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“Kids First: Steinbrenner Pediatric Emergency Room Aims to Take Pain Out of Children’s Hospital Visits”

STEINBRENNER PEDIATRIC EMERGENCY ROOM AIMS TO TAKE PAIN OUT OF CHILDREN’S HOSPITAL VISITS
BY KRISTINA M. DODGE

More than once, Dr. Maximo Luque crossed paths with George Steinbrenner while helping to care for family members of the late Yankees owner at St. Joseph’s Children’s Hospital in Tampa, Florida. ER visits aren’t ideal circumstances under which to meet, but Luque, a specialist of pediatric emergency medicine, can’t help but recall the interactions fondly.

Steinbrenner, says Luque — acknowledging the goose bumps that accompany the memory — never left without getting the names of all those who had helped him and his family while there, from the technicians to the nurses to the doctors. A day later, there’d be tickets, Yankees T-shirts or some other special token of gratitude for the service and work the staff had provided.

“I lived it myself on more than one occasion, and every time, I said, ‘Sir, you’re the reason we exist,’” Luque says from the Steinbrenner Children’s Emergency and Trauma Center at St. Joseph’s.

Luque, medical director of the emergency and trauma center, is confident that, short of seeing the Steinbrenner name on the entryway, many people aren’t aware of his role — or the role his family continues to play today — in contributing to the pediatric emergency care available to the community.

“The people who work every day, we know, and we have our eternal gratitude to him for that,” Luque says of Steinbrenner.

In the early 1990s, St. Joseph’s Hospital was operating with one emergency room when Steinbrenner visited the ER with one of his young granddaughters. He witnessed a flurry of activity, and while the severity of the injured patients — including, apparently, a woman with an ax wound — was not uncommon for such a setting, Steinbrenner felt that children should not have to be exposed to such traumatic and startling scenes. Shortly after, he and his family donated the first of several leader-ship gifts to St. Joseph’s for the creation of a separate emergency room for children.

Since then, the children’s emergency and trauma center has been expanded, reopening in 2013 as part of a larger multiyear building plan designed to keep St. Joseph’s Children’s Hospital on the cutting edge of childcare. Today, the center sees approximately 150 patients daily in a setting that has been especially designed to promote security while meeting the unique medical needs of children and their families.

“We need to be taking care of the kids and have everything we need for them and put it into an environment that offers the most comfort and healing potential,” says Deb-orah Kotch, president of the St. Joseph’s Children’s Hospital Foundation, which facilitates community support of and invest-ment in the children’s hospital, including the emergency and trauma center.

In the emergency and trauma center lobby, bubble walls alternate colors. Visitors have access to games, and projectors turn the floor into an interactive experience.

Farther inside, hallways are adorned with images of hot air balloons and animals in a rainbow of colors. The 22 private rooms have been outfitted in bright blues, purples and greens with animal-print curtains, and instead of traditional white boards, the rooms feature animal-themed light boxes that not only serve as a place to note treatment details, but also function as night lights.

“It’s also one of those features that helps kids,” says Kotch. “At home, a night light gives you that sense of comfort and security. Well, it does in the hospital, as well.”

If all this seems like a distraction, it is. The goal is to make a potentially traumatic situation less so. But the elements that make the space seem more like a playroom than an emergency room are just the start.

“Having a children’s ER, it’s more than just having separate rooms,” says Kotch, who has been with the hospital’s foundation for about 10 years. “What we have in the Steinbrenner ER are physicians who specialize in pediatric emergency medicine. … So it’s not only the environment of care; it’s the quality of care.”

The emergency and trauma center employs 13 board-certified pediatric emergency medicine physicians — doctors who specialize in treating children and adolescents suffering from a variety of serious or life-threatening illnesses and injuries — and a nursing staff that is certified in pediatric emergency care, as well.

Children are not young adults, and they shouldn’t be treated as such, says Luque.

“With adult emergency care, one dose of medication fits all; the equipment, one size fits all,” says Luque. “Children have very unique and special needs in which they need care, medication and technology specifically tailored to their size and needs, and you need not only the expertise, but the training to identify the differences, to know exactly how to intervene with the appropriate doses, technology and management.”

For example, giving an 8-month-old in a critical situation a dosage of medication or fluids meant for a 5-year-old, or the 5-year-old an adult dosage, could be disastrous, Luque says.

Complementing the specialized level of training is the availability of a variety of portable medical equipment that has helped maximize response time by allowing staff to bring machines for testing and X-rays to the patients rather than taking the patients to the machines, which also allows doctors to remain at bedsides longer. The emergency and trauma center has its own sonogram and ultrasound machines that can be used to quickly identify intra-abdominal bleed-ing or foreign bodies, among other things; a C-arm, a portable imaging device; and, for the most critical patients, beds with automatic scales that measure weight in kilograms, the unit of measure used when determining medication and fluid dosages for children.

“[The technology and equipment] help us to do exactly what we need to do immediately, swiftly, and make use of all our increased capabilities that we offer,” says Luque.

Nearly as important as young patients’ physical needs are their mental and emotional ones. While adults possess a level of reasoning that allows them to make sense of an injury and the hospital environment in general, the same experience could create intense emotional distress and fear in a child. Separation anxiety and unfamiliar settings are among the unknowns. But helping to tackle those challenges is the hospital’s child life department.

Liz Walters is one of two child life specialists who cover the emergency and trauma center. Dressed in a uniform of gray scrub pants or khakis and brightly colored polo shirts instead of traditional hospital scrubs or doctor’s coat, the specialists are tasked with helping patients cope with whatever situation they have been thrust into.

“For a young, young kid who is here and who’s had a traumatic experience, they don’t know what the next person walking through the door is going to do to them,” says Walters, pointing to the common misconception among children that anytime they see a doctor, it will be painful.

Walters pulls from an assortment of tools to help her patients manage the situation, activities such as watching their favorite shows on an iPad, blowing bubbles — “It’s amazing how much kids like bubbles,” Walters notes — getting creative with arts and crafts, playing with toys, and, for the older kids, doing crossword puzzles. These techniques are distractions meant to take away the sting of an unfamiliar surrounding by giving patients things that are common and fun, making them — and their families — more relaxed.

When patients are going to undergo a procedure such as receiving an IV or stitches, Walters will use “medical play” to help prepare them for what’s to come. Employing kits with the materials needed to place an IV or stitch a cut, Walters walks children through the process step by step, using age-appropriate language — such as likening an IV to a straw for the arm and calling stitches “string Band-Aids” — and giving them a chance to touch the materials.

“Kids are just more cooperative if they know what’s going on and have a game plan than if you go in and kind of catch them off guard or if they just don’t have an understanding of what’s about to happen,” says Walters.

Child life is a standard part of treatment for patients, as is the use of child advocates, who are available to patients and families after an emergency has been remedied. If a child, for example, is in a bike accident, the child advocacy department may provide that patient with a bike helmet and review bike safety with them and their families.

“We provide support not only for the trauma, but [we] also provide support for them afterward,” says nurse manager Lori Rice.

It is all part of what Luque calls the family approach.

“Yes, you’re in a hospital; yes, you’re here because you’re not feeling well,” he says. “But it should not be, on top of that, remembered by the family or the patients as a stressful situation — the white coat, the needles that go with it sometimes. The family approach is for everybody to feel comfortable, for the child to be spoken to and treated at their level, so even though the situation might not be the best, it’s not remembered with apprehension and bad memories.”

Since George Steinbrenner’s first donation more than 20 years ago, his family has continued to lend its support not only to the emergency and trauma center, but also to St. Joseph’s Children’s Hospital on the whole.

The New York Yankees Tampa Foundation made a donation in celebration of the opening of the new emergency and trauma center, while several members of the family made additional gifts for which they will be recognized with private rooms in the center named in their honor, and Yankees general partner/vice chairperson Jennifer Steinbrenner Swindal, following in her mother’s footsteps, serves on the St. Joseph’s Children’s Hospital Foundation board of directors. Joan Steinbrenner served on the St. Joseph’s development council, a predecessor to the foundation, from 1991 to 2000.

And support isn’t limited to ownership. Since 2012, the Yankees organization has raised funds for the emergency and trauma center through the sale of commemorative George M. Steinbrenner Field T-shirts at its spring training complex, raising nearly $40,000. Meanwhile, members of the Yankees’ Single-A affiliate, who call GMS Field home, visit with patients at the children’s hospital during the team’s annual HOPE Week, an initiative that recognizes those individuals and groups doing good work in the community. The Tampa Yankees also participate in the children’s hospital’s Christmas in July Toy and Donation Drive, during which the T-Yanks’ mascot, Blue, joins players to help deliver toys to the young patients.

“It’s [been] multilayered, multi-generational support both from the Steinbrenner family and the Yankees over many years, and it continues today,” says Kotch.

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