PDA

View Full Version : Minors in the ER



Christabelle
06-26-2014, 06:15 PM
I have a multi-part question for you guys.

1) Who's allowed to stay in the exam room of the ER with a minor? Say a 16-year old suffers a bad break playing football, and his parents are nowhere to be found. Could his coach stay with him? His girlfriend? Or would he be stuck waiting in the exam room by himself?

2) If the leg fracture is bad enough to require surgery to set it plus the kid has a torn ACL, would the surgeon set the bone and fix the ACL or wait on the ACL? After surgery, would they apply a cast or brace?

jaksen
06-26-2014, 10:57 PM
From my experience, and that of my colleagues (coaches and teachers), yes a coach would be allowed to stay with a 16-year old until a parent can be notified and arrive at the hospital. (Or older relative, say older sibling, grandparent, etc.)

I have a friend who did this several times, as a coach, and a teacher friend who did this a few times when parents could not be immediately found or notified. (Remember we've only had cell phones for not so long. Before we had mobile phones, people on the road - driving anywhere - simply were out of reach. And it their destination was a friend, or customer and we didn't know their numbers, again, out of reach.)

So my friend would sit with a hurt child in the ER while everyone hustled around looking up 'emergency' phone numbers. Often the child could give a phone number where to 'reach his dad' but if Dad were in flight, or on the road, or at a customer's place of business, if often took hours to reach him (or Mom.)

But this is just based on what I know.

Trebor1415
06-27-2014, 12:26 AM
My understanding is that an orthopod would fix the bone. I don't believe they also do ACL's, do they?

nikkidj
06-27-2014, 12:41 AM
Orthopedic surgeons do both fracture care and ligament repair-- basically anything musculoskeletal.

If a minor comes into the emergency department without a parent, the coach would be able to stay, but probably not the girlfriend, especially if she's a minor, too. I've had coaches stay with kids until parents show up. Sometimes they leave afterwards, sometimes they stay. Just depends.

If there is both a fracture and an ACL tear, the orthopedic surgeon will likely wait for a while for swelling to reduce (caveat-- I'm not an orthopedist, I just follow their instructions). The patient would be immobilized in the emergency department, either with a long-leg cast or a removable knee immobilizer, then sent home non-weight-bearing until surgery.

HTH

ArtsyAmy
06-27-2014, 03:39 PM
I don't know the answers to your questions, but the issue of permission to treat came to mind as I was reading your post, so I thought I'd mention it (just in case you're not aware). I'm guessing a coach would likely have a form signed by a parent granting permission for medical treatment for the child should it be necessary and the parent cannot be located. Those forms seem pretty standard these days for organized activities for children/teens.

Seems that even with the form, there would be limitations as to what the hospital could do before a parent shows up and consents to specific treatments. So, in the case you're asking about, maybe the hospital staff would treat the fracture and wait until a parent gives permission to treat the ACL if the latter is not considered an emergency. Or maybe neither the fracture nor the ACL would be treated if those injuries are not immediately life-threatening, and the hospital would instead stop any bleeding and wait for the parent to arrive before proceeding with anything else.

Christabelle
06-27-2014, 06:12 PM
From my experience, and that of my colleagues (coaches and teachers), yes a coach would be allowed to stay with a 16-year old until a parent can be notified and arrive at the hospital. (Or older relative, say older sibling, grandparent, etc.)

I have a friend who did this several times, as a coach, and a teacher friend who did this a few times when parents could not be immediately found or notified. (Remember we've only had cell phones for not so long. Before we had mobile phones, people on the road - driving anywhere - simply were out of reach. And it their destination was a friend, or customer and we didn't know their numbers, again, out of reach.)

So my friend would sit with a hurt child in the ER while everyone hustled around looking up 'emergency' phone numbers. Often the child could give a phone number where to 'reach his dad' but if Dad were in flight, or on the road, or at a customer's place of business, if often took hours to reach him (or Mom.)

But this is just based on what I know.
Sounds like exactly like what I needed to know. The Dad is working and it takes him awhile to get from work in another town back to the hospital.


My understanding is that an orthopod would fix the bone. I don't believe they also do ACL's, do they?
I thought they would be able to do both, just maybe not at the same time.


Orthopedic surgeons do both fracture care and ligament repair-- basically anything musculoskeletal.

If a minor comes into the emergency department without a parent, the coach would be able to stay, but probably not the girlfriend, especially if she's a minor, too. I've had coaches stay with kids until parents show up. Sometimes they leave afterwards, sometimes they stay. Just depends.

If there is both a fracture and an ACL tear, the orthopedic surgeon will likely wait for a while for swelling to reduce (caveat-- I'm not an orthopedist, I just follow their instructions). The patient would be immobilized in the emergency department, either with a long-leg cast or a removable knee immobilizer, then sent home non-weight-bearing until surgery.

HTH
Nikki, thanks for your answer about the injury. :) Do you think it would be likely for the ortho to set the fracture soon after injury and then wait several weeks to repair the ACL tear?


I don't know the answers to your questions, but the issue of permission to treat came to mind as I was reading your post, so I thought I'd mention it (just in case you're not aware). I'm guessing a coach would likely have a form signed by a parent granting permission for medical treatment for the child should it be necessary and the parent cannot be located. Those forms seem pretty standard these days for organized activities for children/teens.

Seems that even with the form, there would be limitations as to what the hospital could do before a parent shows up and consents to specific treatments. So, in the case you're asking about, maybe the hospital staff would treat the fracture and wait until a parent gives permission to treat the ACL if the latter is not considered an emergency. Or maybe neither the fracture nor the ACL would be treated if those injuries are not immediately life-threatening, and the hospital would instead stop any bleeding and wait for the parent to arrive before proceeding with anything else.
AFAIK, I think there are a bunch of waivers parents sign before kids play sports, so I'm assuming for story purposes that those were filled out before the season started. I just need to have the kid in the ER for awhile before his father shows up, and everything else will be handled after he gets there. I'm sure the dad can sign off on anything beyond a preliminary x-ray or initial exam. I don't need in depth details, but I wanted it to be realistic as far as the kid waiting and whether or not they keep him for surgery.

midazolam
06-29-2014, 12:26 AM
I have a multi-part question for you guys.

1) Who's allowed to stay in the exam room of the ER with a minor? Say a 16-year old suffers a bad break playing football, and his parents are nowhere to be found. Could his coach stay with him? His girlfriend? Or would he be stuck waiting in the exam room by himself?

2) If the leg fracture is bad enough to require surgery to set it plus the kid has a torn ACL, would the surgeon set the bone and fix the ACL or wait on the ACL? After surgery, would they apply a cast or brace?

1) The coach could stay with him, but could not consent to any medical procedures unless he had written permission from the parent to do so (and even in that case, every effort would be made to contact the parents. This is really delicate legal ground). Technically, the girlfriend shouldn't really be there if the patient is a minor, but this kind of depends on the ER and how much the staff really cares - it's not like an ICU where every visitor is checked in. For patients who are over 18, I've never seen anyone really enforce the "guest list" in an ER exam room, although this is changing with increased security measures nationwide.

2) This really depends on the fracture - is it a femur fracture? Tibia? Open? Closed? If it's bad enough, the kid needs surgery right away (ie within 24 hours) to stabilize and debride it. On the other hand, some kinds of fractures don't require surgery at all. I guess what I'm saying is you could go a number of different ways, whatever works best for your story. The ACL would almost certainly be repaired at a later date, regardless of whether the fracture required surgery. An orthopedist would perform both operations. As for a cast/brace, depends on the surgery and the surgeon's (and patient's) preference.

Hope this helps.

Lpapercranes
07-04-2014, 06:45 PM
As far as letting friends who are minors stay: depends on the location of the ER - like, an ER in a big city is going to be tighter on security. Also, may depend on a staff member being nice vs strict, honestly.

Christabelle
07-10-2014, 09:34 PM
2) This really depends on the fracture - is it a femur fracture? Tibia? Open? Closed? If it's bad enough, the kid needs surgery right away (ie within 24 hours) to stabilize and debride it. On the other hand, some kinds of fractures don't require surgery at all. I guess what I'm saying is you could go a number of different ways, whatever works best for your story. The ACL would almost certainly be repaired at a later date, regardless of whether the fracture required surgery. An orthopedist would perform both operations. As for a cast/brace, depends on the surgery and the surgeon's (and patient's) preference.

Hope this helps.
Thanks, Midazolam. That's a big help. :) Everyone's reply has been great.

He has a displaced transverse patellar fracture, so I want to get him into surgery ASAP, keep him in the hospital about 2 nights (if reasonable) and send him home on crutches and in a brace (a cast would work, but I'd prefer a brace if it's logical in any way).

After he's healed from the initial surgery, would he start on PT and get ready for surgery on the ACL and possible tendon repair?

WeaselFire
07-10-2014, 10:22 PM
1) Any responsible adult could stay through an exam, as long as the exam room doesn't get crowded. Doesn't matter if it's a minor, doctors treat patients, not ages.

2) Set fracture, treat ACL later. Fractures don't need surgery. If it's serious enough to need surgery, they might schedule both at the same time but the surgeon who works on fractures won't likely be the one who works on ACL injuries.

Jeff

pkbax
07-10-2014, 11:43 PM
Regarding who can be in the ER: you've gotten some good answers. In general a responsible adult (in this case the coach) should be able to stay with the minor, and some treatment can start based on the forms parent sign prior to teh season. But they would most likely need parental consent for the surgery. (Some hospitals have a contingency for life threatening situations and some will allow verbal consent over the phone, but dad would have to sign the forms when he arrives as well.)

Be aware, however, that the difference may be if the patient can be put in a closed room vs. a "ward" of beds separated only by curtains. Because of privacy laws (HIPAA, specifically), many ER's with the curtains will only allow someone to stay with the patient for a few minutes at a time except in the case of a minor, and then only 1 parent or adult at a time. (There are even instances when a parent will not be allowed in the room, but that is for safety and sterility reasons, such as major trauma, that do not sound like they apply to this case.)




After he's healed from the initial surgery, would he start on PT and get ready for surgery on the ACL and possible tendon repair?

PT starts in the hospital as soon as they can. They have learned that you will actually heal better if you start immediately. At the very least, the patient will be taught the safest way to get up out of the bed, use the crutches, etc.

juniper
08-09-2014, 08:15 AM
1) Who's allowed to stay in the exam room of the ER with a minor? Say a 16-year old suffers a bad break playing football, and his parents are nowhere to be found. Could his coach stay with him? His girlfriend? Or would he be stuck waiting in the exam room by himself?


Where I work, we're the closest ER to a major ski area that has ski camps which attract kids from around the world.

When camps are in session, we usually have at least one young teenager every day. Sometimes they come in with a coach, usually just a camp employee. They'll have form with them which has name/address/phone of kid as well as parents, plus insurance info, and medical consent signed by parent.

Older teenagers are easier to deal with - in my state, anyone age 15+ can sign consent for medical treatment. Under 15, we're supposed to try to reach their parents by phone. Which can be tricky when the kid is from a different part of the world, with time zone and language issues.

We allow pretty much anyone in the room that the patient says is ok, up to a point. Limit is usually 2 visitors, exceptions are allowed in some circumstances. If the visitors become a problem for the staff, then we make them leave. Security will escort out any troublemakers, and we can call the police if needed.

Our rooms are all private rooms with closing doors.

Fractures don't usually require immediate surgery. We send them home in a soft, temporary cast, or sling, or just wrapped up and a referral to an orthopedist. Surgery is usually a few days later, after the swelling subsides.

Christabelle
08-10-2014, 02:31 AM
Where I work, we're the closest ER to a major ski area that has ski camps which attract kids from around the world.

When camps are in session, we usually have at least one young teenager every day. Sometimes they come in with a coach, usually just a camp employee. They'll have form with them which has name/address/phone of kid as well as parents, plus insurance info, and medical consent signed by parent.

Older teenagers are easier to deal with - in my state, anyone age 15+ can sign consent for medical treatment. Under 15, we're supposed to try to reach their parents by phone. Which can be tricky when the kid is from a different part of the world, with time zone and language issues.

We allow pretty much anyone in the room that the patient says is ok, up to a point. Limit is usually 2 visitors, exceptions are allowed in some circumstances. If the visitors become a problem for the staff, then we make them leave. Security will escort out any troublemakers, and we can call the police if needed.

Our rooms are all private rooms with closing doors.

Fractures don't usually require immediate surgery. We send them home in a soft, temporary cast, or sling, or just wrapped up and a referral to an orthopedist. Surgery is usually a few days later, after the swelling subsides.
Thanks, Juni! All that sounds reasonable.

My character has a dislocated fracture that needs internal fixation, so I'm going to take bit of liberty with that. Maybe the orthopedist on duty thinks early treatment will help prevent loss of range of motion. :)