A Child's Best Advocate: Smoothing the Road to the ER
Does this scenario sound familiar? It's 10 p.m. and your child has fallen and his ankle or elbow is swollen. You don't have any factor at home to infuse, so you must rush to the nearest Emergency Room and sit in the waiting room. And wait. And wait. And wait. Finally, several hours later, they call you into the treatment room. First, he nurse asks for X-rays and afterwards, finally, the doctor on call agrees to infuse your child with factor. At 2 a.m., four full hours after the initial injury, your child in infused.
Across the United States, scenes like these are a nightly occurrence in emergency rooms. "With more and more people on home care, there are far fewer people going to the ER for factor treatment," explains Karen Wulff, hemophilia nurse coordinator with the Louisiana Comprehensive Hemophilia Care Center. "As a result, doctors and nurses have less knowledge and experience to treat people with hemophilia because they see them so rarely."
This is why it is so very important for families to learn which injuries warrant a visit to the ER.
Go to the ER if:
- Your child is not on home infusion
- Your child suffers a significant head or abdominal injury
- There is blood in their stool
- Your child vomits blood
- There is a complete lack of sensation in an arm or leg
- There is any kind of unusual bleeding
Before ever stepping into the ER, families can prepare everyone involved for an easier visit when there's an emergency. Arrange a visit to your local emergency room before a crisis occurs. Call your usual HTC and find out the names and numbers of emergency rooms frequented by their patients. These hospitals will be more knowledgeable in treating patients with hemophilia. Then call the head nurse at each ER and make an appointment to drop by.
You'll need to find out if the hospital has a "fast track" -- a process for ensuring that the sickest or most badly injured patients are taken care of first. Then, learn how to get your own child on that fast track if there is a serious bleed.
Another step you can take to help facilitate the emergency room process is to fill out a card with details about your child's condition and treatment. Some HTC's provide these for their patients.
The most important thing that patients and parents need to understand is the limitations of the ER. "Most ER's take a very long time," says Mary Hudson, nurse coordinator at the Vanderbilt Hemostasis-Thrombosis Clinic. "What might take 20 minutes to treat in your HTC can take 6 hours in an ER because of the triage system."
"That's why, if you infuse at home, it's important to give factor before you go to the ER, if possible," says Susan Zappa, nurse at Cook Children's Medical Center in Fort Worth, Texas. "Once you get to the hospital, the ER can then handle the broken arm or sliced finger beautifully."
The Vanderbilt Hemostasis-Thrombosis Clinic
397 Preston Research Building
Nashville, TN 37232-6310
(615) 936-1765
For more information about bleeding and clotting disorders, call toll-free 1-866-DR BLOOD
VHTC Homepage | About VHTC | For Patients and Families | For Referring Providers | Information About Hemophilia and Clotting Disorders | News and Events | Pharmacy Services
Vanderbilt Medical Center | Vanderbilt University | Help | Search
Copyright © 2002 by Vanderbilt Medical Center. Vanderbilt University is committed to principles of equal opportunity and affirmative action. For more information about this site, please contact the VHTC webmaster. For information about the Vanderbilt Medical Center web site, please contact the VUMC webmaster.