Children’s Trauma Care Found Lacking : Medicine: Panel of experts say nation’s emergency services are designed for adults. Young people are built, respond to injuries differently.

The nation is ill-equipped to provide adequate emergency medical treatment for children and widespread improvements are needed, according to a study released Wednesday by the prestigious Institute of Medicine.

Injuries from accidents are the No. 1 killer of children younger than 14 and disable tens of thousands of children every year. About 21,000 children and young people died from injuries in 1988, the latest year for which statistics are available, according to the study by a panel of experts convened by the institute.

The institute, a division of the highly respected National Academy of Sciences, provides health policy advice to the federal government and other decision-makers.

The release of the study comes at a time known unofficially in the field of emergency medicine as “trauma season,” the summer, when youngsters are out of school, out-of-doors, on playgrounds and on bicycles. It is the time of year when children are especially vulnerable to accidental injury.

Despite the statistics, in many emergency medical systems, “children’s needs have been overlooked as services (have been) developed for adult trauma and cardiac patients,” the report said.

Those who design trauma services for children “cannot presume that they are simply little adults,” the study said, because special anatomical, physiological and developmental differences exist between children and adults that must be taken into account when treating youngsters.

Children are not only smaller, they are proportioned differently from adults and their normal respiratory rates, heart rates and blood pressure differ as well.

Moreover, changes in vital signs that indicate deterioration in an adult’s condition may not occur in children and stages in children’s physiological, emotional and behavioral development can have an impact on how they respond to medical care.

Equipment and supplies needed for children often are unavailable in emergency care settings, the report said.

For example, cervical collars used for patients with neck injuries often are not available in children’s sizes, a situation that “leads to children being placed in collars that are too large, often obscuring their faces, and even impairing ventilation,” the report said.

“There must be different and special equipment, different-sized instruments, different doses of different drugs and different approaches to the psychological support and remedial care to be given to the ill or injured child,” the committee added.

The report was immediately applauded by the National Assn. of Children’s Hospitals and Related Institutions, an organization representing 131 of the nation’s children’s hospitals.

“This report demonstrates what we know all too well in children’s hospitals: When it comes to medical care, one size won’t fit all,” said Lawrence A. McAndrews, president of the association. “The special medical needs of children are often overlooked in the delivery of medical services to adults.”

The Institute of Medicine called for the creation of a special federal office within the Department of Health and Human Services that would focus on ways to bolster the nation’s pediatric emergency medical systems.

It also recommended that Congress appropriate an “absolute minimum” of $150 million over five years for the office’s activities and for grants to state agencies to develop new programs for children’s trauma services.

The panel also recommended expanded training programs for health care workers, saying that programs for emergency medical technicians should incorporate training in pediatric life support, and in the medical, developmental and social needs of children.

“Until recently, emergency care curricula included little information on the special needs of children; moreover, pediatrics curricula devoted little attention to emergency care,” the report said.

On the state and local levels, the report urged that all jurisdictions adopt the 911 emergency telephone system and that areas that already have 911 numbers should enhance their capabilities with computer databases capable of automatically identifying the telephone number and location of the caller.

Finally, the panel recommended that emergency departments create the capacity to deliver some treatment guidance over the telephone in certain situations, rather than summon an ambulance--much as poison control centers currently do.