Coming of Age

Nemours’ ER makes visits smoother for autistic children. There’s also a bonafide “boo boo” team at your service.


Mendy Hood’s teenage son frequents the emergency room at Nemours Children’s Hospital in Orlando—his impaired immune system leaving him vulnerable to constant life-threatening infections.

But Nathan, nearly 16, also has autism, which makes his visits to the ER not only unpleasant for him but also difficult for those around him. That is, until recently.

In October 2015, Cara Harwell, a nurse practitioner at Nemours, helped develop a program called REACH for autistic children, those with other developmental disabilities, mental health problems and sensory integration disorders. REACH stands for “Respecting Each Awesome Child Here.”

“We try to identify these children immediately and put them into a quiet waiting room with fewer windows, soft lighting and distractions such as calming music or weighted toys,’’ Harwell says.

For Nathan, his mother says, tamping down the overstimulation has made all the difference. Not only is he calmer, it’s easier on her because she doesn’t have to explain some of his behaviors, such as a nervous head tic, she says. “In the past I had to explain [his behavior] to every single person in the ER.”

Harwell estimates that 5 to 10 autistic children like Nathan come through Nemours’ emergency department each day. Although Harwell and Emily Bradley, a Nemours certified life child specialist, have just begun collecting data on the program, she says, “We feel it expedites treatment by getting these kids to the exam room quickly,” without physical restraints or sedation. 

Moreover, a recent pilot study conducted earlier this year with the 75 members of the ER staff found that 92 percent of those responding now feel more comfortable treating autistic children. That compares with just 51 percent in the past. 

Expediting treatment also is the goal of a second innovative program at Nemours, which relies on paramedics to treat children with minor lacerations or cuts in the emergency department. Known as the “Boo Boo Care” program, it’s now entering its third year.

Kevin Brito, who founded the program, is one of five paramedics who provide this medical service between 9 a.m. and 3 p.m. daily. The program requires at least three months of training in the essentials of anatomy and three more months training directly with clinicians.

“Supervision always comes with our licensure,” Brito says, adding that if an injury appears too deep, “we would get the physician involved immediately.”

Mostly, he says, the paramedics stitch up toddlers’ chin-and-scalp injuries as they learn to walk, or other less-acute injuries. Out of 32,131 ER visits to Nemours in 2015, paramedics treated only a small fraction of them, about 815 in all. But that number has been going up steadily each year, Brito says.

 “Our work definitely allows physicians not to be tied up with time-consuming procedures,” Brito stresses, a goal that seems to be working. Wait times in the ER have gone down by 30 minutes or more, he says, and the length of the average stay has dropped from 154 minutes to about 95 minutes. 

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