutes) are also in this category.

What services do various medical facilities offer?

• Walk-in clinics – staffed by doctors, or sometimes a nurse. Basic xrays, and treatments like splints and suturing wounds is usually available.
• Community hospital emergency department – staffed by doctors with expertise in emergency care. Xray diagnosis is available, and some specialists like orthopedic and plastic surgeons may be available. Wounds can be sutured and simple fractures splinted.
• Children’s hospital emergency department – staffed by doctors with expertise in pediatric emergency care. The same services that are available in the community hospital ED are available here, but are more tailored to children. A Children’s hospital is not necessarily a trauma center.
• Adult Trauma Center – staffed by doctors with expertise in the treatment of any degree of injury. A full range of specialists is rapidly available that can treat most (Level II) or all (Level I) injuries. Many pediatric services, such as a Pediatric ICU, are available in these centers.
• Pediatric Trauma Center – staffed by doctors with expertise in the treatment of any degree of injury in children. A full range of pediatric trained specialists is rapidly available. Pediatric social services, education and rehab are also usually available.
  

How to choose? First, call your pediatrician for guidance. If they are not available, use the following table as a guideline. Choices are listed in order of preference. If the first choice is not available, move down the list to the next one.

Mild injury

1. Walk-in clinic
2. Children’s hospital emergency department
3. Community hospital emergency department

Moderate injury

1. Children’s hospital emergency department
2. Community hospital emergency department
3. Pediatric Trauma Center (Level I or II)
4. Adult Trauma Center (Level I or II)

(If child is taken to a community or children’s hospital, the doctors will determine if transfer to a trauma center is needed)

Severe injury

1. Level I Pediatric Trauma Center
2. Level II Pediatric Trauma Center
3. Adult Trauma Center

(Other hospitals will transfer to the closest appropriate trauma center)

Some States To Allow High-Power Beer: Good Idea or Not?

Several states have already passed laws to allow up to 16% over the past several years. The average alcohol content of most beers is about 4.5%. Ohio began allowing up to 12% in 2002, and since then Georgia, North Carolina and South Carolina have followed suit. Vermont and Montana lifted their caps last year, and Alabama now allows up to 13.9% alcohol as of May of this year.

The Brewer’s Association argues that limiting the amount of alcohol also limits the flavor, because it is not possible to add as much malt or sugar. They also point out that consumers of microbrews “don’t drink to get drunk. They drink to appreciate the flavors.” In my experience, the people that are treated in trauma centers are not drinking beer for the flavor. It’s hard to argue the “drinking for the flavor” point when you are drinking upwards of a case of beer a day.

There are two major problems with raising the alcohol limits in beer. First, people are creatures of habit. They will spend the same amount of time at the tap, which may result in the same number of beers consumed, even thought they are more potent. The second issue is that if the beer is double-strength or more, one glass will raise blood alcohol to twice the normal level.

For an average 150lb person, one standard beer (5% alcohol) will raise blood alcohol by about 0.03. A single beer with 14% alcohol will raise the blood alcohol level to over 0.08, which is the legal limit for driving. So tossing down a single super-powered beer could land one in jail, the trauma center, or in the morgue. Is it all worth the “better taste?”