Keep calm and get help: Why keeping cool is important in managing emergencies
TWO weeks ago, the new 2024 academic session began after a month-long school break. This means Emergency Departments (ED) across Malaysia are bracing for an influx of young patients.

Consultant emergency physician Dr Elayni Borhan says EDs typically see spikes in visits following extended weekends, school holidays and during seasonal changes. “If the children don’t get sick during the holidays, they will head off to school only to quickly get sick afterwards. And it’s not just one kid, it’s probably the entire class,” she says.

Dr Elayni says this happens because schools and daycare, where many children mingle over an extended period, are hubs for cross-contamination. “And since children’s immune system isn’t fully developed until they are between seven and 10, kids can easily get sick when they go back to school,” she adds.

“Ear congestion, stuffy nose and mild fever are common,” Dr Elayni says, adding that influenza and illnesses with flu-like symptoms are among the conditions affecting the volume of patients in EDs.

Although influenza-related visits are not specifically holiday-related, the rise in patient visits due to flu and other respiratory illnesses increases the total volume of all ED visits in general.

According to Dr Elayni, influenza occurs all year round in Malaysia but peaks from May to July and from November to January.

“The rise in incidents is a cause for growing concern, especially when almost a third of emergency room visits are due to paediatric emergencies,” says Dr Elayni.

Interestingly, Dr Elayni says, data shows a decrease in ED visits among children worldwide during the Covid-19 lockdown compared to pre-pandemic period. “However, it is not clear whether this reduction was due to people’s fears of exposure to Covid-19 in hospitals or less contact with other sick kids in school or daycare,” she adds.

Dr Elayni says EDs typically see spikes in visits after extended weekends, school holidays and during seasonal changes.

Recognising emergencies

Sick and injured children are a unique population that require special care. “Hence, there are differences between treating and providing emergency medical care for adults and children,” Dr Elayni says.

She says most children’s emergency cases fall in the general categories with fever and cough, respiratory distress, upset stomach, infections and injuries from a fall or an accident.

“Based on my experience, I’ve noticed that many parents face difficulties when dealing with injuries or even medical conditions in their children. They are uncertain about when to seek help at the hospital for their kids,” Dr Elayni adds.

Additionally, she says, they lack clarity on the initial steps to take before going to children’s ED.

“One common mistake is underestimating the severity of symptoms or delaying seeking medical attention when their child shows signs of distress,” Dr Elayni says.

Whether you are a first-time parent or not, paediatric emergencies can be very frightening. “When children experience high fever, injuries or broken bones, it’s never easy to just keep calm but you need to remain calm and be in control,” she says, “Therefore, it’s good to be prepared for such an event.”

Being calm, she says, should always come first. Following that, parents should also be familiar with basic first aid techniques, managing choking, cardiopulmonary resuscitation (CPR) and recognising the signs of serious illness or injury.

“You know your child best. As they grow, children show parents how they feel with their behaviour. Even those who can’t talk yet or describe the problem, can tell you when something isn’t right,” she adds.

Dr Elayni says parents need to have clear understanding on when to seek medical attention and how to communicate effectively with healthcare professionals during emergencies. — Sunway Medical Centre

What not to do

Dr Elayni says it is essential for parents to have a clear understanding on when to seek medical attention and how to communicate effectively with healthcare professionals during emergencies. These include the chronology of the illness or accident, medications taken (including dosage and time) and the last time the child ate.

“Additionally, relying on home remedies without consulting medical professionals can sometimes exacerbate the situation. There are cases where parents would use their child’s antibiotics or inhalers, that were prescribed months ago, and give it to a younger sibling. Certain medications are not meant for sharing,” she says.

Decades ago, Dr Elayni says older parents would also advise younger parents to wrap their kids who have fever in thick blankets, or make kids who are shivering from fever wear thick clothing. “The phrase they’d use was ‘to break the fever’. But what this does is worsen the situation, leading to children being brought in with febrile seizures.”

When toddlers or kids have fever, parents should dress them in lightweight clothing. Offering them plenty of liquids can help prevent dehydration.

“Applying ointments or toothpaste on burns is also one of the wrong things that parents do, which doctors see quite frequently. What we do not realise is that sodium fluoride in toothpaste works to coat and prevent tooth decay. Hence, it seals in heat from the burn as well as bacteria, while intensifying the burn’s pain and increasing the risk of infection and scarring,” she says.

Overreact and delay

Dr Elayni says there are also parents – regardless of background – who either overreact to minor symptoms or delay in seeking appropriate medical care. She says while there may be differences in access to healthcare resources in urban and rural areas, the importance of timely and appropriate medical intervention remains consistent across all demographics.

“There are two main reasons for this – the parents’ concern for their child’s well-being and the lack of availability of out-of-hour services. Some parents get anxious and they feel compelled to take their child to the ED, fearing that the condition will get worse with possible complications,” she adds.

While education and socioeconomic status affect parents’ threshold and decision, Dr Elayni adds their accessibility to healthcare services also plays an important role.

“There are a lot more hospitals with ED and 24-hour clinics in urban areas compared to rural areas. Improving access to healthcare facilities, health education and risk communication is most effective for health promotion,” she says.

Dr Elayni says it’s also imperative that parents take preventive action to protect their kids from accidents at home. “Small toys, beads, coins and especially button batteries pose a significant hazard. Sharp objects and household chemicals should be stored away from children’s reach,” she says.

“If you suspect your child has ingested a button battery, go to the nearest ED immediately. When button batteries come into contact with saliva or other bodily fluids, a chemical reaction begins, causing corrosion and tissue damage. Severe damage, including life-threatening injury, can happen within several hours,” she warns.

To make first aid knowledge accessible to all, Sunway Healthcare Group recently launched its Paediatric First Aid E-book through a Children’s First Aid Workshop. The event was a platform to introduce educational resource which features step-by-step instructions and video content accessible through QR codes, to emphasise the importance of informed actions during health emergencies.

For the event, various stations were set up, each led by a doctor. The doctors provided hands-on demonstrations on responding to health emergencies such as choking, resuscitation and fractures.

The e-book aims to bridge the knowledge gap among parents and empower them with practical insights on administering crucial care at home before reaching the hospital. It is also designed to help parents recognise emergencies that require immediate attention and guidance.
StarExtra
From learning first aid techniques to making sure homes are safe, parents can equip themselves with knowledge to handle emergencies.