Pediatric trauma is treated by specialized team

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be "The Informed Patient," with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

A team of pediatric trauma specialists stands ready to care for injured children and teens around the clock.

And today I am talking with their leader. Dr. Kim Wallenstein is an assistant professor at Upstate and the medical director for Upstate's Pediatric Trauma Team.

Welcome to "The Informed Patient," Dr. Wallenstein.

Kim Wallenstein, MD, PhD: Thank you for speaking with me today.

Host Amber Smith: Why is it important for the community to be aware that Upstate has a pediatric trauma team specifically for children?

Kim Wallenstein, MD, PhD: Well, the fact that Upstate has a pediatric trauma team is crucial for not only the local area, but also the entire region.

Upstate has the region's only Level 1 pediatric trauma center, and we can get into what that means for the community, but it provides a resource for the entire region to send their critically injured children to get the top level of care.

Host Amber Smith: So when we say region, Central New York region, how many counties, or what's the boundary, sort of?

Kim Wallenstein, MD, PhD: The Central New York region, we see 14 different counties. It's a very large region of the state that encompasses everything from up to the border with Canada to down to the border with Pennsylvania, and then side to side. And those 14 counties all funnel their patients here. The only nearby regions would be associated with Rochester and Albany. So we are all part of the Upstate region.

Host Amber Smith: So most probably come by ambulance, but also air ambulance?

Kim Wallenstein, MD, PhD: Yes, we have both available to us. There are a lot of issues with transportation, especially in the weather. As you know, in Upstate New York, we do have four distinct seasons, and in the winter, it is harder to get a lot of the transportation, especially by air.

So we do rely a lot on our ground ambulance teams, which are wonderful, but we have the air medical available when the weather allows, in order to transport those more critically injured children.

Host Amber Smith: So let me ask a really kind of basic question. What counts as a traumatic injury?

Kim Wallenstein, MD, PhD: That's a great question because traumatic injuries have a huge definition of variety.

They come in all colors and all types. We consider traumas to be really any injuries that happen as the result of an event, so anything that's not a medical problem, that's a result of something that has happened to somebody, usually unexpectedly. Things like falls, like motor vehicle accidents, bike crashes, ATV crashes, pedestrians hit by cars. And even things, unfortunately, like a child's physical abuse would count as traumas.

Host Amber Smith: So it sounds like cuts, broken bones, a range of things, and it sounds like some could be life threatening and some could be minor.

Kim Wallenstein, MD, PhD: Exactly. And that's why it's great to have Upstate as a resource for all of those different things.

We often get phone calls or queries from other hospitals in our region asking about children that they are seeing in their emergency departments and whether they need to be transported to us because they need a higher level of care, and we're able to give them some guidance on that.

Host Amber Smith: Now, you used the term "Level 1." How many levels are there, and what does Level 1 mean?

Kim Wallenstein, MD, PhD: We go by the American College of Surgeons guidelines and definition. That is our overarching organization that accreditates the trauma centers. And the Level 1 designation indicates that we have the highest level of designation, but there are other levels, too.

Level 1 means that we are the ultimate resource for trauma care, that we have the appropriate resources to care for all trauma patients because we have all the specialists and all of the technology available to us.

Level 2 centers are just below the Level 1 center. They just have a few less resources and sometimes fewer research programs and training programs involved.

And then there are also our Level 3 centers, which are crucial to the care of trauma patients because they are able to function and do that initial assessment and resuscitation of trauma patients when they arrive to them. And those are a lot of our more rural hospitals that get trauma designations.

Host Amber Smith: So how often does the American College of Surgeons accredit trauma centers?

Kim Wallenstein, MD, PhD: We have to go through a full accreditation every three years. So every three years they come around for a two-day, really, really intensive site visit, where they go through every part of our program. We get the entire team together, including all of the administrative people at the hospital, leaders who support our program, and then all of the people involved in caring for the patients. And this happens with both our adult and our pediatric trauma programs, and we have to pass this intensive visit in order to continue on as a trauma system.

Host Amber Smith: Now the Adult Trauma Center and the Pediatric Trauma Center, what is the difference in trauma in a child versus an adult?

Kim Wallenstein, MD, PhD: The child injury pattern is a little bit different, and that's why we have both adult and pediatric trauma programs. Our pediatric trauma program sees patients age 14 and below, and that's what the American College of Surgeons has designated as being pediatric because of the difference in injury patterns and difference in how you deal with injury and the physiology of the patient. Our adult team sees the ages 15 and up. You can imagine that at age 15, 16, that's when the children start driving and getting into more adult-type activities. So the 14 and below ages, we see mostly things that are not as much the same pattern as the adult activities.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Kim Wallenstein. She's the medical director for Upstate's Pediatric Trauma Team. How many patients does the team take care of in an average week?

Kim Wallenstein, MD, PhD: That is completely variable, and you can imagine that different times of the year, you see different numbers of patients.

So in the winter, actually, even though we have a lot of snow sports here, and you can imagine that people can get injured on the slopes and sledding and that type of thing, we actually have a little bit of a dip in volume during the winter. So we may not see as many patients during the week in a typical week in the winter.

In the summer, you can definitely tell when the kids get out of school.

Also, that first weekend in the spring or summer where it's really nice weather, and everybody opens their windows and the kids fall out of the windows, we definitely see an uptick there. So we can have our service full of up to 10 or 15 kids that have been injured, but it's much less at different times of the year.

Host Amber Smith: What type of injuries do you see the most often? You mentioned falls.

Kim Wallenstein, MD, PhD: Falls are always the No. 1, and those are pretty much the No. 1 for most age groups, even with adults. In kids, the falls are a lot of different mechanisms. So the difference between kids and adults that you asked earlier is sort of illustrated in falls.

So you can imagine that children come in all different ages, so they have all different mechanisms of falls. The babies, obviously, aren't walking. or even crawling, perhaps, at that point. So their falls have to do with dropping out of parents' arms, maybe rolling off the bed, things like that.

The toddlers can fall down stairs if they get through a baby gate or have different falls from tables or chairs. Then you get into the older, school-age group, and they have their jungle gyms and porches, balconies, that type of thing, so at every different age group, there's all sorts of different ways that you can fall.

And so falls are always the most volume.

Host Amber Smith: Now, over the summer, there were 11 victims of a house explosion that came to Upstate for trauma care. Eight of those were children.

Kim Wallenstein, MD, PhD: Yes.

Host Amber Smith: So how was the pediatric trauma team able to care for so many children at the same time?

Kim Wallenstein, MD, PhD: A multiple trauma like that definitely stresses the system, and that's why it's so great that we have real organized ways of dealing with our traumatic events, and we also have drills, and we practice these things so that we know how to get the appropriate people involved.

In this case, everything went very well and in a very organized, systematic fashion to take care of these children. We were able to get all of the specialists that we needed and all of the resources. When the number of patients overwhelms the people that are there at that moment, we have backups, so we can always get other people to triage (determine each patient's severity of injuries) and take care of the people if we need to. And so we were able to draw in all of those resources.

Host Amber Smith: What sorts of injuries did these children have, and what sort of challenges did you face?

Kim Wallenstein, MD, PhD: You can imagine with an incident like a house explosion, and I won't go into details about the specific patients, but in general, with a house explosion you can imagine that there's going to be burn injuries because of the heat component of it.

But there's also, in this case, blunt injuries and blast injuries because you imagine that the patients have been in an explosion, basically. And so we saw a variety of these type of things and had to get a lot of specialties involved.

Host Amber Smith: Let me ask you, for a parent who brings their child to the pediatric emergency room after, let's say falling off a bike, can you walk us through what they should be prepared for?

Kim Wallenstein, MD, PhD: When a parent brings the child in, and it really depends on the pattern of injuries and how injured the child is, the trauma team sees mainly, at least when they arrive, the most injured type of patients, and they may even go through what's called an "activation," where we have the entire trauma team assembled in a very systematic fashion to evaluate that patient.

That's a very intense experience, where the kid is rolled into the trauma bay. There's a lot of people around the child to evaluate them all at once. We go through a very systematic way of evaluating the patient. It can be a little bit overwhelming to parents.

Usually, we allow the parents to watch a lot of these things, but sometimes they're sort of sitting in the hallway on a chair and waiting for that update. So we do try to update the parents as much as we can about what is going on and what is next for their child.

The less injured patients, or the ones that do not come in as activations, go to the pediatric emergency department, where they are looked at by the pediatric emergency staff, and then they get the trauma team involved if there's an injury that needs our care.

Host Amber Smith: So right after the accident happens, and the child falls off the bike, a parent may wonder: How serious is this? Should I drive them? Do I need to call an ambulance? Should I call 911?

Do you have some advice for what they should consider in deciding what to do?

Kim Wallenstein, MD, PhD: It's such a subjective thing, but it's never a bad idea to call for a higher level of care. What I don't want to suggest is that any parent just, no matter what the accident, scoop their child up and throw them in the car and come into the emergency department, because that could actually worsen any injury that's existing.

If it's a serious bike accident and the child has hit their head or has some other obvious fracture injury, it's always better to get a medical team involved, like calling 911 so that they can evaluate them, make sure that they don't have a significant head or neck injury and be able to immobilize what needs to be immobilized so that there's not further injury in the process of transport.

There are certainly kids that have very minor injuries; this happened to all of us in our lifetimes, and those are handled differently.

But if it's a significant accident, I would always recommend calling 911.

Host Amber Smith: What are the benefits of coming to the hospital versus an urgent care?

Kim Wallenstein, MD, PhD: The hospital just has more resources.

Urgent care is wonderful for scrapes and bumps and things that are able to be evaluated at a place with less resources. The great thing about a trauma center is we have all the resources. So if the child needs specialized X-rays or CAT scans, then we have those available, and we have the specialists and the pediatric radiologists that can interpret all of those.

Host Amber Smith: Now, is there anything that parents should bring, or not bring, to the hospital with them when they bring their child?

Kim Wallenstein, MD, PhD: It's hard for them to remember anything in that period of time because it's such a stressful situation. So I wouldn't recommend packing up a lot of stuff. If their child is very injured, they'll probably be admitted to the hospital, so bringing some things that will make the child feel more comfortable in the environment is helpful, but that's something to think of later.

In the short term, it's sometimes helpful to, say, bring the helmet that the child was wearing, just so that we can look at it and see what kind of damage that that sustained. It gives us more of an idea of how much force was in the incident.

Host Amber Smith: What's your secret for calming a child who is scared?

Kim Wallenstein, MD, PhD: It's hard in that environment because especially with the activations, there's so many people around the child, and it is a bit of a scary environment, even for an adult, in that situation.

So we always find out the child's name, we refer to them by name and tell them that everything's going to be OK and that everybody is taking care of them.

One thing that we have as a resource, which is wonderful, is our Child Life Team, and they are a wonderful adjunct to come in and help us with exactly that type of thing because they know exactly the little tools and tricks to talk to the child and make them feel more comfortable.

Host Amber Smith: Well, that's good to know. And I want to thank you so much for making time for this interview, Dr. Wallenstein.

Kim Wallenstein, MD, PhD: Well, thank you very much for talking to me today.

Host Amber Smith: My guest has been Dr. Kim Wallenstein. She's an assistant professor and medical director of the Pediatric Trauma Team at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

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