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Critical Care Medicine at Children’s

Leslie HayesDr. Leslie Hayes is a certified pediatric critical care physician at Children’s of Alabama and an associate professor of pediatrics in the Division of Pediatric Critical Care at the University of Alabama at Birmingham (UAB) where she trains medical students and doctors in pediatric critical care.

Every year, hundreds of children are admitted to critical care units at Children’s of Alabama. These patients come from within Alabama and from every surrounding state. They come because we offer them a broad variety of life-sustaining care. We see trauma victims and brain injury patients. There are post-operative surgical patients who need close monitoring. And there are premature babies. In fact, if you name a severe, life-threatening illness or condition, we’ve most likely seen it.

Dr. Sam Tilden started critical care services at Children’s in the late 1980s, and now we have one of the busiest critical care systems in the nation for children. We spend a tremendous amount of time and resources ensuring that our critically ill and injured patients are cared for by the best, fully trained health professionals using the most advanced medical technology. We have nine critical care faculty members and another six faculty members just for the cardiac ICU. We train six critical care fellows at a time.

The Children’s Pediatric Intensive Care Unit (PICU), where I spend much of my time, has 22 beds and is located on the seventh floor of the Quarterback Tower in the Benjamin Russell Hospital for Children, and has about 1,400 admissions a year. Nearly all of our critical care patients are in Benjamin Russell Hospital for Children, but the neonatology service additionally has patients at UAB’s Regional Neonatal Intensive Care Unit connected to OB/GYN services at UAB. Children’s has its own 48-bed neonatal intensive care unit, along with a 20-room cardiac intensive care unit and also a burn center that cares more than 170 patients a year. In addition, Children’s operates a 26-bed special care unit, which is a step-down unit for our ICUs.

The PICU handles the greatest variety of patients. Adult intensive care units (ICUs) tend to be subdivided into more specialized units. Our PICU takes patients needing high-level monitoring, intense observation, special procedures and numerous interventions. Patients range in age from birth through young adulthood. Nurses care for one or two patients at a time, depending upon the severity of illness. We welcome and encourage parents to stay with their children.

Education and training are constant and intense. We train fellows, pediatric medical students, nurses and other medical staff. We are dedicated to our trainees. Our aim is to develop leaders and top-notch researchers.

We are strong advocates for continuous quality improvement. We are always looking for ways to improve care. We exchange research with other pediatric hospitals to ensure that we are operating on par with our peers, and staying abreast of new techniques.

Staying on the cutting edge of medical technology is important. It makes caring for patients easier and more effective. For example, we are now using very high quality ultrasound devices while placing central lines in children. That new technology has significantly improved the safety and quality of central line placement. We also have new video devices that we use while performing intubations to place a patient on mechanical ventilation. This device helps us perform that procedure more safely while also allowing trainees to observe the process.

We try to minimize the risks of hospitalization for children by reducing the amount of time they spend in the ICU, and we are good at that. When compared to our peer ICUs across the country, we have shorter lengths of stay. Providing the most effective care in the shortest amount of time helps return children quickly to their optimal state of health.

Unfortunately, when working with critically ill or injured patients, outcomes aren’t always what we’d like. Sometimes all we can do is deliver the safest and highest quality care in the most efficient way. We have to recognize that children sometimes have an illness that we are unable to cure. At those times we have to work in a family-centered way to understand goals of care for that child and work with the family to do all that is possible.

Critical care medicine is extremely difficult work, but it is also personally rewarding.

Teen Driving

When a teen starts to drive, it’s a thrilling time for him or her, but often a terrifying time for mom and dad — and with good reason.  Nearly half a million teens are injured in crashes on American roadways every year and 3,800 die.

Many factors contribute to teen driver crashes. They include driving while using alcohol or drugs and not wearing seat belts.

Kathy Monroe is the medical director of the emergency department at Children’s of Alabama.  Unfortunately she sees first-hand the consequences of teens practicing unsafe behaviors behind the wheel of a car.

“Teen crashes are often caused by poor decisions like not wearing a seatbelt, speeding, or drinking and driving,” she said. “Often crashes happen due to nothing more than inexperience- they run off the edge of the road, they over correct, that leads them to crash into another car.  Inexperience often leads to crashes.”

Often distractions contribute to a crash. These may take the driver’s eyes, ears and attention away from the road. The most common distractions include:

  • Too many passengers in the car
  • Talking on cell phones while driving
  • Texting while driving
  • Eating or drinking while driving
  • Adjusting the radio, CD player, temperature controls, etc.
  • Loud music in the car or wearing headphones

The good news is, studies show that parents can play an important role in encouraging the safety of their teen behind the wheel.

“There’s very good evidence that 1,000 miles of supervised driving with an experienced driver dramatically decreases crash rates for teen drivers,” said Monroe.

She said often parents encourage their teens to practice driving when conditions are favorable, but that’s not preparing them for real life situations. Instead, it’s important that a teen practices driving as frequently as possible in all conditions and multiple scenarios: interstate, backroads, nighttime and rain.

Not only that, remember that whenever you’re behind the wheel, your “driver in training” is watching. “No parent thinks any teen is listening to them,” Monroe said. “And they may or may not be listening but they’re watching, so know your behavior affects their behavior.”

In fact, research shows that teens involved automobile accidents are more likely to have parents who are poor drivers.

 

Graduated Driver License

One approach that’s been very successful in reducing teen driving accidents is the Alabama Graduated Driver License Law.

The Graduated Driver License contains three components:

  • Curfew
  • Limit of passengers
  • No handheld devices

The Alabama Graduated Driver License Law places restrictions on young drivers to help ensure their safety. Parents should know this law and enforce it with their teen drivers. Your pediatrician can provide a copy of the law to you today or you can visit www.childrensal.org.

Driving is a complex skill that requires education and lots of practice. Parents play a crucial role in teaching their teens to drive safely.

For more on the Graduated Driver License Law and other safety tips for teens and parents click here for our Teen Driving Toolkit: childrensal.org/safe-teen-driving-toolkit