SPOILER ALERT: If you were looking for Grey’s spoilers, you won’t find them here!

Now that I got your attention however, I want to share with you some truths and cool things I learned about being in the Emergency Department.

I was fortunate enough to complete my practicum in the Emergency Department at Children’s Hospital Los Angeles (CHLA) (Check out their program here). I am so thrilled that I did too, because I mastered so many skills that you may not get unlike a practicum in another hospital unit. Now, any practicum will always suffice as experience for your professional development. I am here with a slight favoritism in the ED. If you are lucky enough to be here, then don’t take it for granted!

Now, the first thing I learned is that it is NOTHING like Grey’s Anatomy. There is no crazy rush ALL the time of doctors and disastrous crises that result a patient being in critical condition.

Yes. It’s true, but the ED is amazing in other ways and serves different purposes that most people don’t think about. Now, during my practicum, I saw a handful of incoming traumas via ambulance and helicopter, but I also saw people come in with new diagnoses, illness, minor injuries, and for chronic illness needs. I learned so much from the Child Life team in the ED and they modeled excellent skills for what every child life specialist should have, regardless of any unit.

So here are some important things I learned that will really enhance your opportunities in the Emergency Department, but in any hospital unit.

  1. Assessment-Assessment is key to any unit for every child and family. Assessment in the ED is very different from in-patient units. Since the ED is more of an outpatient setting, assessment has to be done quickly and efficiently. You have to be able to view a child’s development, needs, family dynamics, medical diagnosis and chief complaint, and immediate additional considerations, all within 5-15 minutes of meeting the child and family. Now, as a student, I felt like a deer in headlights the first time I was thrown into doing this. Over time, I learned how to do it and definitely felt very confident once I was ready to apply for internship. It’s a lot to think about in a shorter span of time. Not to mention, the child and family may only stay for a short period of time or transfer to another unit for further care. Any assessment done in the ED is important because that information can be passed along to other healthcare providers who continue to work with the child and family.

    My advice if you are in the ED: Really brush up on your stages of child  and development so that when you work with children and families, your assessment is so much smoother. Being able to distinguish what is and isn’t typically developing will help you determine what type of procedural support and coping interventions you should use. Also, always introduce your role! As a student when I visited patients, I always did it as: “Hello, my name is Jacqueline and I’m from the Child Life department. I am here to provide activities and things for you to do while you are waiting to see the nurses and doctors.”  Easy, and understandable!

  2. Maintaining professionalism in crisis situations-I will define crisis situation here: a time of intense difficulty, trouble, or danger where difficult or important decisions must be made. In the ED, this can happen, especially if a critical care patient comes in that is triaged and requires immediate attention, especially if the condition is life-threatening. There is even a slight possibility you may have a death/grief/bereavement situation. Maintaining professionalism among numerous healthcare professionals working to help a child, plus helping families who are concerned and anxious can be overwhelming and exhausting. Although I did not witness a critical care situation, I did observe several traumas that resulted in the need for more treatment and help in intensive care.

    The child life specialist I worked with did a couple of things that I believe are ways to maintain professionalism: she translated information the doctors and medical team discussed during the child’s care. She also comforted the parent/family member that was present to let them know that their child would be well-taken care of and that the medical team would do what was necessary to help the child. Then she was patient with the family as they expressed their emotions and concerns.

    My advice: always remain calm in a high stress situation and be patient with the child and family. You need to help guide families so they can figure out what they need and help make information as clear as possible. Should other services be needed such as bereavement, continue to provide support. Acknowledge the child and family’s emotions and allow them to be expressed. Just listening and being present means so much!

  3. I.V. starts-
    If there is one thing that was done 90% of the time in the ED, it was I.V. starts. By the end of my practicum I even got an I.V. to keep on hand so I could use it as a model for patients to touch and learn about the I.V. This is the best place  for new child life students to master the art of teaching children and adolescents about I.V. starts. Here’s why: because of the unpredictable environment of the ED, you may not have any medical preparation equipment to explain the I.V., other than some parts of the I.V. itself. It is important to pay attention to the language of how you address this information to the patient. For example, an I.V. is not like a straw; a straw is what you use in a drink. An I.V. is a small thin tube. American Family Children’s Hospital has a great reference sheet with how you can explain an I.V. to a child hereI.V. is usually placed first in the ED before a child is transferred to another unit. So even if you start your practicum in another unit, make sure you learn this. It’s a child life staple, like bread, or Grey’s Anatomy episodes with Dr. Dreamy.
  4. Patient interactions-
    Patient interactions are going to vary in length of time. Sometimes you may have 2 or more patients that require your attention-at the same time. Although these interactions may be brief, and often prioritized, every little bit you do counts! You have to explain your role quickly and effectively so that you can build rapport quickly. Not an easy task, but it is achievable! Patients and families were appreciative of me putting on a movie in the room or bringing playdoh and coloring pages, even though when I returned to the room, they were often discharged within 45 minutes. Since time in the ED can vary and you see patients there for longer than 2 hours, always re-assess and check on their needs. ED is a very unpredictable environment, but when you make interactions with patients significant and make the environment more familiar, the child and family will respond better to the care they are receiving. I saw children and families attitudes change drastically after I brought in a board game or craft to keep their attention during those long waits to see the doctor or go to CT scan. I got loads of thank yous!

    So although the ED isn’t like TV shows, it is a great learning environment to build several child life skills. Even if you don’t get a practicum in the ED, advocate for one in your internship! You will not regret it and you will have amazing experiences unlike any other unit!

    I thank CHLA for my practicum opportunity and a huge shout out to the Child Life ED team for helping me make my practicum such a memorable learning experience!