Ask Us Anything About… Pediatric Trauma

Description – The video begins with a view of an ambulance parked outside the Emergency room entrance then slowly moves to see three men standing behind the open doors of the ambulance.

Scott Gilbert – From the campus of Penn State Health Milton S Hershey Medical Center, welcome to ask us anything about pediatric trauma. I’m Scott Gilbert. As parents, none of us really want to think of our children needing the services of a trauma center or even just an emergency department, but it’s good to know that there are some high level specialty care services available should that be a necessity for any of our children. And that’s what we’re here to talk about today. Because here at the medical center, this facility was recently re-accredited by the Pennsylvania Trauma Systems Foundation as a level one pediatric trauma center. Of course the medical center is also accredited as a level one trauma center for adults. We’re here to talk about the pediatric side today, and we thought it’d be good to start outside where the folks from Penn State Hershey Lifeline EMS and Penn State Lifeline Critical Care Transport, they’ve brought the pediatric ambulance over and we’re going to be taking a brief tour of that before we head into the emergency department. And here to tell us a little bit more about this vehicle, we have paramedic Clay Wood. You see RN Dan Meese back there inside the ambulance and also Justin Becker, he’s an EMT with Lifeline. And thanks for being here today, guys. Clay, tell me about some of the features of this pediatric ambulance. What makes it specialized for children?

Clay Wood – So our ambulance pretty much is set up the way your local ambulances are in your community. These are 911 ambulances and paramedic units. Additionally, on this unit, we carry some equipment and medications you typically find in a critical care unit in a hospital.

Description – The camera pans to show inside the ambulance designed for pediatric patients and the man inside the ambulance points to items with his hands.

Clay Wood – Such as ventilators in case you have a breathing tube down, additional monitoring equipment, and IV infusion pumps in case you’re on a bunch of different medicines we encounter in a hospital or transporting to the Hershey Medical Center we can maintain all those infusions as well.

Scott Gilbert – And so when we talk about pediatric trauma, it’s not necessarily accurate to say that this ambulance transports trauma patients here to the medical center, right? This is usually an inter-hospital transport vehicle?

Clay Wood – That’s correct. Usually the critical care transport ambulance transports patients of high acuity, sicker patients, from outlying hospitals back to the Hershey Medical Center where our specialists can treat them. A certain percentage of the patients we do transfer are trauma related, we do see a lot of children that come in with trauma related emergencies. In the further outlying hospitals we certainly have our helicopter services, a Lifeline aircraft that are available to transport those patients in. But in the local area, we’ll be coming in the critical care ambulance to transfer those patients.

Scott Gilbert – But there is outside that certain radius, that’s when the helicopter comes into play, right?

Clay Wood – That’s correct.

Scott Gilbert – Sounds good. Anything else you want to show us about this ambulance before we make our way indoors?

Clay Wood – That’s pretty much it. Our crew compliment consists of a paramedic nurse and EMT, and with those different disciplines on board we can provide a much larger service than what’s available from a local 911 service.

Scott Gilbert – Okay, guys. Thank you very much for your time and showing us the ambulance today. I really appreciate it.

Clay Wood – Thank you for having us.

Description “ The other men around the ambulance wave bye.

Scott Gilbert – Absolutely. You’re watching ask us anything about pediatric trauma here from Penn State Health Milton S Hershey Medical Center. I’m Description “ As Scott Gilbert continues to speak, the camera rolls backwards to see the entire Emergency room entrance. The camera continues through the emergency room™s main doors and walks down the hallway and into the specialized Pediatrics Trauma Emergency room.

Scott Gilbert, thanks again. We’re indoors now, and we’re going to see what happens inside a trauma bay here at the medical center. Now as we do so I want to remind you that you can ask us questions at any time by posting them as comments below this Facebook feed. Feel free to ask us questions. It won’t be posing to the experts that we meet inside here, because again, the whole point of this, the reason we’re here doing this today, is we want to kind of de-mystify the process. As I said before, none of us as parents really want to think of our child needing the services of a pediatric emergency department or even a trauma center especially, but we’re going to go back here. The hall, here, right inside the ambulance entrance here at the medical center. And I should mention that of course, this is a live working hospital. There’s always a chance we may have to vacate the trauma bay if a case comes in while we’re here. But we’re going to take our chances. We’re going to walk in now to this trauma bay where we’re going to say hello to Amy Morgan. She’s a program manager of the pediatric trauma program at the medical center. Thanks for being here, Amy.

Description – Scott enters the Pediatrics Trauma room where there is a lot of equipment and trauma bed. Two people are in the room waiting standing next to each other. The person on the left is a male doctor named Dr. Brett Engbrecht and to the right is a female physician named Dr. Amy Morgan. Scott Gilbert begins to ask them questions.

Amy Morgan “ Sure!

Scott Gilbert – And also Dr. Brett Engbrecht is medical director of the pediatric trauma program. Thanks to both of you.

Dr. Brett Engbrecht – You’re welcome.

Scott Gilbert – So we were just outside talking a bit about how patients arrive here. So tell us what happens when a trauma patient arrives here at the medical center. What are the first steps that happen from an internal perspective?

Dr. Brett Engbrecht – So when they arrive, the paramedics will bring them into the trauma bay, we will get a brief report about what happened to the patient, injuries that they know about. We’ll move the patient over to the litter and we’ll start examining the patient.

Scott Gilbert – Now what determines the component of the team, or the composition of the team that meets that patient at the door?

Dr. Brett Engbrecht – So it depends on how severely injured we think the patient may be. There are different levels of activation, and the highest level of trauma activation would involve about 15 people being in this room to care for that one patient. And those 15 people are from multiple specialties, both physicians and nurses and technicians to help assess the patient and treat the patient.

Scott Gilbert – Here in the trauma bay, it’s obviously a bigger room than we’d think of a normal emergency department being, but goes it a lot deeper than that. Amy, tell us about some of the features that are unique to a trauma bay, and especially a pediatric trauma bay?

Dr. Amy Morgan “ So children are not small adults. They have a lot of needs and developmentally and physiologically that adults don’t have. For example, children come in all different shapes and sizes. What equipment we need for an infant would be very different equipment we need for a 16 year old football player.

Scott Gilbert – So tell me a little bit about some of the special equipment that you have here. Can you give us a bit of a tour and point to some stuff for us?

Description “ As Amy speaks and points with her left hand; the camera spans the room to see multiple types of specialized equipment inside the room.

Dr. Amy Morgan – Absolutely. So if you look over to your side you can see the x-ray machine that is hooked right into the wall. The patient doesn’t move, we move the x-ray machine to the patient. We have a ventilator at the ready to go, we have airway equipment, we have multiple pieces of equipment here so that if we needed to turn this room into an operating room or do a procedure with a child or a teenager we could do that right away.

Scott Gilbert – So it’s a lot about adaptability then?

Amy Morgan – Absolutely.

Scott Gilbert – And when we talk about pediatric trauma, what are some examples of the types of cases that you see that would rise to the level of what you classify as trauma?

Dr. Brett Engbrecht – So we see most commonly falls, is the mechanism that brings children in. There are also motor vehicle collisions. Children falling from a bicycle and getting injured in addition to the common playground falls one might see. And most of the injuries we see have to do with either the bones, so broken bones, or with the head, either a skull fracture or bleeding around the brain or in the brain.

Scott Gilbert – And I understand there might be as many as 15 people in this room at once, right?

Dr. Brett Engbrecht – That’s correct. So we have the trauma surgeons, emergency medicine personnel, nursing personnel, anesthesiologist in the room. We’ve got x-ray technicians, operating room personnel, everybody focused on the patient who’s here.

Scott Gilbert – You’re watching ask us anything about pediatric trauma from Penn State Health Milton S Hershey Medical Center. We are inside one of the trauma bays here at the medical center, specifically a trauma bay that is made to accommodate either adult or pediatric patients. We’re talking with Amy Morgan who is the program manager for pediatric trauma here at the medical center and also Dr. Brett Engbrecht who’s the medical director of that program. I’d like to ask some questions that parents might have. Such as, if heaven forbid my child would need to come in here, what is my role? Where should I be? So how do you integrate parents into the process? Starting with where do they stand? Where can they be during their child’s treatment?

Amy Morgan – So we know that children do better when their parents are nearby, and the parents do better when they’re near their children in a crisis situation. We have a protocol which we call family presence. We do everything we can to have the parent be in here with the resuscitation team and their child as needed. We have a screening process we go through to make sure we’re not causing undue stress with the parent, but we try to get the parent right to the bedside with their child as quickly as possible.

Scott Gilbert – And if you have any questions, by the way, during this conversation, feel free to add them to the comment field here. And I also want to take the opportunity to encourage you to follow the medical center on Facebook so you can get a heads up about future ask us anything about episodes and other types of programs. So when it comes to parents, and their role in the process, we did talk outside about the fact that sometimes pediatric patients will arrive by the critical transport helicopter, known as Lifeline. If that’s the case, the child may be here before the parent. How does that work in that kind of situation, where the parent arrives after the child?

Dr. Brett Engbrecht – So we do what we have to do to take care of the child. And if there are conditions that we can delay treatment, we would prefer to wait until the parents arrive and then we can talk with them about the conditions and what needs to be done and get their permission to treat the child. There are some times where the child has life threatening injuries and time is of the essence and in those situations we do what we have to do to take care of the child.

Scott Gilbert – So this is, as we mentioned, a level one pediatric trauma center. When we say level one Amy, what does that mean?

Amy Morgan – It means that we provide the highest level of care for the injured patient and their family, injured pediatric family and their family.

Scott Gilbert – Sure. And so a specialized team needs to be at the ready 24/7, what does that team consist of?

Dr. Brett Engbrecht – Well that team consists of trauma surgeons, it consists of nursing, nurses with special training, and emergency medicine personnel, the whole spectrum of not just surgeons but medical physicians that may need to help take care of the child. So orthopedic surgeons, neurosurgeons, cardiologists, cardiac surgeons, an operating room that’s ready to take care of children 24 by 7 with the anesthesiologist. So it’s everything that it would take to take care of an injured child is here.

Scott Gilbert – So yes, 24/7 availability of that team. So you’re watching ask us anything about pediatric trauma from the Penn State Health Milton S Hershey Medical Center. I’m Scott Gilbert alongside Amy Morgan also Dr. Brett Engbrecht here from the trauma team. And we also had a comment posted online as part of the Facebook page here. It says Kristin shared a comment to thank the team for caring for her daughter. What is that like, to get that kind of feedback? That does happen on social media quite regularly on the Penn State Hershey Facebook page. What is it like to hear from parents after the fact that you made a big difference?

Amy Morgan – It’s wonderful. It’s why we do what we do. You know, we want to make a difference in the life of a child and their family in a moment of crisis. And so it’s very gratifying to hear thank you from a family whose lives we’ve touched.

Scot Gilbert – I think one of the big misnomers about a trauma center is that it is the emergency department, when in fact the emergency department is really the gateway, correct, to the rest of the facility? And they may need the resources of any of a number of parts of the facility. Can you talk about that Dr. Engbrecht and kind of, where a child goes, and how that’s determined, where they go after they’re here in the trauma bay?

Dr. Brett Engbrecht – Yes. So as you said a trauma center is much more than the emergency department. We have our fingers essentially in every part of the children’s hospital and the adult hospital. Depending on the injuries a child has, once they are done in the trauma bay we may send them to the emergency department, they may go to the operating room, they may go up to the pediatric intensive care unit, which is a requirement to be a level one pediatric trauma center, they may go to a regular children’s hospital medical surgical floor. So they could go anywhere within the children’s hospital or even into the adult hospital depending on their needs.

Scott Gilbert – So Tammy is asking us a question on Facebook. Thank you for your question, Tammy. She’s asking if this unit is both for a child and for an adult? It is adaptable for both, right?

Amy Morgan – It is. We have to be flexible because we never know who’s coming in the door and who we’ll be called upon to care for. So this room, this trauma bay, can take care of adult trauma patients as well as pediatric trauma patients.

Dr. Brett Engbrecht – And we’re the only level one adult and level one pediatric trauma center in the state, so we’re the highest level trauma center for both adult and pediatric. We take care of both. And some people would question well why don’t you have just for children? But our children may be 250 or 300 pounds, which is just as big as adults, so we have to be prepared to care for the smallest up to the biggest, and our rooms are set up to do that.

Scott Gilbert – You never really know who will come through the door, you have to be ready for anyone.

Amy Morgan – That’s exactly right.

Scott Gilbert – The Pennsylvania Trauma Systems Foundation, is that who accredits the medical center and others?

Dr. Brett Engbrecht – Yes. So in the state of Pennsylvania, the PTSF is the accrediting body that decides who can be a trauma center and what level. That’s different than other states where many states are covered by the American College of Surgeons. Our standards have to meet or exceed the standards of the American College of Surgeons.

Scott Gilbert – Okay. And we also have a comment on our Facebook feed here, from Joe DePato, who’s part of the Lifeline Critical Care Transport Crew. And he notes for us that often times Lifeline will obtain a phone number for a parent before leaving a referring facility. And that allows the crew to kind of immediately communicate with the family after patients arrive, to get consent for procedures and treatment and that type of thing. So that communication is a very central part of what you do, I imagine.

Amy Morgan – So you can imagine as a parent, how terrifying it is, when your child is loaded into a helicopter and they are gone. And you are left standing at the referring hospital to get in your car and drive to Hershey Medical Center. It’s terrifying. It’s an endless ride to get here, and if we have a parent’s cell phone, then our Lifeline staff is wonderful with staying in touch with the parents as they’re on their way, to help try to alleviate some of their fear and concern.

Scott Gilbert – Some very good questions and comments so far online, thank you very much for those. And thank you very much for watching today. Before we wrap things up, I want to give both of you the opportunity to give us any closing comments, things to kind of put patients’ and parents’ minds at ease about the concept of their child coming to a trauma center, or even the emergency department as a whole.

Amy Morgan – I would just say that you know, as a trauma program manager, and as a mom of two children, nothing matters more to me than making sure that we’re doing the right thing for your child, that we are providing excellence and the highest level of quality of patient care for both the injured child and their family while combining that with compassion as we care for all of you during a really stressful time in your lives.

Dr. Brett Engbrecht – Yes, I would agree.

Scott Gilbert – Well said. And we do have a really good question from Tammy. I’m glad you asked this. She asked is there more than one trauma bay? In fact, there are two trauma bays, right?

Description “ The camera pans the room again and off in the distance you can see an additional Pediatric Trauma bay and Amy Morgan Explains.

Amy Morgan – That’s right. So we talk about the adaptability of a trauma team. We have two trauma resuscitation bays here at the med center, but we also have the capability if we have more than two trauma patients coming in a tone time, we have a mechanism in place to then put other patients in other emergency department rooms as appropriate for their level of injury.

Scott Gilbert – Okay, so again, that adaptability is a key theme I’m hearing here.

Amy Morgan – Absolutely.

Scott Gilbert – Okay. Thank you very much for your time, both of you. I really appreciate it.

Amy Morgan – Thank you.

Dr. Brett Engbrecht – It’s our pleasure.

Scott Gilbert – And thanks to each of you for watching, whether you’re watching this feed live or if you’re watching it on playback. And if indeed you’re watching this at a later time, you can still ask your questions and we’ll pose them to Amy Morgan and Dr. Brett Engbrecht. Just feel free to post them as comments and we will again track down the answers and we’ll add that to this Facebook post. Thank you very much for watching. This has been ask us anything about pediatric trauma from the Penn State Health Milton S Hershey Medical Center.