EMERGENCY CARE WITHOUT PARENTAL CONSENT

For years we have been telling parents that if someone other than you arrives with the baby or child (in your absence) that a form should accompany them. The form is known as the Parental Consent Form. This form, allows medical personnel to initiate care for your infant or child prior to your arrival at the hospital.

Examples of this potential conflict would be when a grandparent or aunt/uncle, babysitter, nanny, etc. brings the baby to the E.R. without a signed statement from the parent, allowing care to proceed until you arrive. This would provide the doctors & nursing staff with knowledge about the infant/child’s medical history (allergies, other health issues, medications). The assumption is that this information would clear the way to initiate treatment with medications, imaging studies, other necessary sedation of the baby or child for a wide variety of illnesses or injuries.

The American Academy of Pediatrics (AAP) has issued a new policy statement regarding these potential conflicts. The decision of the AAP for the revised policy on parental consent was summarized in this statement:

“Current medical ethics recommendations also appear to support the E.D./E.R. treatment of unaccompanied minors“ so the statement reads. Furthermore, the AAP statement included: “The physician should seek consensus from the patient or family as soon as possible.”

Simply put, this change suggests that preauthorization (with a note or letter, signed by the parent) is not a necessity and that proceeding with treatment of the minor will be based on a variety of factors.

When we instruct parents in our CPR and first-aid classes the issue of parental consent is always on our check-list of important things to do. We strongly suggest that all parents provide this document to those who have childcare duties, even those blood relatives who are not the parent or legal guardian of that minor.

Forms of this type are easily found on the internet and simply requesting a generic parental consent for medical treatment of a minor. Some states may have laws requiring notarization of the document. Not so in California.

WHAT IS A PEDIATRIC NURSE PRACTITIONER?

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DOES YOUR HOSPITAL HAVE GOOD PEDIATRIC CARE?

The American College of Emergency Physicians (ACEP) & The American Academy of Pediatrics (AAP) has released a policy statement on hospital preparedness that is worth your time and interest.

As an educator, I am frequently asked by parents, “Which is the best emergency room for my baby>” or “Does (this or that) hospital have good pediatric care?”

If we go back to the mid-80’s, we find a study of pediatric patient readiness in both the Emergency Department (ED) as well as the hospital as a whole. That study showed that pediatric “needs” were not being met by emergency medical services (EMS) systems that included pre-hospital and ED care. Their data revealed higher death rates from trauma to children (12%) compared to adults (7%). It also revealed something else. That 22% of these infants & children required transportation to a second facility, “indicating a possible lack of necessary services at the first hospital.”

Another sampling of 101 hospitals, intended to represent an accurate reflection of the acute care receiving hospitals in this country, was done. This study revealed that, “…7% of hospitals routinely admitted critically injured children requiring intensive care to adult intensive care units, rather than transferring them to a facility with a pediatric ICU,” then added, “appropriately sized equipment for care of pediatric patients was more likely to be missing than comparable equipment for adult patients.”

The fact that these professional associations have addressed this issue offers some hope for improvement in this important area of family health. The ACEP policy statement on emergency care guidelines states that “hospital ED’s must possess the staff and resources necessary to evaluate all persons presenting to the ED.”

As recently as 1995, the AAP published guidelines that categorized facilities into different levels of preparedness. This statement, Guidelines for Pediatric Emergency Care Facilities address the issues raised in the studies and make it clear to acute receiving hospitals just what is needed to care for our infants & children.

With respect to implementation of the guidelines, the policy statement, “…empowers emergency physicians and pediatricians to address the preparedness of their facility for the care of children with their hospital and health maintenance organization administrators.“

As parents, you certainly need to take the initiative in this area. Speak with your pediatrician and ask pointedly, “Is our hospital ready for our kids?”