it

When It's an Emergency: Stories from Seattle Children's ER (Parts 1 - 5)

we interrupt our regularly scheduled

program so that we may bring you a coma

for special presentation when it's an

emergency

stories from inside the Seattle

Children's emergency room it's always

open always ready you don't know what's

gonna come in you don't know how

families are gonna be he was having a

lot of distress freezing 24/7 365 days

of the year so there was like a lot of

blood and so I just called 911 the

emergency room of Seattle Children's

sees it all it's hard to see kids who

are sick or hurt from heartbreak so hope

everybody always says you know I was I

just looked away for a second

we take an inside look at the triage the

training and the typical I felt they

kind of Bend so I knew I think it when

it's an emergency

stories from inside Seattle Children's

er good evening I'm Molly Shen here we

are at one of the best places you never

want to go the emergency department at

Seattle Children's it's where you'll

find world-class pediatric emergency

care you hope your child never needs but

plenty do need to come here this ER had

almost 40,000 visits last year tonight

we take you inside to see the inner

workings of the emergency room of

Seattle Children's inside doors that

never closed and never turn away a

patient if there's such a thing as a

typical day at the emergency department

here at Seattle Children's it usually

involves some ambulance arrivals

sometimes even a helicopter will deliver

a critical case like this tiny baby with

big medical concerns but no matter what

comes in the door on any given day the

people who work here work very hard to

keep this place from feeling like a

prime-time TV drama in order for us to

provide the best care in the safest care

and very detail-oriented care and

mistake-free care the best environment

to do that in is not an environment

where everyone's shouting out orders and

running around it's one of as much

control as possible we drill often we

want people to be practiced we want

people to be gonna listen to you okay

very attentive to detail and and not

distracted and we want the family

experience to be positive too clinical

director of emergency services dr.

Russell migite knows families who are

here appreciate that environment in the

midst of their personal crisis where she

was submerged under water the family of

five year old Alena Jennings will

remember this day for the rest of their

lives the day they could have lost their

little girl in a swimming pool in the

blink of an eye and got her out in about

twenty or thirty seconds but she's been

having difficulty breathing she

swallowed some water and vomited up some

water and that can lead to some

difficulties especially within the first

12 hours while emergency providers work

with Alena you can see the stress on her

family it's pretty scary she's gonna go

to our intensive care unit and hopefully

and I believe that she'll probably keep

breathing on her own but she may need

some assistance the patient and family

experience is front of mind here every

day they're looking just to make sure

her blood gases stay good and that her

lungs are good and that she's breathing

okay and she doesn't want a respiratory

distress cases like Elena's show that

you never know what the day or night may

bring it's stressful and it's hard it's

hard to see kids who are sick or hurt

but we also know that it happens and so

the people who are here are here because

they want to make a difference and

people

who are here accept the fact that part

of making that difference in being

involved is dealing with the fact that

that sometimes there are very tough

situations to deal with Oscar is just

two days old but he looks really really

good

he definitely is breathing fast he's not

breathing with work he's not working to

breathe he's his mother's third child

and her instincts told her his breathing

didn't seem right there you go buddy

and she thought she should have him

checked he was having a lot of distress

breathing grandma agreed well I felt

that Children's Hospital was the best

place to go to make sure my little

grandson was taken care of properly

Oscar gets a thorough exam including a

chest x-ray so doctors can find out

what's going on with his breathing from

tiny newborns to teenagers I felt they

kind of Bend though and you were

thinking a broken bone a painful abscess

that'll need to be drained an asthma

attack all kinds of conditions and

concerns bring worried families through

the ER doors let's look at his palms and

their souls because I know he already

has a rationale but he may actually get

another rash with this in his throat I

think that's something that we have to

continue to be mindful of is the fact

that even for patients who don't seem

like they're here for a critical issue

it's the most important thing to that

family at that time the early diagnosis

for Oscar is extra fluid on the lungs

that didn't get fully squeezed out when

he was born that explains his rapid

breathing which is of course concerning

but not uncommon but this is a really

savvy mom who did all the right things

and saw all the things watched for all

the things that she needed to watch out

for and went to her primary care

physician of her primary care physician

sent her here so they have a good safety

net and the safety network for them it's

all serious to the people who are

involved but in the in the big spectrum

of things this is bread and butter

pediatrics and

you know it's part of what we do and

it's part of what we enjoy doing and the

good thing about this is I think this is

gonna have a really happy ending most

children who come here do get a happy

ending like Alena who never stopped

breathing on her own and now gets to

move to a regular room for what will

likely be a short stay mom pulled

through - oh my golly I love this

hospital the staff is over-the-top

amazing

it's another happy ending in a place

where a typical day is anything but

typical it's true that those who work

here never know what the day or night

may bring but they do know that they'll

be working with children from tiny

newborns to growing teens this ER and

all the people who work here are

uniquely equipped to deal with children

five-year-old Abigail Nelson took a bad

fall at her preschool playground and

landed in the emergency department of

Seattle Children's she managed to break

both bones in her forearm and the bones

are broken enough and they're displaced

enough that were going to need to put

the bones back into place so she can

feel properly her x-rays shows she

really did a number on that arm so these

are the two bones of her forearm her

radius and her own and you can see

there's definitely a fracture right in

the middle of the bone on both sides

this is why we always do two x-rays

because this x-ray you can see there's a

fracture but it doesn't look too bad

when we look at the x-ray from the side

you can see what's in what normally

should be a straight bone is quite

angulated and this is the part that

really needs to be fixed as those bones

need to be straightened so she can heal

properly

fixing Abby's arm doesn't sound very fun

one of the most important things that is

that we tried to make this as the least

amount of trauma in pain for Abby as

possible so we're going to give her some

medications that will treat not only her

pain but will help her basically fall

asleep while we get it done she won't be

completely asleep it's not Jenna Lana's

but she won't have a hole she won't have

any memory about what's going on and she

she won't really be aware of what's

going on in a room but the nice thing is

it's a very safe medication to get that

heavy sedation

Abbi will need an IV also not fun for a

five-year-old knock knock hi guys is

Abigail's room enter Paul foster my name

is Paul and I'm our Child Life

Specialist

the works here at the hospital so I'm

different than our nurses and doctors

okay so my job here at the hospital is I

help you understand what's going on and

then try to make it a little easier and

more fun does that sound okay Paul

prepares Abby for what she can expect in

a way that she can understand I'm here

to help make their stay a lot easier my

job is to help assess how kids are

coping with their emergency department

stay and I provide preparation education

and for our younger kids lots of

distraction to help get them through

certain invasive procedures how's he

been doing so far since you got into you

do okay in triage Paul is a Child Life

Specialist all of the providers here are

trained in dealing specifically with

children using comfort and distraction

techniques that are appropriate to a

child's age and situation but Paul is

the big gun called in when a patient

needs that extra special touch so this

is the small strong you wanna feel it

it's really soft it's mom and dad this

is an IV if you guys haven't seen one

before so what we do is we put the small

straw inside one of our bodies blue

lines and we can give you medicine

through it

and it makes you feel all better and

it's gonna help take away the alleys in

your arm he doesn't hide anything from

the kids rather he educates them on

what's about to happen and why in an

age-appropriate way so sometimes kids

ask me they say Paul what is this small

straw gonna feel like do you want to

know what it feels like yeah kids tell

me that it feels like a small pinch

I love the educational component I love

getting to educate kids about why they

come to the hospital and what the staff

are doing cuz you know for a lot of

people you know seeing the white coat

come into a room is kind of a scary

thing but you know knowing that all the

doctors and nurses here

really love to help kids get feeling

better and to educate them on you know

why we do a blood pressure cuff and why

we take their temperature and all those

things I really I like seeing that click

in the child's eye of oh oh that's why

they're doing that and I really enjoy

that and you watch with your eyes and

see if we find it Paul also uses

distraction to help young patients

through a procedure is that the one

instead of a be focusing on that IV

about to go in she's turned away

engrossed in a book that Paul brought a

broken bone an IV this is pretty typical

stuff here in the ER but it's a very big

deal for Abby and her family a yellow

frog okay Abby being five it's important

that I meet her where she is

developmentally understanding that she's

not an adult and she doesn't necessarily

want to know everything but she wants to

know everything that's important to her

so understanding what it is a

five-year-old understands and what it is

a five-year-old wants to know at the

same time providing an appropriate level

of information for the parents who of

course want to know everything I want to

make this for Abby like I said she's had

a bad day I want her to leave this

experience with not only without trauma

but hopefully with a smile we're gonna

give it to you right through your small

straw okay

so there's no there's no more owies nope

sometimes kids say that it feels a

little warm but no Ally's okay and then

you'll wake up and your arm will be all

fixed and you get to go home but what I

will please make you talk

that's right and you won't feel anything

yeah yeah it was it was really scary it

was huh the tumble three year old Peyton

took while vacationing in Seattle

certainly scared her and her parents my

daughter had a fall over at the Science

Center into an open what used to be it

look like a little pond and fell over

the chain wha and hit her best at her

head but the time in the emergency room

even the stitches really weren't so bad

and Paul who helped her just kind of

ease made her laugh and brought him

bubbles and books and coloring and

everything so she was much more

comfortable with that part of it and

then he came in and talked to Peyton and

explained to her the process of what

they were going to do and so she could

understand an ER visit as a child can

set a lifetime attitude toward all

things medical good or bad if this is a

traumatic experience

patients could fear doctors hospitals

even needles well into adulthood those

who work here in the emergency

department know the importance of making

this experience as painless and positive

as possible I just always yeah well she

did a great job tolerated everything

great so in terms of giving you advice

for what to talk to her about at home I

can't think of anything because she did

so well okay so but if questions do

arise usually she'll kind of express it

through play house or just kind of keep

an eye out through that we try to have a

pain-free environment so we always want

to make sure patients don't have pain

but we recognize that a lot of the sense

of pain is anxiety and if we have people

who are specially trained to reduce the

anxiety but as our physicians our nurses

but especially our Child Life

specialists it makes a huge difference

for the family that children leave

smiling and happy even after an invasive

procedure Abbey is waking up to an arm

that's put back together so it can heal

doctors fixed her arm it's all better

now

she's now excited about a pretty pink

cast in her future and not at all upset

by the day's events and Peyton heads

home with some souvenir stitches and a

smile Paul isn't the only Child Life

Specialist here at Children's while he

works in the ER other Child Life

specialists in other parts of the

hospital help kids deal with surgery

cancer treatment and hospitalization

coming up that top reasons for emergency

room visits here at Seattle Children's

can you guess what's number one and how

prevention can be the best medicine what

doctors are doing to keep you from

having to come here in the first place

you

here are the top ten reasons for visits

to the Seattle Children's emergency

department number 10 a rash 9 laceration

which is a cut or gash number 8 otitis

media

a middle ear infection number 7 a broken

bone 6 asthma 5 abdominal pain the

fourth most common reason for an ER

visit to Seattle Children's a soft

tissue injury like a bruise sprain or

strain number 3 upper respiratory

infection number 2 gastroenteritis a

stomach virus and the number one reason

for an ER visit to Seattle Children's

fever you can see from that top 10 list

that many of the things that bring

children here are certainly concerning

but not that high adrenaline

life-and-death situation that Hollywood

portrays fortunately those situations

don't happen often but they do happen

that's why everyone here has to be ready

for the big one at all times tune into

any Hospital TV show and you'd think

emergency rooms are constantly bringing

people back from the brink but that kind

of excitement is more about ratings than

real life we know when you watch ER on

TV or other shows everything is really

acute and emergent and I think when we

look at our patients most ers don't have

that high level of acuity and

emergencies so we might have one or two

percent of our patients per year that

need a full blown resuscitation but we

have to be ready for that any time of

day or night for any cost whether to

trauma cause whether it's a medical

cause when it's a cardiac cause drowning

or anything else we have to be ready for

that so Ronnie we've gotten we're in the

IDI Air Lift has just transferred her

over she's already on monitors she's got

a working IV ready for anything at any

time that's why training and lots of it

is so important patient weighs 12.5

kilograms and is no drug allergies teams

run scenarios complete with role playing

sometimes with scripts to follow to

fine-tune communication so we just did a

scenario which nr in terms of simulation

that's practice we're practicing it's an

opportunity for us to work on skills and

on communications challenges that we

face every day and it's a chance for us

to work on them and practice them over

and over again so our skills get better

and our processes run smoother

some simulation training is so realistic

it's hard to tell it isn't the real

thing correct comedy as this team tries

to deal with the resuscitation drill a

technician makes the sim babies

breathing blood pressure and heartbeat

react as a real babies might so Sarah

after you've gotten the intubation meds

ready then we'll start a bolus this is -

dropping and I'm struggling eventually

the staff at Seattle Children's are

national leaders in developing and

implementing simulation training like

this sequence medications they set the

standard for how providers across the

country train and prepare let's top the

scenario with practice this kind of

emergency becomes routine even though

it's relatively rare as appropriate and

immediate response can be life-saving

and it's probably similar to what pilots

do you know they practice and they

practice and they practice so when they

have an emergency it's second nature and

one of the most important things the

emergent partment is to anticipate and

be prepared of the nearly 40,000

emergency room visits to Seattle

Children's last year a good number of

those were for things that could have

been prevented no offense but when it

comes right down to it doctors would

rather not see you here not if taking

their advice can keep your child safe

and healthy Ben Franklin once said an

ounce of prevention is worth a pound of

cure that sentiment rings true every day

here at the emergency department at

Seattle Children's any parent here would

love to turn back time anything to have

avoided this visit in the first place

anything to keep their child safe hi I'm

dr. Ben Danielson a pediatrician at

Seattle Children's Hospital I'd like to

talk with you a little bit today about

pedestrians

doctors at Seattle Children's want kids

to avoid ER visits just as much as

parents do that's why they take the time

to star in public service announcements

over the airwaves and on websites to

share important and specific safety

information there's no question that the

best way to protect your child when

they're on a bike a scooter or skates is

to wear an appropriately sized helmet

they give tips reminders and advice that

might keep them from seeing your child

in the emergency room wear a life jacket

as ER Doc's they'd love nothing more

than to put themselves out of business

to never be needed again each year

almost 5000 children nationwide fall out

of windows such simple things as an open

window at home or a hard hit at practice

can turn an ordinary day into an

emergency situation make sure your child

has the right safety gear and then it

fits properly in an instant those safety

caps only work for so long accidental

poisonings send 50,000 children to the

hospital every year nationwide i'm dr.

suzanne nazar an emergency room doctor

dr. Suzanne Mazur sees an average of 3

or 4 cases in the Seattle Children's er

each week kids who've gotten into

prescription pills or household cleaners

because parents didn't take steps to

keep them out of the hands and mouths of

babes two-thirds of kids who are

poisoned are kids less than aged five

and almost all of those are preventable

so an unsupervised kid getting into a

medicine you know just for a minute

the parent looks away and the child gets

into a medicine Seattle Children's also

hosts community events educating and

equipping families to keep kids safe

the trials are outreach events such as

this one at Green Lake offer bike

helmets and life jackets at low prices

and properly fitted in hopes they'll get

used and potentially save lives I think

it's cool that there

life jacket since it should be required

I think it's a great excellent program

and I think everybody should take

advantage of the outreach the education

first insist on adult supervision

all of these ounces of prevention can

add up and make a weighty difference

learn to swim drownings for instance

have dramatically decreased in the past

few decades since dr. Linda Kwan made it

her mission to help stop such

preventable tragedies we have worked

really hard by trying to get families

aware of the risks and we've worked hard

with a Health Department they've been

amazing leaders in this with us partners

with us and with work to get legislation

passed to to make children safer like

wearing lifejackets and the health

department has worked to have

legislation to make our pools safer and

so all of this has has led to

contributed to I believe that the reason

why we're seeing so so few drownings the

ER at Seattle Children's is here when

you need it you should wear a helmet two

kids are more likely to wear a helmet if

their parents do but hey if you can

avoid ever having to come here even

better

absolutely prevention is the name of the

game Seattle Children's has compiled

many safety and wellness tips for

parents and caregivers if you'd like to

learn more go to seattle children's org

slash safety

- wellness sadly not all emergency room

visits are the result of accidental

injury or illness abuse is a reason for

a small percentage of pediatric ER

visits again prevention is key when it

comes to abuse prevention begins very

early and with education a crying baby

an exhausted parent this is the time a

child is most at risk of abuse the peak

age at which it occurs is somewhere

around two to four months of age and

that coincides with the time when babies

are crying the most if you look at a

large population of Bay

there's big Criers and their little

Criers but they always start low about

two to four butts that they're at the

peak and then it falls off after that

and it's right around the time when

babies are most fussy and most crying

that the injuries tend to occur a lot of

times in the history particularly if

there's a confession you learn that it

was inconsolable crying that led to the

events I couldn't make him stop crying

so I got frustrated I felt like the

worst mom on the planet I felt like

maybe I had a bad baby this is a video

produced by the National Center on

shaken baby syndrome as part of a

statewide program to prevent abuse many

birthing hospitals in Washington are now

giving these DVDs to new parents telling

them it's normal for babies to cry

sometimes inconsolably and giving them

ways to cope when that happens it's okay

to be frustrated it's what you do when

you get frustrated I think anybody who's

been a parent of an infant and it's

being honest well it will tell you they

hit a point when they were extremely

frustrated and even angry with the baby

and we want parents to know that's going

to happen they're not bad parents

because of that but they have to be able

to react in a way that won't injure the

baby as past medical director of Seattle

Children's Protection Program and a

former emergency room physician here dr.

Kenneth Feldman says ER teams are

trained to look for signs of abuse

especially in babies so often we see a

bruised infant at an age when they're

not mobile enough to bruise themselves

there we see tears in the mouth and if

we look closely with x-ray will often

see broken bones elsewhere in the body

even one abuse case is one to many but a

few years ago the number of cases spiked

we

thought we were seeing about one and a

half a month between children's and

Harborview which are the two

institutions that get the majority of

these kids in the central Puget Sound

area in 2008 we saw a major jump to the

mid 30s associated with the onset of the

recession and then over the last couple

years had settled down to where we're

seeing in the mid 20s a year there are a

number of reasons why shaking through

the DVD and educational pamphlets it's

hoped parents will understand that

crying is a normal phase of development

for an infant and that they'll make a

plan for dealing with it in a way that's

safe for their baby the main tip for

parents dealing with a crying baby after

ruling out that the baby needs to be fed

changed or is in some sort of pain put

the baby in a safe place such as a crib

for a few minutes while you take a break

the baby will be okay to cry it out for

a little bit and you'll feel better able

to cope after a short time away coming

up when your child is hurt or sick how

do you decide whether to come here or go

to an urgent care clinic we'll have

advice for parents and later come along

on a journey on which you've probably

never been down deep to retrieve a

swallowed coin this is a rather frequent

journey at Seattle Children's and it's

not just coins doctors removed see the

unique collection of things once

swallowed snorted or stuck in ears

in the last year a total of 735 patients

an average of 2 each day were treated in

the Seattle Children's emergency

department for mental health issues some

of the top mental health problems that

bring children to the ER include

depression anxiety disorders eating

disorders bipolar disorder and

aggressive or violent behavior when

something happens that requires more

than a band-aid and a kiss it can be a

fine line between a trip to an urgent

care clinic or appear to the emergency

room here's a look at how to navigate

that decision-making process I want you

to look right 12-year old Nick got a

piece of burning ash in his eye at a

bonfire with friends the other night we

got some water some splash it try to go

peace out it's not bothering Nick too

much but it is concerning his mom it was

swollen in red so Nick is here at

Seattle Children's Urgent Care Clinic in

Bellevue on a Sunday afternoon to get

that I checked a lot of families come

here rather than the emergency room when

their concern can't wait for regular

clinic hours I think the main thing to

think about is if you think it's clear

that your child is very very ill and may

need to be admitted to the hospital or

have a procedure done that's gonna

require subspecialty care that you

should probably go to the main emergency

department for a more kind of minor

complaints a lot of the cough and cold

complaints and sore throats and year

there you know does my child have an ear

infection that's something we're very

capable of dealing with here sometimes

it's hard for a worried parent to decide

between the ER and an urgent care clinic

let's ask dr. Josh Weldon for some help

starting with a for allergy attack if

your child has respiratory symptoms as a

result of an allergy like they have a

known allergy and they're having trouble

breathing

that's 911 or to the emergency

department if your child has a rash and

you're not totally sure why it's

certainly something we can evaluate how

about asthma also depends a little on

severity will usually initiate that

treatment here but if it's clear that

they're fairly sick and might need to be

admitted then we'll transfer them to the

Maine Edie B is for broken bone most can

be handled at the urgent care clinic but

any fracture where there is visible

deformity should be handled at the

emergency room if your child broke their

arm and it's sticking out of its skin

hopefully that would nobody wants that

to happen but if that happens you need

to go to the Maine emergency department

because you're going to need to have

sedation and C orthopaedic and those

kinds of things minor burns dehydration

diarrhea all common reasons for urgent

care visits same with E and F ear

infections and fever most cases can be

seen here H head injury a patient who

hit their head and had a very brief or

no loss of consciousness is a patient

that were happy to evaluate here but we

do not have a CT scanner here so

patients with severe head injuries who

are not at their back to their

neurologic baseline or clearly have have

significant head injuries need to be

seen in the emergency department there's

an entire alphabet of reasons your child

may need to see a doctor when their own

isn't available if it's life-threatening

call 911 injuries though an urgent care

clinic is often the perfect fit you know

our our job is to is to take care of

patients and families close to where

they live and we enjoy doing that we

often really want to do our best job

interfacing with people's primary care

doctors seven-year-old eight aya got

very sick from an infection that

required bloodwork and IV antibiotics

dad and siblings enjoy a video game in

the lobby

her mom was happy to come here instead

of the hospital er I'm glad that you

know that Children Hospital is here on

in Belleville instead of you know like

in Seattle like we used to go at the

convenience and it's closer to our house

don't worry if you guess wrong between

the ER and urgent care clinic Urgent

Care doctors and nurses here at the

Bellevue clinic canis

a situation quickly sometimes consulting

with emergency medicine providers and

decide on the most appropriate place for

care almost every day they transfer a

patient from this clinic to the ER

either by ambulance or parents car why

don't you lay back okay this is not

painful I promise if it was gonna hurt

I'd tell you Nick got to get his eye

examined with some cool glow-in-the-dark

drops and a type of backlight to check

for damage to his eye he'll go home with

some antibiotic drops after a short

Sunday visit with a doctor close to his

home okay you did great wasn't so bad

right in an effort to better serve the

urgent medical needs of patients and

families Seattle Children's will be

opening two new Urgent Care locations in

the coming year the plan is to offer

urgent care clinics in three locations

Seattle Mill Creek and Bellevue similar

to the urgent care clinic located at

Seattle Children's Bellevue clinic and

surgery center the two newest clinics

will be open evenings weekends and

holidays when your regular doctor is not

open coming up overcoming language and

cultural barriers in the emergency room

ha Seattle Children's works to speak

your language when a patient is on the

way to the ER by ambulance helicopter or

sent by a primary care doctor the

communication room will know about it

this room is part of the ER is staffed

by ER nurses and helps providers prepare

for what's about to come in the door

then we're prepared and we give better

care we get safer care it's um it's less

chaotic in an emergency situation clear

communication is crucial we've seen how

the team here frequently trains and

practices together and how communication

is key to sound emergency care but the

patient and family are part of the care

team too so when an emergency brings a

child in the ER doors effective

communication with them is also

important no matter what the language

and that's what you've seen before when

she's need to come in

the hospital a trip to the emergency

room can be scary enough but imagine

having a sick or injured child and you

don't speak the same language as the

medical staff that's a frequent

occurrence here in the Seattle

Children's er has anyone else been sick

at home and we often will have patients

for four or five different nationalities

in our merged apartment at any one time

many who don't speak English as a

language or even as a second language

Meno Constanzo is one of about 20 staff

interpreters at Seattle Children's why

do you ask if there was blood Mino or

one of his colleagues can be here in the

ER within minutes helping bridge the

language and potential cultural

differences between the patient family

and providers make sure that

communication is flowing and that their

families and understand what is being

done to their children so no impetus you

say it bein psych when I do that you can

see how the family's relaxed and they

open up a lot easier and if they didn't

ask question I understand what's going

on it's invaluable you know we have

families that are not english-speaking

and their child is ill and so they're

already under a lot of stress and so to

have professional interpretive services

here just really helps relate

information in a much more efficient and

clearer way and I think it really helps

decrease the family's stress and it

definitely helps with our efficiency go

home - okay now the communication goes

both ways not only do families need to

clearly understand what providers have

to say doctors and nurses also want to

understand the concerns and needs of

patients and their families in a

culturally sensitive way we have our

on-site interpreters it allows us to

really interpret the cultural

differences and find out what the family

is really thinking what they really need

beyond just the medical verbage going

back and for

come with open than that deviled annuity

and Seattle Children's provides free

interpreter services day and night with

in-person interpreters in many languages

and has immediate access to telephone

interpretation in more than 150

languages and dialects it's crucial for

an ER that covers such a large and

diverse population we have just a superb

bunch of interpreters who are here 24/7

they come in when we need them we have

some that are in the hospital all the

time and then others that come in and

it's amazing because sometimes I'm not

even sure where the country is where

their folks are from but we have an

interpreter who speaks that language and

it just makes the care so much better

and allows them to really again be part

of the process and help us with the

solution rather than being told what

they have to do in a way that they may

not understand it's a job that's very

rewarding and at times challenging the

most difficult part for me it's when I

have to deliver bad news to the families

as much as I try to not get involved

with the situation it's sometimes it's

very hard especially with families that

are not understanding very well you know

why their kids get cancer for instance

I'd say it's pretty tough sometimes but

then again there are a lot of good news

too because kids are very resilient and

they you know they have this energy to

to get better and and the parents are

very hopeful too and they're very

attentive to to the care that their

children need so there's a lot of good

news to him that's a very fulfilling

that makes me feel great I love my job

interpreter services aren't offered only

in the emergency room but also

throughout the hospital and clinics here

at Seattle Children's

coming up next the changing role of the

Seattle Children's er through the years

a look at its history and future and one

of the more unique collections you'll

see coins jewelry pretty confetti oh the

places they've been and what stories

these objects can tell

although children make up nearly a third

of all ER visits nationally it is

estimated only about 6% of hospitals

have all the pediatric supplies they

need according to a report from the

Institute of Medicine Seattle Children's

is among that six percent that does have

all the needed pediatric supplies the

emergency department at Seattle

Children's started as just a small room

next to a clinic

it really was an emergency room now it's

an entire department serving nearly

40,000 cases a year a lot has changed

Seattle Children's first opened its

doors more than a century ago with a

small Children's Ward in Seattle General

Hospital four years later Children's

opened a 27 bed hospital on Queen Anne

Hill polio and tuberculosis were among

the most common diseases treated it

wasn't until the hospital moved to its

present location in 1953 that it had

even a one-room emergency department in

the following decades doctors and nurses

treated emergencies in just two small

rooms then you began to see relatively

rapid expansion we had a new expansion

in the mid 1980s and then that pretty

fairly soon was not adequate that was

doubled in the 90s and then now we have

it on both sides of the hall a fairly

significant area but we're growing out

of space though children's provides the

best pediatric emergency care in the

region the current ER built in 1993

wasn't designed to accommodate the

growing number of patients who need it

patients like eight month old Caleb

we're in today because initially he had

pulled his feeding tube out and he was

having a hard time breathing caleb has

biliary atresia a life-threatening

disease of the liver and desperately

needs a liver transplant his doctors say

he won't make it to his first birthday

without it is that them

Caleb's fragile medical condition means

frequent trips to the ER for emergency

issues all the problems are compounding

and the closer we get to his liver

failing the more problems were going to

find so there was like a lot of blood

and so I just called 911

19 month old Tori has a genetic disease

that requires many cranial surgeries and

a tracheotomy tube that tube came out

somehow Tori was rushed to another

hospital that wasn't equipped to handle

such a specialized pediatric emergency

so she came here the ER at Seattle

Children's have the equipment and

expertise to take care of it and made it

look easy today doctors and nurses treat

nearly 40,000 patients in the ER each

year many of those have serious medical

conditions and rely on the unique

expertise that Children's er provides

especially at night and during weekends

when other resources are not available

visits to Children's er have increased

more than 30 percent in the last five

years alone population growth medically

complex and fragile children and a

difficult economy that limits access to

health care are taxing the current er

that acts as an important safety net for

children who need it most

current physical space constraints can

impact all children who need er services

especially during busy evening and early

morning hours and during the high volume

viral seasons if we have a breakdown in

our primary care system we're going to

be using emergency rooms more and more

I'm concerned with this current

budgetary problem that actually access

to primary care is going to decrease and

the need for the emergency room will

increase to add to that a children would

have very complex problems or acute

problems and our desire in society to

make sure these children survive as

quickly as possible and do as well as

they possibly can you need emergency

services for that he's breathing with

support from the community Children's

will move the emergency department to

the ground floor

of their new building named building

hope where it can expand to better serve

the growing number of patients coming

through the doors if you want to learn

more about plans for expanding Seattle

Children's a our and other parts of the

hospital go to seattle children's org

slash building hope so a lot has changed

over the years one thing that hasn't

changed is a common way that otherwise

healthy children end up here in the ER

you're about to see a strange kind of

collection so we have the whole range of

coins we have quarters and this one's a

dime we have a couple pennies it's not

so rare to collect coins we have a

Mexican coin here or pretty pins what's

rare about the items in dr. kathie C's

collection is where they've all been it

is eye-opening for people to know what

kids get into and and helpful for them

to know that just these little things

can cause problems these are all things

dr. C has removed from children things

swallowed inhaled or shoved into an ear

or nose we have had stories of kids who

are doing counting projects in preschool

with beans and we've had little runs of

you know kids two or three kids from the

same preschool class with beans in their

ears and beans in their nose plenty of

beans pieces of pretty confetti even

shards of glass

ouch there's glass that was stuck in the

voice box and so as you can imagine

those have sharp edges and can cause a

lot of injury kids don't seem to be

picky about what they'll inhale or

ingest parents need to know that healthy

kids can get into anything that lives

around common household objects you can

see there's quite a variety but coins

take the cake for most popular most

common things we take out of kids are

coins from the esophagus and you know we

all have coins lying around the house

they're shiny and they're pretty and so

young kids will tend to put them in

their mouths and it's a normal

developmental stage and sometimes

they'll swallow them that's exactly what

happened here on an x-ray it's easy to

see the one

shiny pretty nickel now residing in this

baby's esophagus it's not quite so easy

to get it out doctors must go on a

search and remove expedition fishing for

something that went where it shouldn't

nickels dimes even quarters are

regularly retrieved usually with very

little damage done it's all still

potentially dangerous though and very

serious some things are especially so

the main public health messages recently

has been the the problem with disk

batteries as we have more and more toys

that are powered with disk batteries and

electronic objects lying around the

house we're always changing batteries

out and those little disk batteries can

be really problematic they can actually

be life-threatening

the charge from the battery when it's in

contact with a moist surface will

actually start to erode through the

tissue and it can cause death we

consider that a true medical and

surgical emergency even somewhat minor

things can constitute an emergency

inhaled popcorn pieces or tiny chunks of

nuts can lead to big problems here are

some beads this is a bead from the ear

we tend to get little plastic things

this speed was in the nose most pieces

of dr. C's collection have been removed

from babies and toddlers most not all

these blow darts are kind of a theme

where it's a usually straight pin with

some sort of soft stuff at one end and

those we tend to get out of teenagers

and typically teenage boys where they're

blowing dart through a straw or

something and instead of blowing out

they take a deep breath in there's

another blow dart dr. C started this

collection 20 years ago and this is only

a small part of it with each passing

month each swallowed ring or inhaled

sunflower seed her collection grows as

does the safety message this all

represents a message she hopes everyone

will swallow it tells a story of what

kids get into it's just nice for people

to see the things that kids can

ingest or aspirate kids who are

otherwise healthy are at risk for for

foreign body aspiration and foreign body

and Jessen and I think it's important

for parents and the general public to

understand their risk back to esophagus

cam there's that nickel found at last

and plucked from where it doesn't belong

yet another addition to dr. sees growing

collection dr. C hopes to one day

display her entire collection in a

public part of the hospital she wants a

visual and effective reminder of what

kids can get into and the damage it can

cause when we come back an update on

some of the little ones we met

throughout this program how they're

doing now

for most patients a few hours is all

they'll spend here in the emergency room

but they may remember it for a lifetime

throughout this special that was shot

over the summer we met several children

experiencing an emergency situation

here's an update on how they're doing

now

three-year-old Peyton is doing fine the

gouge on her forehead that required

stitches is healed now her mom says she

has a small scar slightly visible in her

hairline and a good story to tell about

her family's vacation to Seattle little

alina who went under in a swimming pool

has no lasting physical effects from her

ordeal she is more afraid of the dark

and of being alone her mom says but is

otherwise healthy and happy caleb is

still waiting a liver transplant and his

condition has worsened his family says

the waiting can be excruciating not

knowing when or if a liver will become

available in time on a happier note

caleb recently rolled over and sat up on

his own for the first time he giggles

frequently and is a happy baby

Caleb's family urges everyone to educate

themselves on organ donation more than

100 thousand people in the US are

waiting for a life-saving organ

transplant some of them are just babies

like Caleb and finally we're happy to

report that a broken arm didn't slow

five year old Abby at all she had to

miss swimming lesson two this summer

but managed to still crime on playground

equipment cast and all Abby's cast is

off now and her arm has healed one thing

about an emergency room visit very few

people know ahead of time that they're

coming fewer still would expect a TV

camera to be part of the deal we would

like to thank all the families who

allowed us to be part of their er

experience and to share this inside look

with you thanks also to the providers

who work here for letting us capture

part of their world and thank you for

watching

good

Fisher Communications