Sunday, April 19, 2015

Injury prevention tips straight from the ER

The CDC recently released data showing that although child death rates from injuries are decreasing, unintentional injuries remain the number one killer of kids, claiming the lives of 9,000 children in the U.S. in 2009 alone.

Injury prevention tips straight from the ER

According to the director of the CDC’s National Center for Injury Prevention and Control, “Every 4 seconds, a child is treated for an injury in the emergency department, and every hour, a child dies as a result of an injury.” (AP Photo)
According to the director of the CDC’s National Center for Injury Prevention and Control, “Every 4 seconds, a child is treated for an injury in the emergency department, and every hour, a child dies as a result of an injury.” (AP Photo)

By Hazel Guinto-Ocampo, M.D.

The CDC recently released data showing that unintentional injuries remain the number one killer of kids, claiming the lives of 9,000 children in the U.S. in 2009 alone. Car crashes, suffocation, drowning, poisoning, fires, and falls are the most common ways children are hurt or killed.

According to the director of the CDC’s National Center for Injury Prevention and Control, “Every 4 seconds, a child is treated for an injury in the emergency department, and every hour, a child dies as a result of an injury.”

In our community emergency department (ED), 40 percent of children’s visits are for injuries. Most of the injuries we see are related to sports, and falls from stairs or playground equipment. Among play equipment related injuries, falls from monkey bars and trampolines result in worse injuries such as concussions and broken bones.

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The warmer, sunnier days we enjoy now and ahead, come with more opportunities for outdoor play, sports, and travel, and unfortunately, for injuries to occur. Here are some pointers regarding childhood injuries:

1. Be informed.

 Know which injury prevention strategies work best. Fortunately, experts in injury prevention have done most of the work for us. As more research data become available, recommendations regarding safety evolve, so it’s important to stay up to date. Here are reliable sources of injury prevention information:

Centers for Disease Control and Prevention: The CDC’s Safe Child website is packed with practical tips for protecting the kids in your life.

National Center for Injury Prevention and Control: Another CDC site, this one includes valuable advice on keeping teen drivers safe, brain injury prevention and more.

American Academy of Pediatrics: Turn to the AAP’s website for the latest information and plenty of tried-and-true tips. The site now features info on disaster preparedness for families, for example.  

National Highway Traffic Safety Administration: You’ll find crash ratings for cars (important if you’re in the market for a ride for your teen), tips for choosing the right car seat, important information about impaired and distracted driving and more here.

2. Be a role model.  

Set an example by always wearing a seatbelt when you’re in a vehicle, a helmet when you’re bicycling or in-line skating, and a life jacket when you’re canoeing or kayaking.

3. Be on the lookout. 

Supervise young children at all times - around stairs and bath tubs inside the home, and around swimming pools, bodies of water, play equipment, and playgrounds outside.

4. Be prepared

Have important information and telephone numbers readily available, preferably stored or programmed in your cell phone.  These phone numbers include:  your child’s doctor, your pharmacy, and the nationwide Poison Control Center – 1 (800) 222-1222.  Important information includes:  your child’s health insurance carrier, food and drug allergy history, and immunization (particularly, Tetanus) history.

Have a first aid kit available at home, and consider carrying a more compact version in your car. Here is my top 10 list of items (not necessarily in order of importance) to have in your first aid kit:

(1) Ice pack.  This makes any bruising or swelling better within a few minutes, and can be helpful in controlling wound bleeding. The longer the ice pack is applied, the more effective it is.  Child friendly versions are available for infants and toddlers, who will most often resist getting this applied. The result is way worth the fight.

(2) Wound cleanser.  Most people’s reflex is to immediately apply a Band – aid to a wound.  However, the most important initial step is washing the wound with water or hydrogen peroxide.  Non-stinging cleansers in a spray bottle are also available.

(3) Gauze pads.  These are invaluable for applying pressure - the most effective way to control bleeding from a wound.  A clean washcloth may be used as well.

(4) Bandana and safety pin.  This is the simplest way to fashion a sling for any arm injury.

(5) Pain reliever such as Acetaminophen or Ibuprofen. 

(6) Antibiotic ointment.  This should be applied after the wound has been washed.

(7) Diphenhydramine (Benadryl).  This should be given immediately for any allergic reaction.

(8) Hydrocortisone ointment.  This is very useful for local allergic reactions, such as from an insect bite or sting.

(10)Tweezers. These are great for pulling splinters out.

Consider taking a CPR course.

5. Be smart. 

When can an injury be safely treated at home and when is an ED visit necessary?

An injured child with any of the following needs to be treated in the ED:

  • Injury resulting from a significant mechanism such as being in a  high speed car crash or  car roll-over, getting struck by a vehicle while walking or on a bike, falls of 5 ft. or more  in children 2 years or older or 3 ft. or more in children less than 2 years.
  • Any head injury with loss of consciousness (passing out), severe headache, persistent vomiting, or when the child is not acting right.
  • Any eye injury.
  • Any nose injury with significant swelling or persistent nose bleeding.
  • Any injured permanent tooth, especially if the tooth comes out of the socket.
  • Any neck pain or inability to move the neck.
  • Any persistent belly pain, especially if vomiting occurs.
  • Any concern for a broken bone, such as  – significant arm or leg pain and swelling, inability to move an arm or leg, deformed arm or leg, persistent limping or inability to walk.
  • Any gaping wound, especially if it’s on the face.
  • Any wound that continues to bleed.
  • Any animal bite causing a break in the skin.

When in doubt, call your child’s primary doctor.  It is always smarter to err towards going to the ED rather than waiting.  

After any injury requiring a visit to the ED, it is best to not feed or give your child a drink.  Eating or drinking may affect or delay procedures which your child may need.

When should 911 be called and when is it safe to drive a child to the ED?

911 should be called when a child needs a life or limb saving procedure immediately.  Examples include any injured child with unconsciousness or abnormal mentation, breathing difficulty, or limb amputation.  For other situations, this is a judgment call.  It is always smarter to err towards calling 911.  A trained first responder or paramedic, after assessing the situation, can provide advice if an ambulance ride to the ED is necessary.

Hazel Guinto-Ocampo, M.D., is chief of pediatric emergency services at Bryn Mawr Hospital.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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