What Actually Sends Children to the ER in Arizona

We are not a pediatric emergency room, and we treat children every day. El
Mirage and the cities around it have a lot of young families, and a large share
of who comes through our door is children.

This is not a list of ways to avoid us. Some visits are unavoidable and some
are exactly right — a broken arm belongs here. It is a list of what actually
brings children in, in this valley specifically, and which of those are
preventable.

Call 911 for: a child who is struggling to breathe, unresponsive or limp, has
had a seizure, is blue or grey around the lips, cannot be woken properly, or has
been pulled from water.

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Drowning, first, because it is the one that matters most

Drowning is the leading cause of death for children aged 1 to 4, and in a
place where pools are open most of the year the exposure simply does not stop.
The reason it belongs at the top of this page rather than buried in it is a
single factual correction:

Drowning is silent. It does not look like the films. There is no splashing,
no shouting, no waving. A child in trouble in water goes under quickly and
quietly, often within twenty seconds, and the adults nearby usually do not
hear anything.

What that changes:

• Supervision means watching, not being present. A phone, a conversation or
  a barbecue is enough of a gap. If several adults are around, name one person
  as the watcher and hand the role over explicitly when they stop.
• Fencing works, and it works when nothing else is happening. Most
  pool drownings at this age happen during a non-swim time, when a child
  gets to the water unnoticed and nobody is looking because nobody is swimming.
• Doors and gates need to self-close and self-latch, above a child's reach.
• Empty buckets, coolers and paddling pools after use. A child can drown
  in an inch or two of water — a sink or a bathtub is enough for a baby.
• Swimming lessons reduce risk and do not remove it. A child who can swim
  still needs a watcher.
• Learn CPR. Every other item on this list is a barrier, and barriers
  sometimes fail — this is the only one that helps after they have. You do not
  need to know it perfectly; you need to have done it once.

If you find a child in the water

Get them out and call 911 immediately. Put the phone on speaker and leave it
on — the dispatcher will talk you through what to do next, including CPR,
and they do it for exactly this situation.

Do not stop to look for a pulse or to work out whether it is serious. Every
second before you call is a second the ambulance has not started.

And get them checked even if they seem fine afterwards. Breathing problems
can develop in the hours following, and that is a real thing rather than a
precaution.

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Heat, which is our second season rather than an occasional event

• Never leave a child in a car, not for a minute. A car heats far faster
  than people believe, and cracking a window does very little.
• Hot surfaces burn. Pavement, pool decking, playground metal, seatbelt
  buckles, car seats. A young child cannot always tell you the ground is too
  hot until they are already on it, and toddlers' skin burns faster than an
  adult's.
  More on burns
• Move outdoor activity to early morning, and treat mid-afternoon as
  indoor time for much of the year.
• Children dehydrate faster than adults and are worse at recognising it.
  More on dehydration

Scorpions, and the bugs that come with a desert address

Scorpion stings are one of the more common reasons families arrive here, and
young children react more severely than adults do.
What to do about scorpion stings

Swallowed things, and the two that are emergencies

Most swallowed objects pass. Two do not:

• Button batteries — the coin-shaped lithium ones in remote controls, key
  fobs, greetings cards and light-up shoes. These burn through tissue within
  hours while the child may look entirely well. Come in immediately.
• Magnets — two or more, or one plus anything metal.

And medication, which is the commonest childhood poisoning of all — often a
visitor's handbag or a weekly pill organiser on a low table, because organisers
are built to open easily and are not child-resistant.
Poisoning: what to do first

Falls, sport and playgrounds

The everyday stuff, and mostly unavoidable. Two things are worth knowing:

• A child who will not use a limb has an injury, whatever it looks like.
  Children are more reliable than their swelling.
• Any head injury with vomiting, drowsiness, confusion, or a headache that is
  getting worse needs checking — and so does any head injury in a child who
  cannot yet tell you how they feel.

Fever, and the ages where the threshold changes

• Under 3 months with a fever: be seen the same day, always. This is not a
  judgement call.
• Any age, with: difficulty breathing, a rash that does not fade when
  pressed, a stiff neck, a fever that will not come down, drowsiness, a fever
  lasting more than a few days, or a child who is simply not themselves.
• You know your child. "Something is wrong and I cannot explain what" is a
  legitimate reason to come, and it is right more often than it is wrong.

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The five things that actually prevent visits

Ordered by how much difference they make here, not by how easy they are:

1. Pool fencing plus a named watcher. Nothing else on this list is close.
2. Nobody in a parked car, ever.
3. Medication and batteries out of reach — including visitors' bags and
   pill organisers.
4. Heat timing — outdoor activity early, mid-afternoon indoors.
5. Helmets and car seats, correctly fitted for current size rather than
   last year's.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• X-ray and CT on site, and a full laboratory. Ultrasound is called in from a mobile service.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours where a child needs watching rather than
  admitting.

We are not a pediatric emergency room. If a child needs pediatric
specialist care, admission, or surgery, we stabilise them and arrange the
transfer to a children's facility. For anything severe, or if you cannot
travel safely, call 911 rather than driving.

Bring: what happened, what they have taken and when, any medication they are
on, and their immunisation status if you have it.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Poison Control: 1-800-222-1222 · If this is a medical emergency, call
911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your child's history or what is happening now. If you are
unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• Centers for Disease Control and Prevention — Drowning Prevention — https://www.cdc.gov/drowning/about/index.html
• MedlinePlus (National Library of Medicine) — Drowning — https://medlineplus.gov/drowning.html
• Arizona Department of Health Services — Heat Safety — https://www.azdhs.gov/preparedness/epidemiology-disease-control/extreme-weather/heat-safety/index.php
• Arizona Poison and Drug Information Center — Scorpions — https://azpoison.com/venom/scorpions
• Poison Control (National Capital Poison Center) — Poison Help, 1-800-222-1222 — https://www.poison.org/

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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