>> 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?
>> 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.
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.
>> 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?
>> 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.
>> But there is outside that certain radius, that's when the helicopter comes into play,
right?
>> That's correct.
>> Sounds good.
Anything else you want to show us about this ambulance before we make our way indoors?
>> 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.
>> Okay, guys.
Thank you very much for your time and showing us the ambulance today.
I really appreciate it.
>> Thank you for having us.
>> Absolutely.
You're watching ask us anything about pediatric trauma here from Penn State Health Milton
S Hershey Medical Center.
I'm 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-mistify
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.
>> Sure.
>> And also Dr. Brett Engbrecht is medical director of the pediatric trauma program.
Thanks to both of you.
>> You're welcome.
>> 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?
>> 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.
>> Now what determines the component of the team, or the composition of the team that
meets that patient at the door?
>> 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.
>> 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?
>> 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.
>> 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?
>> 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.
>> So it's a lot about adaptability then?
>> Absolutely.
>> 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?
>> 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.
>> And I understand there might be as many as 15 people in this room at once, right?
>> 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.
>> 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?
>> So we know that children to 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.
>> 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?
>> 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.
>> So this is, as we mentioned, a level one pediatric trauma center.
When we say level one Amy, what does that mean?
>> It means that we provide the highest level of care for the injured patient and their
family, injured pediatric family and their family.
>> Sure.
And so a specialized team needs to be at the ready 24/7, what does that team consist of?
>> 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.
>> 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?
>> 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.
>> 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?
>> 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.
>> 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?
>> 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.
>> 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.
>> You never really know who will come through the door, you have to be ready for anyone.
>> That's exactly right.
>> The Pennsylvania Trauma Systems Foundation, is that who accredits the medical center and
others?
>> 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.
>> 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.
>> 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.
>> 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.
>> 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.
>> Yes, I would agree.
>> 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?
>> 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.
>> Okay, so again, that adaptability is a key theme I'm hearing here.
>> Absolutely.
>> Okay.
Thank you very much for your time, both of you.
I really appreciate it.
>> Thank you.
>> It's our pleasure.
>> 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.