Stan and Clarence chat with Dr. Jeff Louie about pediatric ER concerns.Dr. Louie is a pediatric emergency physician for M Health Fairview Masonic Children's Hospital. He also serves as Associate Professor for the Department of Pediatrics and Division Director of Pediatric Emergency Medicine at the University of Minnesota.Listen along as we chat about the most common pediatric ER concerns, risk factors, seasonal variations, and more.Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships. More about their work can be found at http://huemanpartnership.org/
Hello, everybody. Welcome to Health Chatter. And today's topic is emergency room issues, especially dealing with the pediatric age group. We have a great guest. and a great friend who I'll get into in just a second. We have a wonderful staff that helps us get these shows out to you in a successful way.
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So thank you to you guys. You are second to none. And then of course, there's Clarence Jones, my co-host for Health Chatter. We've been doing this for a while. We're having great, great time. I was talking to him the other day and he says, God, Stan, I think we're overachievers on this podcast.
He said, when we first started out, we were thinking about doing a show monthly and we're getting shows out weekly, which is really, really good. It also indicates that we aren't devoid of topics in healthcare, if you can imagine that. Clarence, second to none, you're the best. So thanks for being involved with us.
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I have a great colleague and friend and neighbor who actually lives right across the alley from where I live in South Minneapolis, And that's Dr. Jeff Lewis. So Jeff is Associate Professor, Department of Pediatrics, Division Director of Pediatric Emergency Medicine at the University of Minnesota.
Got his background at Loyola University in Chicago, residency in Maryland, University of Maryland Fellowship. And at the Children's Hospital in Pennsylvania. So he's been around the country a little bit, getting some useful insights. He's very, very insightful. I must say that as far as ER issues are concerned. And I'll tell you a quick story. I was sitting right next to Jeff just a few weeks ago.
at a fundraiser and we were just chatting away and I said, so how are things in the ER? And then he proceeded to tell me about some real issues that are hitting the scene, which we'll get into. So I said, Jeff, you gotta be on health chatter. He said, let's do it. So here we are today. So Jeff, thanks for being with us. It's a pleasure, pleasure being with us. So let's start out.
with the issue that really kind of brought this to the forefront. And that's mainly, it's kind of around two major issues that are facing the ER, especially for kids, and that's mental health. And also, ironically, kind of, and curiously, residential placement. So take it from there, Jeff. Maybe you can kind of tee it up and then we can talk about it.
So thanks for having me, Stan. So yeah, there's two biggest issues that we're still enduring in the emergency departments. And these are the emergency departments in general, from our facility to other facilities in the Twin Cities and throughout the state, is the increased numbers of both mental health kids with suicide ideation, aggressive behavior, homicide ideation.
And there's a subset of those kids who are our residential placement kids who also have these mental health, problems, but they are not deemed to be eligible for admission to mental health inpatient units. But either the foster parents or their parents can no longer care for them at their homes or facilities cannot care for these kids at home because they're now too violent.
And so they come to our emergency department And just for safety issues, we just can't discharge them. So they board in the emergency department. So both mental health kids who don't have an admission just yet to go to inpatient facilities and the residential placement kids, are also boarding our ER for placement. So those are the two biggest issues right now.
So this is disturbing. I mean, really. I mean, it's just like when we first discussed it, it's just like, what? First of all, is this something relatively new?
It's relatively new for... from the impact of COVID. And it's a multifactorial issue and it affected everyone across the country. I have medical director colleagues throughout the country and we all have the same problems in varying degrees. And if you recall, when COVID hit, there was the, what was it called? I can't remember specifically, it was called where you couldn't go to work, right?
Locked to lockdown. And the lockdown affected everyone, right? Not only small businesses, but hospitals. And I've been thinking about this a lot last night. Matter of fact, I probably didn't get much sleep last night about the whole frequency, the timetable. So when COVID hit, there was a lockdown and a lot of things that would generate money or productivity for the hospitals went to zero.
The ORs closed, inpatient units closed, critical care units closed. And so when you lose money, you have to start laying off people. And you lay off people, And then all of a sudden the lockdown ends and then a combination of being locked down and virtual school and social media, we saw a huge spike in mental health kids that we've never seen before.
In our emergency department, we used to, in fact, my emergency department was never meant to, as well as most emergency departments, we are never meant to manage mental health kids at this volume. Literally, instead of one a day, we're seeing 15, 18 mental health evaluations a day.
And that just burdened the whole system because with the influx and the rise of mental health kids, now there's a problem of inpatient bed units. And we have to remember that when COVID hit, a lot of the inpatient units basically closed down for a while and they lost consciousness. And now we have a problem of trying to hire physicians, nurses, mental health techs back into the unit.
And they're having problems filling those beds, filling those units with the proper number of people. So then you got a backlog of everything. They can only take, only half the unit was full and they couldn't take any more until they hired more people. And we don't have space, then you start boarding the ED.
All right, so- You know, it's, you know, for most of us, you would think of an ER for emergency treatment, but not, I guess, residential placement, right? So let me, I mean, you know, that's what we go to the ER for, you know, whatever, a broken bone, you know, chest pain, whatever it may be. Respiratory distress, you name it.
Okay, so now we're dealing with mental health issues where they aren't necessarily, if I'm reading it right, have to be treated. They just have to be housed.
Is that correct? Right. And you're absolutely right. Emergency departments were never meant to manage mental health in a sense that to make the patient safe and then go home. We deal with acute problems, chest pain, burns, we manage them, we stabilize them, and then we transfer it to the inpatient units. And fairly, and most of the time within a timely fashion.
With mental health, the issue is we can acutely manage the mental health crisis with mental health assessors and whatever else we need to calm the patient down, we keep them safe. And then our mental health assessors will evaluate the child and then they'll say, okay, yeah, this patient needs to be admitted, but we have no beds.
And now we're stuck because we don't have the resources to continually to continue the treatment of mental health in the emergency department. And that's the biggest issues.
In the beginning of the influx of mental health kids, we'd have, I think it's across the board, all the hospitals, we'd have 12 kids who were unsafe to go home and they were boarding the emergency department, but they weren't getting therapy.
They would sit in the ED for how many days it takes to get a bed in some inpatient unit somewhere in the state of Minnesota, sometimes in Wisconsin, sometimes in the Dakotas. And, you know, five days of just us watching them, make sure they don't hurt themselves or harm other people. It puts a burden to the emergency department.
But again, we're not, we're not, we've never had training in this before.
Right.
and that's it's just that's it's wild all right clarence what do you what do you this is really sad and disturbing go ahead it's very very sad and disturbing but i want to i want to know what uh impact does the substance abuse issues have on the number of young people coming into the department as well because i think that um
Is that, I mean, with the increase in substance abuse and those kinds of things, is that also a factor in you seeing more young people?
Yeah, and that's, so you both, thank you for bringing that up. And it comes back to my training. I was never trained to manage acute crises of mental health, in a sense, right? How to decompress these kids, how to calm them down. What medications can you use to calm them down? And then, the addiction problem really started to arise, started to increase in the prevalence of kids with mental health.
So we're not only dealing with kids with withdrawals from fentanyl, but a lot of mental health kids have substance abuse. And most mental health inpatient units have two separate units. There's one unit that just takes care of pure mental health issues, suicide or aggressive behavior. And then there's the suicide kids or aggressive behavior kids who are on drugs.
And the problem is, is that there's such a huge number of kids with mental health disorders who are using substances that those beds are always full. And so we'd have kids in our emergency department who have suicidal ideology, who are chronically using marijuana or chronically using alcohol. And those kids need a special unit, not just a regular unit.
What you're saying is that right now the hospital system or the system is not set up necessarily to deal with those young people with both of those issues, right? I mean, it's either you're in one silo or you're in the other silo. And you're saying that there's a need for a special silo, right?
Especially, well, yeah. I mean, it comes down to there's just not enough beds in the state of Minnesota for inpatient treatment centers, right? It's a limitation of the bed space.
But even that, we were still having issues because the length of treatment it takes for inpatient kids, inpatient mental health unit kids who have substance abuse on top of their behavior kids, they may take longer to be at a point to go home or to go to a residential placement. And so this is backlogged still.
Okay.
Let me do a follow-up question. Go ahead, Clarence. Let me do a follow-up question because you brought up something. You talked about the lack of practitioners. What kind of effect is this having on the practitioners who have to work in this environment?
I think, you know, so we have mental health assessors at the University of Minnesota, which they're very good at what they do. But, you know, when you talk to them, Especially in the beginning, you'd have only a few assessors to try to evaluate 10, 15 kids. And they can't work 24-7 because they're getting burnt out too. And where our facility is at is on the West Bank.
They not only assess the adults, but they assess the kids. So the adult side has a plethora of mental health people too because they're dealing with their influx. You remember that in the beginning of when our emergency department opened up, we used to just walk the mental health kids straight across to the West Bank because they have all the specialty folks over there.
But now they're so full that my unit, my emergency department had to flex and manage these mental health kids. And it's for the safety of the kids because now we're seeing kids as young as five or six years old who are aggressive. And the parents don't feel safe with these kids at home.
And you can't put a five-year-old on the adult mental health, you know, and the West Bank ED is just not safe for those kids over there. So we tend to take kids 12 and younger. And then if the adult ED is too full, then we'll see older kids up to 18 with mental health stuff.
So Jeff, what's the, okay. You know, I, I, I'm still kind of overwhelmed by this as I can imagine, only you guys are, but, um, what's the average stay for a kid that, that comes into your, your ED and has to stay there.
What's the average amount of time? So in the beginning of the surge of mental health, and we're talking just pure mental health, it was anywhere between three to seven days. And we may have five to seven kids in the emergency department boarding. And over the two years or so, we've developed more processes to move these kids out of my ED and move them to the West Bank or to get them...
And again, our assessors are very good at what they do. Once they deem a child that needs to be an inpatient unit, they will work with our inpatient mental health unit on the West Bank, as well as talk to the other mental health facilities in the state.
So for our listening audience, the West Bank is the other side of the Mississippi River from where the University of Minnesota Hospital and Emergency Department is. And there's a hospital on the other side of the river that has psychiatric units there. But as Jeff is saying, they're filled up all the time. So, all right. Does this...
indicate that emergency physicians like yourself will eventually have to be trained in mental health issues? Or do you just think that this is kind of a blip in what's been going on and things will calm down to where you get back to kind of a level of normalcy?
That is a great question. There are emergency medicine physicians who are duly trained. They are emergency medicine and psychiatric trained, but those are far and few between and they tend to be the adult doctors. There are very few pediatric emergency medicine physicians who are duly trained in psychiatry. I only know one. And it's not you, right? And it's not me, and he's in Rhode Island.
So I don't think that Peds, emergency medicine docs are ever going to be to a level of comfort to start treatment of mental health in our emergency department. And matter of fact, we probably don't even want to do that because mental health is a whole new subject that, you know, we get trained in medical school. Like I said, in fellowship, very little training fellowship.
And so we literally would start from scratch and that's, that would not be safe for the patients.
Essentially, we're doing a total of four shows on mental health that kind of go around our show right here. And so it'll be really interesting to interconnect the subject matters. Clarence.
Yeah. I'd like to know, with the crisis that you're experiencing in the emergency room, how is that affecting the other patients?
Great question. So What we've decided to do in my unit is obviously need to balance the safety of my medical patients, our patients with chronic trauma, as well as the safety of the mental health borders, as well as the residential borders. And my emergency department is small. It only has 12 beds.
And so we can't, if I have seven mental health children or patients in the emergency department, I can't afford to put them in rooms. which I would want to do, but I can't because we're still seeing 80 to 100 medical kids a day. And if I lose seven beds, that only leaves me with five beds to move these 100 patients.
And so we've chose to board them in the hallways, which is not ideal, but it's the best that what we can do for my small footprint. Other hospitals may room their mental health kids in their rooms, but then they lack the number of rooms to see the medical kids.
And with our complexity of medical conditions, you know, heart transplants, liver transplants, bone marrow transplants, we can't afford to have those patients wait in the waiting room. Yeah. you know, on top of it. It's not safe. It's not safe. Yeah. The balancing measure that we do every single day.
And it's, it's, it leads to burnout because you're dealing with all so many different variables at any one particular time. And then we have to keep them, keep in the back of our minds is that these residential borders or these mental health borders at any one time became, can become violent. So now I have violence in my hallway and,
And I still need to try to protect kids in the emergency department. So why are they only showing up?
Why do they only come to an emergency department? Isn't there any other avenue?
I think a lot of the problem, I'm not 100% sure on this particular topic, but during COVID, a lot of the residential mental health units or houses or facilities closed down. So... And there are resources outside of the emergency department, but maybe families don't know about them. There's a crisis hotline that you can call from Hennepin County to have someone come to your house.
But I kind of understand, too, if your child is so violent at home that you fear for your own life, you call 911 and then the police and the ambulance crew pick up the kid and bring him to our hospital. Right, right, right.
So, all right, let's kind of angle this a little bit. First of all, what do you recommend? That's number one. And then how might that lead into policy changes or, I don't know, legislation or something that can help here?
The many issues that we've come across is obviously is financial. We would love to have the kids who are boarding, the mental health kids as well as the residential boarders, to initiate some kind of therapy in the emergency department since they're there for days for the mental health kids.
And what we haven't talked about are the residential boarders who can be in the emergency department for months at a time. So if you're there for months at a time, not getting any kind of therapy, any kind of coping skills,
You know, we try to get them at least a psych consult to maybe adjust medications or whatnot, but then they really don't get face time with the therapist to discuss their issues, their anger issues, their suicide ideation and teach them the code.
And there has not been a process yet because of lack of mental health professionals who actually could come down, who have time to come down to the emergency department. Because our mental health folks right now are in the inpatient units trying to take care of those folks to get them out of the inpatient units.
So are any of you and your colleagues, you know, talking policy changes now? So give me a for instance.
So we do have, mHealth do have senior administrators who are working with DHS, Department of Human Services, I guess. These talks have been going on for several years. And there are several theories of why it isn't working as well as it should. One, obviously, is there aren't enough specialized group homes to take care of these kids because it closed down. They haven't opened them up again.
And two, one theory is, and I'm just going to say this, is that DHS says, well, at least they're in the emergency department and they're safe. Yeah. And that, you know, and to me, yes, they are safe, but we are in the emergency department are incurring costs. Yeah. So there was a paper, and I'll have to send this to you guys, I apologize for not even thinking about it.
There was a publication in New England Journal of Medicine, it was a commentary manuscript, and they basically did cost analysis for specifically pediatric mental health boarders. And they found out that it costs about $227 an hour to board these kids in our emergency department. So if you have a kid from my residential kids, $227 an hour times three months, right?
We're just losing so much money that we'll never recoup, you know?
Yeah, and it's one thing, the money, it's another thing, the appropriateness of care, you know?
Right, right. It's the lack of care from... in my opinion, our lack of wanting to care more from the government. Because if they were to give us grants, we can afford to have therapists in our ED to help manage these kids. And maybe these kids get to go home. Or now they're more suitable to go to a residential placement. Clarence.
Oh, what about telehealth? I mean, you know, you...
Is that something that would be useful with this crisis? I think that's a great point. But once they're in the emergency department, again, the folks that would do the coping and the therapy are in the inpatient units taking care of those kids. And so I am unaware that there are therapists who are available to do telehealth for the kids in the emergency department.
And that certainly has not started in our unit. Maybe it has started in other units, but I find that doubtful because someone would have to pay the therapist to do these consults and continually manage these kids. It's one thing to get a therapist once a week, but it might be a different therapist. And that just adds to confusion.
Yeah, consistency of care becomes a problem. So let me ask you, okay, so obviously, you know, a variable in all of this are the costs. So, all right. So kid has dropped off at the emergency. Who's paying for this? I mean, is it coming?
I mean, is it just, And the insurance companies certainly are not helping. So the way I understand it, if you drop off a child for mental health, let's just say mental health issues, radiation, and they are deemed unsafe to go home, but it may take five days for them to be transferred to an inpatient unit.
As I understand it, and I'm pretty sure it's true, is that the bill for that particular patient is just that one encounter. It's not five days. Even though I'm taking care of them for five days, it's just a one encounter. So like two hours worth of... Whatever it is, yeah.
Wow. Wow. So it's kind of... It's beneficial for the health insurance companies. Yeah, because they don't have to dish out any money. Okay.
Okay.
it's mind-boggling. What I would love to do is have a follow-up on just this discussion for emergency room because I want to talk about some other things here with you. But a follow-up to see, okay, where are things? Are things getting better? Is there some legislation? Are they opening up office buildings that are empty now because everybody is telecommuting?
I don't think it's for a lack of space. I think it might be a lack of professionals. And also costs, but that's where legislation could come in to help maybe figure out places and help to hire people. But anyway, a lot to be determined here, but I just have to underscore this, that this is troubling and sad. and sad, and I truly hope that there will be some solutions sooner than later.
So, all right, let's talk about the ER in general. You've been an emergency room physician for many years now. What are the most common things that you see, especially for kids?
It depends on the seasonality.
Yeah, yeah. That was the other question we were going to have.
Yeah, okay. And this year was weird. This last winter was weird because it had to do with kids going back to school. Usually there's a sequence of events that we can kind of predict. As winter starts coming down, you know, kids are in school. Usually around December, January, maybe October, November, we'll start seeing the flu virus. And then sometime after that, we'll start seeing the RSV virus.
And it kind of follows influenza. But this year, it was really difficult because we're seeing a combination for almost five months, winter months, of COVID kids, influenza kids, and RSV kids all at once. Whoa. So that's why many emergency departments, including ours, had long waiting times because we just seen so many kids.
And this is back in a day where kids had to be COVID negative or positive to go back to school. And so we're doing a lot of testing for COVID that parents can say, hey, my kid was sick. We went to the emergency department and they are COVID negative. So they need to go back to school. And that was a huge problem is that there weren't enough
access points for parents to get free COVID testing and get a result right away so that kids go back to school or they go back to daycare. So last winter we saw, we're seeing over a hundred kids almost 150, I can't remember, but definitely 120 kids a day for months. And, you know, on top of boarding kids for the mental health and residential.
And so we had to think outside the box on ways that we can safely manage these kids, treat them appropriately, resuscitate appropriately, and then either admit them or send them home. You have 120 kids on average a day. In a 12-day unit.
12 beds.
And how many physicians? We upstaffed our group. So we have almost two physicians for about 18 hours a day, sometimes even three. Okay. To four. Just so that we continue to need to move patients and make sure they're safe before they go home or need to get admitted.
So the total ER has how many staff, including nurses, et cetera? Yeah.
Yeah. We typically have, back in the day when this really hit us hard, we were always short nurses, but in general, in the evening time, I'd say we'd have four to five nurses. Okay. With three to four docs. Yeah. But we have to kind of keep in the back of our mind of the boarders and the EDs. They are also in our patient population that we have to take care of.
So we were pretty thin on ratios, right? You always talk about nurse ratios to patient ratios. At times, and I'm sure it was across the Twin Cities where I'd have one ED nurse taking care of six to seven kids. And I'd have, and the doc ratio was, you know, especially on the overnights was one doc with maybe 15, 20 patients. So it was, we were stretched really, really thin.
So, all right. So, you know, I, I recall, you know, during when COVID was at its height certainly in the, in the cardiovascular realm that I was involved with we were seeing, we were not seeing patients in the ER because people were afraid to go in and to the ER for whatever emergency situation they may have because they figured it would only get more complicated. Did you see that as well?
In other words, pediatric patients that probably should have shown up in the ER but didn't because of an extenuating circumstance like COVID?
We were certainly seeing sicker kids because they didn't want to show up I think parents are waiting to see if their kids will get better or not. You're delaying coming in. There's also a combination of parents just want the parents to trigger too fast. It's like the old expression of bioterrorism. You may not have been exposed to the gas, but you want to be evaluated.
So when you see kids in ED, how long have you had your fever? An hour.
just an hour yeah right right right yeah so they're trying to be a little bit more proactive on one end right but we've definitely seen that a subset of kids who were presenting pretty late who were really really sick yeah yeah okay let's talk a little bit more about seasonal variations um Okay, so all of a sudden spring hits and summer hits.
And I'm assuming, but you correct me if I'm wrong, that you see more falls, you see more broken bones, because kids are on bicycles, et cetera, et cetera. Talk to me about that.
So yeah, definitely as spring, as the weather clears up and it's dry outside, we'll start seeing an uptick in lacerations because kids are tripping and falling more outside. And then you'll see an uptick in factors, risk factors, femur factors. And then there's a combination of the kids riding ATVs.
whoo-hoo fashion burn um so definitely trauma is an uptick during summer yeah trauma broken ankles twisted ankles uh stubbed toes fish hook accidents we see fish hooks yeah we see those yeah you know um sports related injuries during the summer heat related injuries um yeah
So what surprises you? In your career, what are some of the cases that have, in the emergency room, that have surprised you?
So for the most of us, and I can probably speak to all emergency medicine doctors, is that you always have to keep your radar on common things presenting uncommonly. So if you have a kid who's wheezing, Is it just from a virus? Is it just from asthma? And in this, we just recently saw someone who was billed as a, what we call bronchiolitis.
So a virus is causing wheezing and the child ended up having heart failure. Huge heart on x-ray. It was missed initially. And so we always teach our residents to anticipate what you're going to look for, but also keep your radar on for weird things that we may see. We've seen kids who we think may have a skin abscess, and you've probably seen these videos, there's actually a bot fly. Wow.
There's a bot fly because they were in a country that was endemic with bot flies. But again, Stan, that's what makes our job kind of fun.
Yeah. Well, interesting. Yeah, for sure. Yeah. So, all right. So let's, let's talk about screening for potential abuse. So I'm going to tell a quick story here. When, when our son was, was young, really quite young, he was bouncing up and down on, on our bed. And anyway, make a long story short, he fell literally on the bed, but
it turns out that he twisted his leg a certain way and boom, he had like a hairline stress fracture. So we brought him in because, et cetera, into the emergency department. And I remember distinctly, I believe it was a physician or a nurse, I can't remember at the time, but asked me to come into a different room And they asked me what the story was, you know, how, how this happened.
It turns out that they also did the exact same thing with, with my wife to see, to make sure that our stories coincided. Okay. They were, they were right. Okay, so tell me, and I assume that they were, you know, at the time they were looking to see, okay, what's going on here? What do you do today? Similar type of thing?
Very similar type of thing. We are a little more sensitive. I think any children's hospital is very sensitive to child abuse because that's something they're going to miss. And so we have criteria on certain age of presentation of injuries. So... You know, a three-month-old who presents with a femur fracture is child abuse until proven otherwise because they're not on a trampoline. Right, right.
And so it depends. It's age-dependent. But for the most part, we will discuss any suspicious injury with our child abuse team. And our child abuse team is probably one of the best in the country. We have this physician named Nancy Harper, who's an internationally known child abuse expert. She set up protocols throughout the whole mHealth system to screen for kids for child abuse.
And so she's, you know, using evidence-based medicine and quality improvement projects. You know, so if I have a one-month-old who's got a bruise on the forehead, that doesn't make any sense because how do you bruise your forehead? You know, how do you tear your frenulum on your lip? They can't do that.
And so we're pretty diligent, especially kids less than six months of age, looking for markers for abuse.
Yeah.
Yeah. Obviously, any kid who has an intracranial bleed or a skull fracture, we're always talking to the child abuse team to see how should we manage these kids.
You know, for years and years, I worked with Dr. Robert Tanbenso, who is now passed on, but he was an international expert in the area of child abuse and neglect. And we testified in particular child abuse cases. And one of the classics that I remember distinctly that Robert was asked about was a child who fell down the stairs
okay, was treated for a, at that time, a broken rib, which is basically he can't do much. But anyway, to make a long story short, this child had four broken ribs. And the telltale sign for abuse is they were all at different stages of healing.
Yeah.
Okay. So, you know, obviously if you fall down, we're all going to be fractured the same way. So, you know, these are, these are types of things that, that are looked for. And unfortunately some, you know, physicians are often called in to testify on these types of cases. Okay. So drug use, what percentage of your kids that you see are involved in some kind of drug use? of some sort.
So we, we always screen kids who have mental health conditions who are being evaluated for their mental health. And I would say a majority of those kids will test positive for, usually it's going to be marijuana. Sometimes it's amphetamines. Yeah. And then we'll see kids who are actually going through withdrawals from benzos or, or fentanyl and other narcotics.
Yeah.
Um, firearms. Yeah. Um, it, it is, it is a problem that we're, you know, that we, we occasionally will see those kids in our emergency department, but our level of trauma status is level three. So if you got hit by a bullet, you're going to end up at probably Hennepin County. Okay. Um, but we do, we will see GSWs that walk into our door. Um,
And it's funny because a lot of times they're actually, you know, they're older, they're adults who walk in our door with gunshot wounds. But for kids, it's, you know, we actually looked at our data throughout the mHealth system not too long ago, just in kids in general who were involved with some kind of gunshot wound.
And again, the mHealth system are level three trauma centers, but I think we did a five-year review and I think there are about 30 kids.
Okay.
But these were probably kids who were not seriously injured. Yeah, but still a firearm injury nonetheless.
Absolutely, absolutely. So, all right. And then the other thing is obviously when people present themselves into the ER, you don't turn them away. I mean, the first thing you do, you don't necessarily check for insurance. If there's some kind of a level of seriousness, you get them in and care for them, correct?
Regardless of their insurance status, ethnicity, we will always see kids who walk in our door.
Right, right, yeah.
Care is needed. And we'll figure out all the logistics later. We do figure it out later. And if they have to admit it with no insurance, we still admit them to the hospital.
Yeah, yeah, yeah, yeah.
Robert, thoughts?
Can you hear me? Yes. Okay. I'm having a little technical difficulties at times. But as I'm sitting here thinking about this, what message do we want to have community to know about the issue? And what can the community be able to assert to help?
in terms of trying to address the issue, because it is something that, you know, as Dan was saying, mind-blowing to me, to think about, you know, young people having to be boarded in the emergency room. And so what is it that we should be, what should we know? I mean, so that's, I want to just put it out there like that.
Yeah, I think parents need to know and families need to know and kids need to know that their expectations when they present to the emergency department with mental health crisis is that we will always take care of their kids the best of our ability to keep them safe. But because of limitation of space,
We may need to board them in the hallways, at least for my facility, but they will be assessed by a mental health professional in a timely fashion as best we can. And this kind of goes out to the community for the people who are presenting to our emergency department with medical conditions that you will see patients sometimes in the hallways.
And that's just the reality of where we're at right now. Versus if you present to a different hospital, it may take a long time to be seen because they put their mental health kids in rooms. which is, I think, amazing thing to do, but wherever you're gonna go, you're gonna deal with mental health conditions in any emergency department.
You need to expect that hopefully it won't happen, but there may be violence in the emergency department. I don't wanna scare people away, but this is a reality of what we deal with every day.
Yeah, yeah. It's sad. On the other hand, For all of us, we have to thank physicians like you and departments like you work in for the type of care that you provide on an emergency basis. And we all face emergencies of some sort or another. And knowing that the care is available is the key message, is the real, real key message.
And so, you know, many, many thanks to all the emergency room physicians and staff, and especially during the stressful situations that I know you were facing when COVID And that just was a variable that you didn't want to have to deal with, but it complicated a lot of care. So thank you very much. And thank you for bringing all of this to our attention. We greatly, greatly appreciate it.
We reserve the right, Jeff, to bring you back on, even with a couple of your colleagues to talk about, okay, where are things now? Okay, are things better? Have policies been implemented? Has there been some legislation that has helped you? Has there been some finances that have been put into the system that can help ease things up? Whatever it is, let us know and we can get you.
And you can also use this podcast. to help message the problem out there. So thank you. To our listening audience, we have more shows coming up on mental health issues with Dr. Mike Trangle from Health Partners. Those will be shows coming up next. It's kind of a quadfectra of shows on mental health issues. because mental health in and of itself is such a huge, huge issue.
So to all of you, keep health chatting away.
Hi, everyone. It's Matthew from Behind the Scenes. And I wanted to let everyone know that we have a new website up and running, healthchatterpodcast.com. You can go on there. You can interact with us. You can communicate with us, send us a message. You can comment on each episode. You can rate us.
And it's just another way for everyone to communicate with Stan and Clarence and all of us at the Health Chatter team. So definitely check it out. Again, that's healthchatterpodcast.com.