Children are not young adults: a call for standardized guidelines for dealing with pediatric patients in the emergency department of Canadian community hospitals.

Emergency departments deal with a spectrum of sick, distressed, and critically ill patients. For many patients, especially children, experiencing an emergency department can be a traumatic experience in itself. One personal experience firmly etched in the principal author’s mind is of a mother in the emergency department desperately trying to cover her 5-year-old daughter’s eyes and ears to shield her from the screams of a nearby adult in pain, and the swearing of another disgruntled patient. Unfortunately, scenarios like these will inevitably arise in Canadian community hospital emergency departments, where children routinely share waiting and treatment areas with adult patients. We propose that a standardized Canadian guideline be developed to improve the environment and facilities provided to children in such combined emergency departments (cEDs). Such a guideline will hopefully improve the quality of health care for both pediatric and adult patients, while standardizing facilities available to children outside of specialized tertiary pediatric centres. Currently, Canadian emergency departments are not required to meet standards that address the specific needs of their pediatric patients, leading to potentially harmful variations in the environment and services provided to children. International literature and guidelines have emphasized that implementing a childfriendly environment, appropriate prehospital assessment, and pediatric-appropriate hospital staff and training are the most important tenets for catering to children in cEDs. The International Federation of Emergency Medicine has also stressed that establishing standards or guidelines of care for pediatric patients “assists both managers and clinical staff to deliver improvements.” Children represent a significant proportion of patients attending emergency departments; 30% in Canada, 22.1% in the United States, and 26.5% in the United Kingdom. In the United States, only 7% of these patients will be treated in a space designed to accommodate pediatric patients. In Ontario, the number is slightly higher with 14.9% of children being treated in specialized pediatric facilities. The remaining children will access cEDs within community hospitals. Ideally, a minimal standardized level of care should be provided to all children in Canada, irrespective of which hospital such children attend. Currently, there are three national guidelines (United States, United Kingdom, and Australia), which address the care of children in cED; however, no comparable guidelines are available for Canadian cEDs. In the United States, The Joint Policy Statement: Guidelines for the Care of Children in Emergency Departments (2009) and The National Paediatric Readiness Project were implemented to improve pediatric care in cEDs. In the United Kingdom, the Standards for Children and Young People in Emergency Care Settings 2012 outlines a standardized approach and also provides a framework to measure improvement. In Australia, The Guidelines on Emergency Department design (2007) outline the importance of specific pediatric treatment areas and equipment. We envision similar protocols for Canadian cEDs, incorporating aspects of the aforementioned international guidelines. However, we feel that such guidelines should be developed with a