- Will you consider this?

Your little one is sick or has an accident and needs emergency treatment, but ER waiting rooms can be frightening for them, so the Children's Hospital of Illinois has answered the call.

(upbeat music) As the Downstate Trauma Center, OSF Medical Center sees critical cases, but if your kiddo is injured, there's a kid size emergency entrance and an area created just for the younger population.

Dr. Victor Chan, homegrown, is here with me, the Emergency Services Director at OSF St. Francis Medical Center, and he is here to explain.

Welcome, and welcome back home.

- Thank you.

Yeah, thank you.

Thank you for having me.

- You're a graduate of Richwoods High School.

- I am.

Grew up here in Peoria, so I'm happy to be able to call Peoria my hometown.

- All right, and you came back.

So you went to, from Richwoods, you went to U of I.

- Yep, from Richwoods I did my undergraduate schooling in University of Illinois Champaign, and then went up to Chicago for medical school and completed my residency training there in emergency medicine, and been back in Peoria now for eight, nine years now with my wife and two kids.

- Is emergency medicine, is that what you always wanted to do, or how did that develop?

- Yeah, you know, emergency medicine, going through school, you're always trying to figure out, you know, what is the specialty, what is that thing that you want to do the rest of your life, and when I found emergency medicine, I think it was the perfect balance for me.

It's a great balance of medicine, as well as some procedural skills, and then there's never a dull moment.

So there's a lot of excitement, always, in the emergency department.

- And full moons really add to it, right?

- [Victor] Absolutely.

- On the kids side as well as the adult side, or?

- Yeah, it's odd that you can definitely see sometimes whether there's a correlation with the tidal of the moon, but it's definitely, sometimes you can see some fluxes with the volumes and the craziness that happens.

(Victor and Christine laughing) - Well, again, welcome back, and then.

- [Victor] Thank you.

- Now, you came back and you were practicing in the emergency rooms, correct?

- Yeah, when I came back, and I've obviously been always practicing emergency medicine.

When I first came back, we're very lucky in Peoria here.

We're affiliated, OSF is affiliated with the University of Illinois College of Medicine, which has one of the campuses here in Peoria.

And so when you practice here, you are able to actually also teach, and you're part of the faculty at the University of Illinois.

And so for the first part of my, when I returned, I was part of the academic core faculty.

Did a lot, was very involved with the teaching, with the medical students on campus, in the city, as well as our three-year emergency medicine residency program.

And then now I've transitioned now for a few years, and I've been serving as the Chief of Emergency Services.

- And that's quite a challenge.

- It definitely keeps you busy.

I think, you know, the big piece recently has been catching up with, you know, trying to keep up with COVID and all the different changes and maneuvering around the needs of the community, the hospital.

- Now let's talk about the pediatric emergency room.

It opened when?

And then it had a little pause in there, but explain.

- Yeah, absolutely.

So we actually moved into this newer, our milestone building opened in 2010, actually, and so we've always had a focus on pediatric care, but I would say as early as probably 2015, 2016, we saw the need to provide 24/7 around-the-clock care, particularly for our pediatric population in the area.

And so in 2019, actually, July of 2019 was when we were able to fully open and had 24/7 coverage in a designated area, particularly for kids.

- [Christine] Kid friendly.

- Kid friendly, very kid friendly.

You know, it comes down to all the signage on campus.

The campus directs you, the OSF campus can be very large, directs you to the emergency area, shows you where to enter for the pediatric emergency department specifically.

And so we reopened in July of 2019, excuse me, opened in July 2019, 24/7, and unfortunately no one could predict, the pandemic hit.

- Right.

- So it was in March of 2020.

- [Christine] 2020.

- Yep, exactly, was when we had to make, you know, we had to make changes and be flexible with the pandemic.

And so we truncated some of the coverage, at least overnight, and continued to provide great pediatric care, but sometimes there would be times where, you know, it would be a kind of a combination model.

So we've been fortunate enough now, in now the summer July of '21, we've reopened back to 24/7, specifically designated pediatric emergency department now.

- Well, trauma is trauma, no matter how old you are, but then to have the little ones in with the mixed population, that could even be worse, I would imagine, if they saw somebody who'd been in a car accident be wheeled in, or, you know, any other malady.

- Yeah, trauma can be very scary, especially if you're not, you know, even if you are in the medical profession, it's hard to get used to.

We're very fortunate here in the emergency department at OSF.

We have a state-designated Level 1 adult and pediatric trauma center, so that means that we have 24/7, all the resources that we would need for traumatic injuries.

So whether that means in the emergency department, as well as neurosurgery, trauma surgery, all the other specialty services that you would need if you were in the unfortunate case that you needed to be seen for a traumatic injury.

- So staffing.

You have specialists there, pediatric specialists, nurses, doctors, everything.

- Yeah, absolutely, and thanks for bringing that up.

Certainly one of our strengths in the pediatric emergency department.

So staffing wise, our nurses are, we have a core group of pediatric nurses that are specially trained in pediatric emergencies.

So they have special training in pediatric advanced life support, neonatal resuscitation, pediatric trauma, as well as pediatric critical care services.

So all our nurses are very well trained.

Our physicians are all Emergency Board certified.

We're lucky to have our pediatric emergency department Medical Director is Dr. Trish, Theresa Riech, who is actually triple boarded.

She's boarded in emergency medicine, pediatrics, and internal medicine, so she leads a great group there.

We have as also part of the team, our child life specialists.

And so probably one of the most valuable members of our team, because they really help alleviate that anxiety of coming into a medical care facility.

- And not only for the children, but for the parents as well.

- Exactly, exactly.

So they're specially trained in assessing a child's developmental level, and then also trying to assess the dynamics of that family, of the parents, and then alleviating the stress for obviously the child, but then also for the family members and then involving the caretakers and family members as part of that, letting them know what the expectations are as part of that visit.

Sometimes they'll even, so that might mean, you know, it might be using toys for distraction, which we have plentiful of, but then also it might mean explaining what each instrument is.

If, you know, if a child needs to go through a laceration or cut repair, what should one expect, what are the sounds, the feelings, what what to expect, what are the people that are in the room, just to alleviate some of that stress that can be there.

- So they explain to the kids and the parents what's gonna happen, and then everybody can deal with it.

- [Victor] Absolutely, absolutely.

- And then what happens when they're not dealing with it quite so well?

(laughs) - Yeah.

- [Christine] A lot of screams and flailing about.

- That can happen, and so we certainly have the ability as a pediatric emergency department to, if we need to, and obviously we take it with consideration, but we can sedate a patient, a pediatric patient if needed, but there's a couple more steps probably even before getting to that, that we try to see if there's other ways to alleviate the stress.

So we have access, actually we have nitrous gas or laughing gas.

So you might be familiar with.

And our child life specialists can even make it more fun, so they can infuse different flavoring or different tastes so that, you know, (Christine laughing) whether, if it's, I don't know, bubble gum or that you might prefer, and so it's a little bit less intimidating.

We have fun gadgets, another way to administer medication.

So, you know, no one enjoys giving medication to kids, and sometimes that can be tough, so whether it's additional to providing medications via mouth.

We have this atomizer that essentially turns solution into a mist, and so it can be squirted up the nose.

- Inhaled?

- It's inhaled, exactly, to provide anxiolysis and pain control.

- And kids don't realize that.

They're just getting a little mist on their face.

- Sometimes that's a little better than getting medicine everywhere.

(laughs) - Or getting a shot, needles.

- Exactly, exactly, yeah.

So then, we certainly make the effort and consider what's appropriate for the child, and then if we need to, then we can, we certainly have all the resources to do a full sedation and all the monitoring for the patient safely to perform that procedure.

- How many kids do you generally see?

Is there an average of the number of kids that were coming through prior to COVID?

And then now it's, you know, gearing up again?

- Yeah, we were seeing probably around...

So our overall, all our entire ED sees about 80,000 visits in a year.

Pre-COVID, we were probably about 15, 16,000 visits, and then as that pandemic initially hit, there was a large dip in the volume and now we're starting to see kind of similar volumes again.

I think part of that is, you know, everyone's kind of back to somewhat of a norm, and as we enter the summer months, we're gonna see kids out of school, and, you know, unfortunately accidents can happen, and we'll be seeing more kids again.

- What's the... Is it mostly bicycle accidents?

Is it maybe sometimes, maybe car accidents, but kids just playing, falling off of the sliding board or swing set or whatever?

Is that?

What is the most common injury that comes in?

- Yeah.

There's a lot, I would say, and it kind of probably fluxes with the season.

I would say we see a lot of, cough, fever, kind of bread and butter illnesses that we would normally see in the respiratory, traditional kind of winter season.

We've been seeing that delayed, influenza come in through the spring.

As you transition into more kids being, you're right, being on bicycles and being on swings or skateboards or whatever it may be, we start to see more orthopedic injuries, and so probably mixed in with, you know, kind of the usual little bugs and such that we can have.

- And then there's Life Flight.

So Life Flight's bringing kids and adults in as well.

- [Victor] Yeah.

- [Christine] And you have staffing specifically for that.

- Absolutely.

We have a great Life Flight program.

We are actually Illinois's busiest flying program, just because of the large catchment area that we cover here in the Central Illinois area.

So we have the ability to, as a Level 1 pediatric center, bring in a lot of our, serve the area for hospitals that don't have that ability, and so Life Flight helps transport them.

Sometimes they may need to be stabilized in the pediatric emergency department, but then we have a great children's hospital as well to be able to continue that care.

- And then we cover, it's Indiana to Iowa, right?

And then Interstate 80 down to just north of Springfield?

- [Victor] You got it, yep.

- Okay.

- That's a pretty large area, which accounts for essentially why we have so many flights.

(laughs) - Right.

Well, so there are specific rooms, if I recall correctly.

There's a quarantine room, too, in the emergency room.

- [Victor] Yeah.

- Specifically for what?

- Yeah, thank you for bringing that up.

So, you know, the pandemic has taught us that we need to be much more aware, obviously, of all illnesses and injuries, and so we have redesigned our waiting room.

It starts off, even just entering the waiting room.

So depending on your complaint, we have a waiting room for infectious complaints, and then we have a waiting room particularly for non-infectious complaints, just so that, you know, there's less of a potential for exposure there.

Our rooms have the ability to be, all rooms have the ability to be closed off, and then obviously to wear PPE, personal protective equipment to protect the patient and the staff.

Absolutely.

- And if there is a big emergency in town, something has happened, there's also stations, I believe in the hallways, right?

That people could be placed, or kids could be placed just until room becomes available or that's what makes us a trauma center a Level 1?

- Yeah, we have a great...

I was very impressed when I first, when I came back to see and visit the center.

There's these, when you visit the hallways, and it's almost easy to miss, 'cause it looks like it's blended into the decor, and it's almost kind of James Bond style, because you can, these fixtures or paintings can be moved off to the side, and then there are hallways that can be expanded into treatment areas, and so it provides everything that you would really need in a large disaster.

Oxygen, suction, you know, air compressor, that kind of thing, and so that's really neat.

And so in the event that any large disaster were to happen, yes, we do have that capability.

- But we don't want that.

- [Victor] We don't want that.

(laughs) - We don't even want that disaster.

- [Victor] Absolutely.

- But we are really, truly blessed to have not only the children's hospital, but to have this specified pediatric emergency room.

- Yeah.

I think having a specific children's emergency department really provides, obviously not only, you know, we talked about the facility that's very child friendly, and the staff, but it also speaks to the clinical care that's provided.

And so sometimes we joke about, in medicine, are kids just kind of small adults, right?

(chuckles) - [Christine] And they're not.

- They're not, absolutely.

The pathophysiology is very different, and so having, you know, being part of a large academic care center, it means evidence-based care.

So it means adhering to guidelines that are up-to-date.

It means adhering and understanding the clinicians, knowing the most up-to-date research.

It means contributing to that research.

So we have faculty that are well publicized and contribute to the research, and it means obviously teaching that to the medical students, to the residents that are there.

And so I think that's very important because medicine's always changing, so being able to know what the most up-to-date guidelines are and then changing with it is very important.

And that's what we do.

So we provide evidence-based care medicine.

- When you were a child growing up here, did you ever have to be taken to the emergency room?

- I have... Good question.

I have not had that opportunity, but I do recall an incident with my sister, where she, something with her arm and had to go to get an x-ray, and so I vaguely recall an incident that we had to go.

But I think, you know, with two kids now, I think having a children-specific emergency department is definitely, we're very fortunate to have, and without doubt, I mean, that's where we would bring our kids if anything were to happen.

- So explain to our audience, when you go to the emergency room, when you take your children to the emergency room or when you take them to an on-call, because there's a big difference.

Some people just go straight to the emergency room and maybe that's not such a good idea.

- Yeah.

I think that, you know, sometimes it can be hard to differentiate, so that's a great question.

You know, I think that your child's pediatrician or child's primary care physician is always a great resource at first, that they always have a great office staff to help answer some of those questions.

The next level is usually the urgent care, and we have a large amount of great urgent cares in the area.

My wife actually works in one of the urgent cares as a nurse practitioner, and they provide great care as well.

But obviously then, for things that are more severe or more concerning, the emergency department is kind of that highest level of care.

And so probably to be able to distinguish the three, I would say, you know, if you're ever in question and something's very urgent, please, we want to be there.

We want to be able to care for your child.

Usually I would say for quick, immediate, if you can't get into your pediatrician, the urgent care is a good place for kind of, you know, cough, runny nose, earaches, that kind of stuff.

- An initial consultation.

- Absolutely.

And you know, it's not the ability to...

If there's a missive, if the urgent care feels like there's something that needs to be seen in the emergency department, they will properly escalate, absolutely.

But we're always happy to see patients in the emergency department.

- And how many rooms are there specifically, then, in this emergency, this specified emergency room?

- Yeah, in the children's emergency department, we have always usually about 10 to 12 rooms open at a time, but the great thing about the space that we're in is that it can expand and grow.

And so it's not particularly, we're not set in those, you know, 10 to dozen rooms.

If we need, there's other spaces that we can always expand, depending on the volume that arrives.

- Well, and also, it has its own entrance and there is, isn't there a St. Jude entrance as well?

- Yeah, there's a St. Jude entrance.

So as you kind of enter the emergency department, there's a, you'll see aside for the adult emergency, and then there's pediatric emergency.

The signage is very clear, and there's big red signs there, and St. Jude is actually upstairs, so is also another different entrance as well.

I was gonna share, even from the standpoint of being welcoming to the kids and being able to help alleviate some of the stress, you know, walking into a medical facility sometimes can be a little... - [Christine] Overwhelming.

- Overwhelming.

It can be a little boring for a kid.

(laughs) Our triage rooms, we are equipped.

We have, when they walk in, you can see there's two.

You can have a chance to ride on, it's the exam room tables.

You can ride on Henrietta the Hippo or Frankie the Firetruck, and so that just makes it a little bit more of a fun... - [Christine] Kid friendly.

- Yeah.

- That's how they're greeted.

- [Victor] Absolutely.

- So that takes some of the stress off of them and their families.

It's like this isn't such a bad place to be.

- Yeah.

(laughs) Right.

- And then, like average length of stay for an emergency kind of thing.

Is there such a thing, or am I making that up?

- No, there definitely is, and I think it largely varies.

So, right, in an emergency department, we will always, and I think we can all agree that whoever is the sickest should be seen first.

And so we certainly have that model.

We adhere to, it's a ESI index triage process based off level one through five.

So one is your highest acuity, life threats, where five is the lowest, and so based off your acuity level, we will see patients based off, obviously, how soon they have, how long have they been waiting, but then a large focus on how acute the complaint is.

And so I think, I would say, you know, to answer your question in terms of length of stay and visit, it largely depends on how sick you are.

Obviously for hopefully less acute complaints, then you're in and out faster than patients that might need to be there a little longer.

- Okay.

But all in all, so you went away, just didn't even really move out of the state, came back here, mostly because we had this excellent facility, correct?

- Yeah.

It's a great facility that ties in, obviously, all the great resources that we have, all the great clinicians in terms of the specialists that we have in the Children's Hospital of Illinois.

It's a great place to practice and be as a patient, just because we talked about the academic focus and being a very evidence-based department, and so all those just offer such a great place to work, but then also, obviously, you know, it's great to be able to be part of, to contribute that to the community.

- And what do you see foresee the future, if anything, for our area?

- Yeah, absolutely.

I think trying to, particularly for the children's emergency department, it's probably trying to find growth opportunities in terms of what we can do for our larger catchment area, just because sometimes it can be a lot to travel all the way to Peoria.

And so what are some opportunities that we have that we can, whether it's extending some of the expertise or making it easier to get to Peoria, so that we can provide that care.

- All right, well, you're gonna stay busy, I can tell that.

- (laughs) Absolutely.

Thank you much.

- Thanks so much for joining me, and welcome home.

- Thank you.

Thank you for having me.

- Oh, you are quite welcome.

Hope you enjoyed learning all about this.

I know I learned a few more things, had some questions to ask.

So thanks for joining us.

Stay safe and healthy, and hold happiness.

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