Emergency care in Marin County gets a lift for sick children

Michelle Tracy, director of Emergency, Trauma Services, Education and Professional Development at MarinHealth, recalls the “anxious mom” who arrived in the ER one day.

In fact, the angst over her child overwhelmed her, enough that Tracy stepped in.

“I said, you have to calm down and go in the (room) calm,” Tracy said. “You can be as nervous as you want out here in the hallway when the curtain’s closed. But when you go in there, you have to be calm and in a good space.”

Another time, a 7-year-old who broke his arm was equally upset that he was missing his school’s end-of-year party. The nurse and her team threw him a party in the hospital room to help lift his spirits.

Both illustrate that when children arrive in an emergency room, they need to be treated in different ways than adults.

Those differences are top of mind for doctors, nurses and the staff who receive and treat seriously ill and injured children in the ER.

MarinHealth Medical Center and Kaiser Permanente San Rafael Medical Center are helping calm families during the specialized pediatric emergency treatment they provide.

The hospitals’ collective work recently became more seamless after the state approved Marin County’s emergency medical services (EMS) agency’s plan to improve and streamline its pre-hospital services.

“(Children) require specific sizes of equipment for stabilizing airways, administering IV fluids and medications, and ensuring safety equipment for ambulance transportation,” Karrie Groves, a registered nurse and program coordinator with Marin EMS, said in a press release. “Changes in our system were made specifically to address this special population and are in place today.”

Tracy added, “So now, from the time an ambulance picks up a child until the time the child is discharged, they are receiving specialized pediatric care that they did not have to leave our county to receive.”

Both MarinHealth and Kaiser Permanente San Rafael are certified pediatric receiving centers at the county level. The certification means their individual emergency departments have met the level of appropriate processes, staff, training and equipment needed to treat children when they arrive at the hospital.

In addition, MarinHealth is an “Ouchless ED” through its partnership with UCSF Health, meaning the hospital has child-friendly protocols in place to help relieve children’s anxiety and pain. The hospital received that training back in 2016 through UCSF Benioff Children’s Hospital, according to Tracy.

The “ouchless” training involved learning to see the emergency room through the eyes of a child in a number of ways, including engaging with children according to their age and level of maturity, avoiding needles whenever possible and using distraction techniques during treatment.

The distraction techniques can be quite simple. Sparkly bubbles are a big hit for refocusing children, and every child who comes into the emergency department gets to pick either a doll or a teddy bear, Tracy said.

“If we need to put an IV in them, for instance, we put it in the teddy bear first. That way they see what it’s going to look like … before we do it to them,” she said. “If we have to put a cast on, we do it to the teddy bear first. And then they can take that home with them.”

When a needle must be used, the area where it will be inserted is numbed beforehand, said Tracy, who has worked for MarinHealth for nearly 10 years.

She noted the emergency department’s new CAT scan and MRI machines are in child-friendly rooms, with lighting that can be changed to show rainbow colors and clouds in the sky.

“We try to make (the visit) as anxiety-free as we can, but it doesn't always work,” Tracy said. “The other thing that we try to strive for is anxiety-free parents.”

Dr. Kristen Cadden Swann, medical director of Kaiser Permanente San Rafael’s Pediatric Receiving Center, recently gained that implicit level of understanding for what parents go through. She became a first-time mom less than two weeks ago.

“I would feel 100% comfortable taking my child ... to the ER here in San Rafael because we're ready,” said Swann, who has worked at the hospital for five years. “If anything happened, we have all the right equipment.”

Like MarinHealth, when a child comes to Kaiser’s emergency department, the staff is ready.

“You're there for the kid first, and you talk to them first and get on their level,” Swann said. “You don't just walk in and talk to the parents. We usually know it's a pediatric patient when we walk in, so we’ll bring a sticker or a little stuffed animal or something like that to ease into it.”

That approach works — for the most part.

“Sometimes they're scared of strangers, and it's hard. You walk in there with a white coat and they are terrified of that,” Swann said. “In those situations, we start talking a little bit and just try and calm them down. Sometimes we just have to step out, take the coat off and come back so they can get used to you.”

Kaiser also has “ouchless” protocols in place, avoiding needles whenever possible and providing children with coloring books and video games on iPads to help ease anxiety and fear. The facility also has dedicated pediatric rooms decorated for children, she said.

Swann noted the county every year requires its two pediatric-certified hospitals to ensure their emergency departments continue to be pediatric-ready.

“We go through this whole checklist” that includes everything from making sure staff continues to be trained, the right equipment is in place and pain is properly controlled. Cases are also reviewed to make sure every aspect of treatment needed was done. “We're always working on this.”

For Tracy’s part, the heightened capability to care for traumatized children in an emergency setting has brought relief to her and her staff.

“What a difference,” Tracy said. “When I started here, we were holding kids down and not giving them anything to numb them up before we gave them shots. Now we can watch these kids leave happy with their teddy bear or their doll. And it's just such a different experience.”

Cheryl Sarfaty covers tourism, hospitality, health care and education. She previously worked for a Gannett daily newspaper in New Jersey and NJBIZ, the state’s business journal. Cheryl has freelanced for business journals in Sacramento, Silicon Valley, San Francisco and Lehigh Valley, Pennsylvania. She has a bachelor’s degree in journalism from California State University, Northridge. Reach her at cheryl.sarfaty@busjrnl.com or 707-521-4259.