The coronavirus (COVID-19) pandemic has created some uncertainty among families about the safety of accessing health care. Danielle Mercurio, D.O., a doctor in the Emergency Center at Johns Hopkins All Children’s Hospital, says with preparation and mindfulness, there is minimal risk in coming to a pediatric Emergency Center.
Let’s talk about ways to prepare for emergencies. First, where to go?
When it comes to emergencies, it’s always best to have a plan ahead of time. Know where the nearest Emergency Center is located, but during the pandemic, find out if that Emergency Center combines patients of all ages, or has a separate care area for children. Is there a nearby children’s hospital like Johns Hopkins All Children’s? Pediatric hospitals throughout the country right now are likely safer because COVID-19 seems to generally have greater impact on older individuals. By choosing pediatric specific health care facilities, you may limit the chances of exposing yourself and your child to someone with COVID-19.
What else can we do to prepare?
Keep a mask for you and your child, along with hand sanitizer, in your bag or car at all times. Though most facilities will provide these at the door, you never know if there will be long lines, crowds of family members due to circumstances like car accidents, heart attacks, etc. Our facility is limiting waiting room occupancy, but other facilities may have different rules. If you have concerns about entering the facility, you can either call upon arrival or ask the security team at the entrance if there are special precautions or concerns for your individual child.
Are there any emergencies that can be handled at home?
Yes. While our staff at Johns Hopkins All Children’s never wants any child to suffer, there are certain illnesses and injuries that can be handled by a simple sick visit with the pediatrician, many even via telemedicine. This includes rashes, most ear and throat pain, some abdominal pain, most colds, or medication refills for chronic illness such as asthma or diabetes. Running out of chronic medication is a common reason for EC visits right now. So, to avoid an unwanted visit, call your physician early, before you run out of medications.
What are your thoughts on urgent care facilities?
Many urgent care facilities are open for things like simple ear pain or lacerations, but if they are not pediatric specific, there may be an increased risk of COVID-19 exposure. Minor wounds such as small animal scratches or bites can be gently cleaned with soap and water, dressed with bandages and monitored at home. If needed, the pediatrician can also monitor these types of injuries via telemedicine visits.
What about emergencies that should not wait at home, even though COVID-19 is a risk?
We at Johns Hopkins All Children’s, as well as most health care facilities throughout the world, are taking every precaution possible to reduce the risk of transmission. Despite this, your child may still need our expertise in the Emergency Center. We understand the hesitation. But we have seen patients with ruptured appendix, broken bones without stabilization, severe gastrointestinal illness with dehydration and hypoglycemia and, even those things associated with a parent’s worst nightmare, like unrecognized, worsening cancer, come in far too late because their families are scared of COVID-19.
If time permits and you have concerns about coming to the Emergency Center, I encourage you to call your primary care physician early on in the illness to discuss your child’s symptoms. He or she can help you make the decision. By law, the Emergency Center staff are not allowed to give medical advice over the phone, but your primary care physician, who knows you and your child, is able to do so.
No parent should have to go through this alone. It is stressful enough having to be the parent, and the teacher, and the constant entertainer during isolation protocols. We do not want anyone to feel like they also have to be the doctor. We want to empower you to ask for help, and to come to the Emergency Center when you need help. We will do everything in our power to keep you and your family safe.
Are there any circumstances that should come directly to the Emergency Center or call 911 without calling the pediatrician first?
Yes absolutely. Here is a list, but it is not complete.
- Infants less than 60 days old with rectal temperatures higher than 100.4 degrees Fahrenheit.
- Immunocompromised children with fevers higher than 100.4, including but not limited to patients on chemotherapy, receiving bone marrow transplantation, sickle cell anemia, neutropenia, spherocytosis, those without a spleen and those taking many immune-modulator medications.
- Any patient complaining of trouble breathing, or those that physically appear to have trouble breathing such as labored breathing, fast breathing, or if you see their ribs and neck muscles prominently between breaths, etc.
- Any child less than 5 years old with intractable vomiting, meaning they cannot tolerate any water or fluids, for more than four to eight hours, with or without diarrhea, and reduced urine output when compared to the day before.
- Any child with altered mental status, meaning that your child’s ability to respond to you is completely impaired. This is more than a child being tired with a fever.
- Any child having seizures without a history of seizure disorder.
- Any child experiencing symptoms concerning for anaphylaxis, such as throat swelling, coughing, wheezing, trouble breathing, rash, vomiting, diarrhea or fainting just after eating new foods or being stung by an insect.
- Any injury that will not stop bleeding despite holding pressure for about 15 minutes.
- Any injury that looks obviously deformed or swollen. Sometimes kids have broken bones but hide it well. If you notice your child is not using his or her hands, arms or legs, the child likely needs an X-ray, even if he or she denies pain.
- Any male child or teenager with severe pain, with or without swelling, in the testicle.
- Any female child or teenager with sudden onset, severe, one-sided pelvic pain.
- Any child with abdominal pain that cannot jump up and down, especially if he or she has pain worse on the right side, fever, vomiting or loss of appetite.
- Any child with severe headache, severe abdominal pain or one who is not engaging as he or she normally does with the family and instead is sleeping excessively or refusing to drink fluids.
On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report.