What is Pediatric Emergency?

Dr. Takaaki Mori discusses the emerging field of Pediatric Emergency in Japan and its potential for Vietnam.

Pediatric emergency is all about saving the lives of children. It’s a very different approach to providing medical care to children than that of general pediatrics. A general pediatrician will examine a child presenting with certain symptoms—for example, jaundice—and first consider what the most likely cause might be. An emergency pediatrician’s first thought will be, “what life-threatening condition could be responsible for these symptoms?” Only after ruling out the most dangerous possibilities will the pediatrician then turn to more common explanations. So while the diagnostic process might be very similar, the order in which things are done is markedly different.

While this important field of medicine is in its infancy in Vietnam, pediatric emergency practice has been around in developed countries like the USA for 30 or 40 years now. In my native Japan, pediatric emergency medical science has a very short history. I was among the first Japanese doctors to specialise in the field when a pediatric emergency department was established in the Tokyo Metropolitan Children’s Medical Center by my mentor, Dr. Nobuaki Inoue. Dr. Nobuaki had worked in the field in the US, and was keen to build the first pediatric emergency department in Tokyo. I hope very much to participate in the growth of this specialty here in Vietnam.

When I started out, three or four children’s hospitals in Japan had just been combined into one big medical center—that was our general hospital. The Tokyo government were trying to push the establishment of pediatric emergency in Tokyo, which gave Dr. Nobuaki the opportunity to build our department.

Classically, general pediatricians deal with child patients suffering from medical issues such as cold, cough and fever through to mild trauma. For critically ill child patients—those who have been victims of traffic accidents and so on—physicians who would normally attend to adult emergencies would deal with the children. This was the situation in Japan when I entered the field, and it is still the case here.

After Dr. Nobuaki returned to Japan, the pediatricians in our hospital started to deal with children suffering from critical medical and surgical conditions, following the American model. I was a pediatrician with an interest in the surgical sphere at the time, so I decided to enter pediatric emergency in Japan.

Essentially, the field is very similar to standard emergency medicine, particularly in the way we treat many kinds of emergency and medical conditions. But pediatric emergency differs in that we have to think about the child’s growth and development—we have to adjust the treatment and approach depending on the child’s age (or perhaps other conditions). For example, when we apply stitches, we follow a different procedure with a one-year-old child than with a child of ten. For some pediatric emergencies, we perform sedation in cases where an adult would not need it—for reasons of safety and to lessen their anxiety, and for the comfort of the children as well as the parents.

There is also the issue of the size of a child’s body. For pediatric emergency medicine, we have to prepare different medical equipment depending on the child’s age and weight. We usually use different types of equipment of different sizes, from infant to adolescent. An endoscope used on an adult, for example, could not possibly be used on a child. Currently, children who require such procedures in Vietnam must leave the country to receive treatment.

One hot topic in pediatric emergency medicine is the use of X-rays. People are becoming increasingly concerned about radiation exposure in children. In Japan, I was personally involved in promoting the use of ultrasound techniques in children to replace the use of X-ray and CT scans for pediatric emergency conditions. I have successfully detected conditions such as appendicitis as well as critical injuries using ultrasound rather than X-rays, sparing the patients from unnecessary radiation exposure. This is an area that stands primed for development in Vietnam, as the difference is procedural with the required equipment already available here.

One advantage that emergency pediatricians have over regular emergency doctors is that we’re quite used to the ultrasound, because we have to study neonatology during our residency in pediatrics.

What attracts me to pediatric medicine? Personally, I prefer working in an acute care setting where a quick decision is needed to treat the traumatised patient. If I administer proper treatment, the patient’s condition can change dramatically

At the Tokyo children’s medical center, we had some private ambulances for pediatric patients, similar to the modern, fully-equipped vehicles used by our medical practice here. When call-outs occurred, we would ride out to the scene, pick up the child patients and start treatment immediately while bringing them to the hospital. Prior to that, the ambulance would have to bring the child to hospital first for observation, so it would take much longer before the treatment. Accompanying the ambulance to the scene of the accident when the patient’s condition was critical—such as in the case of a brain hemorrhage—could make all the difference.

I remember one infant who was just 3–4 months old who had difficulty breathing, and went cyanotic—turning blue with low oxygen saturation. I brought the child to the clinic for aeration before intensive care. Any longer, and the infant wouldn’t have had a chance to survive. Speed is important in such cases. Quick and accurate analysis and a decision to give appropriate treatment has saved lives. It is an immensely rewarding experience to save the life of a child.

Sometimes it is not possible to get to a child in those critical moments. This is why it’s very important for people who take care of children—even those already capable of administering first aid to an adult—to familiarize themselves with life-saving techniques that can help sustain the life of a critically injured child. I would advise teachers, parents and other people who work with children in Vietnam to seek out a first aid course that includes pediatric emergency protocols. As with all emergencies, time is everything.

Dr. Takaaki Mori, Pediatrician, Family Medical Practice Vietnam