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Talking to Children About Tornadoes

Families and professionals have different challenges in supporting children after disasters depending on many factors. First, of course, is the degree of impact.  Children who were injured or lost their homes obviously have very different needs from those who had no direct effects but who saw damage in their communities or on TV, or who spent time during the storm in a closet but did not get the worst of the storm.  This blog is meant to help you figure out how to help the children in your lives cope and recover.

Signs of Distress

Children’s needs vary by age and by their personality before the event.  Sensitive children may be upset just by hearing conversations at school or church, while other children can be surprisingly robust.  That said, it is useful to think about some common responses to disaster at different ages, especially when there is some direct effect on the child’s life. 

Young children often regress, acting less mature than previously.  For example, a child who was doing well going to bed and sleeping in her own room may have trouble with this, and get very upset at bedtime. 

School aged children may be more reluctant to leave their parents’ sides, may have bad dreams, and may become quite alarmed at any change in weather. 

Teens may become irritable or withdrawn.  For most children, these issues will resolve with time, but it may take patience for their caregivers.

What to Expect

Those who work with people who have experienced disasters often talk about stages that they may go through.  For example, it is common for the initial period to involve both shock and numbness, and a period of intense activity trying to deal with the immediate situation.   There can then be a short “honeymoon” when people are glad to be alive. 

But often this is followed by a period of disillusionment and frustration, as it becomes clear that things won’t return to normal right away.  This can be a painful time when people of all ages experience anxiety, feelings of sadness or hopelessness, and sometimes recurrent memories, difficulty concentrating, and other symptoms even in very normal individuals.  

Eventually, most people rally and develop new routines and supports as they gradually return to more normal times.

Regroup Sooner Rather Than Later 

Help children rebound faster by returning to a predictable routine as soon as possible.  This routine includes the basics like sleeping, meals, play and school on a regular schedule. 

Second, allow and facilitate the child to talk about what they experienced.  It can be helpful for children to “tell their story” repeatedly.  For younger children, this may mean “playing it out.” Keep in mind that as an adult, you may need to help the child find a positive resolution to the story, making sure that it ends with the family back together in a safe home with new possessions, for example.

Sometimes children may have difficulty expressing their feelings through words. Activities such as drawing, painting, taking photographs, and pounding play dough can allow children to express their feelings and memories in another way.

Many children benefit tremendously from the opportunity to help with the recovery process.  From the young child who helps to pick up sticks in the yard, to the school age child who helps with a bake sale to raise money for the Red Cross, to the teen who volunteers to help an elderly neighbor clean up, we know that making a difference helps the volunteer as well as the recipient.

If friends or family members are injured, even very young children can make a card or send a balloon or stuffed animal to their loved one. This gives them a role to play during this time of crisis, when even the grownups around them may be worried or anxious about that person’s well-being.

Seeking Support

Finally, adults need to look after themselves in order to provide optimal support to their children.   When in doubt, helpers in the community, including friends, relatives, pediatricians and family doctors, and counselors at school and church often are waiting for opportunities to help.  Various agencies across the state, notably Hospice have resources for children who experience bereavement. Mental health resources are available if needed, and the primary health provider is often a good place to figure out when and if such support is appropriate for an individual child or family.

Melissa Johnson, PhD, is a WakeMed child clinical psycologist with the pediatric development team, and Susan Davis, WakeMed Children’s Hospital child life specialist, co-authored this blog.

Want to know more?  WRAL also interviewed  Melissa Johnson about how parents can help children cope with disasters.  This story aired on April 19.

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WakeMed Treats 47 Storm-Related Injuries; Chainsaw Safety Urged During Clean Up

WakeMed Health & Hospitals, Wake County’s only Level 1 Trauma Center, treated a total of 47 patients with storm-related injuries this past weekend among its five emergency departments in Raleigh, Cary, North Raleigh and Apex.  Of these patients, 13 of patients remain in the hospital, two were transferred, and 32 have been treated and released.

WakeMed is strongly encouraging safety as clean-up efforts progress.  Chainsaw injuries are typically the most frequent and serious injuries seen after storms that cause a significant number of fallen trees.

“Neither gas nor electric chainsaws are safe. Chainsaws are inherently dangerous tools, and people who do not have experience simply should not operate a chainsaw,” warns Osi Udekwu, MD, director, WakeMed Physician Practices – Trauma & Surgery. “Additionally, even people who are experienced with a chainsaws need to use common sense and extreme caution when operating this very dangerous equipment. Chainsaw lacerations are very difficult to treat because they do not cause clean cuts.”

Follow these steps from Federal Emergency Management Agency (FEMA) to protect yourself and others. Remember, safety features cannot substitute for knowledge.

  • Get the dealer to demonstrate how to use the saw. Read the manual, learn all you can before using the saw – it’s a potential killer.
  • Wear snug-fitting protective equipment. That includes goggles, face and head mask, gloves, boots, ear protection, and heavy-duty clothing. Wear the equipment properly.
  • Carefully check the area for loose bark, broken limbs, or other damage before trees are felled or removed.
  • Cut safely; keep both hands on the handles. Keep the handles dry, clean and free of oil or fuel. Keep your eye on the blade and what you are cutting. Cut with the lower edge of the saw blade whenever possible. Cutting with the tip of the saw is inviting injury. Let the chainsaw do the work. Don’t try to force the saw.
  • Do not overreach or cut above shoulder height. It is very difficult to control the saw in awkward positions.
  • Do not operate a chainsaw in a tree or from a ladder unless you have been specifically trained and are equipped to do so.
  • When cutting a spring pole or other tree under stress, permit no one but the feller to be closer than two tree lengths when the stress is released
  • Do not operate a chainsaw when tired, if you have been drinking alcohol, or if you have been taking prescription medication or non-prescription drugs.
  • Do not smoke while refueling your saw. Move the chainsaw at least 10 feet away from the fueling point before starting the engine. Use gasoline powered chainsaws only in well ventilated areas
  • Sharpen the saw regularly.
  • Look for anti-kick nose guards, quick-stop brakes, and wraparound hand guards on any saw you use. Kickback accounts for almost a third of chain saw accidents.
  • Don’t wear yourself out. Stay alert. Take frequent breaks.

U.S. Occupational Health & Safety Administration (OSHA) is also an excellent resource for chainsaw safety information. 

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WakeMed Submits CON to Add 101 Beds

WakeMed Raleigh Campus

WakeMed Health & Hospitals today submitted two Certificate of Need (CON) applications to add 101 beds in as identified in North Carolina’s 2011 State Medical Facilities Plan.  WakeMed is proposing to add 79 acute care beds to Raleigh Campus and 22 acute care beds to Cary Hospital.

Both Raleigh Campus and Cary Hospital currently operate above the State’s CON performance occupancy threshold of 71.4 percent for hospitals the size of Cary Hospital and 75.2 percent for hospitals the size of Raleigh Campus. By 2015, growth coupled with an aging population, will cause Raleigh Campus and Cary Hospital to have occupancy rates at or above 90 percent if no additional beds are opened at these facilities.

WakeMed Cary Hospital

“WakeMed is the leading provider of inpatient health care services in Wake County – the second fastest growing county in North Carolina.  And, WakeMed’s high inpatient occupancy drove the allocation of 101 beds in North Carolina’s State Medical Facilities Plan.  Additionally, the other hospitals in Wake County currently have un- or under-utilized acute care beds and have not shown a good track record in providing the inpatient capacity that the community needs,” notes Stan Taylor, WakeMed vice president corporate planning. 

Taylor continued, “Wake County will soon have five hospitals and four stand-alone emergency departments in geographically diverse, densely populated areas, ensuring access to healthcare across the county.  Wake County does not need more hospitals. It needs to add more inpatient capacity in the county’s two busiest existing hospitals, leveraging existing infrastructure and support services already in place to add beds quickly, cost-effectively and efficiently.”

Letters of support for WakeMed’s Certficiate of Need are still being accepted.  Click here to learn more.

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WakeMed to Break Ground on Wake County’s Fifth Hospital; WakeMed North Hospital

WakeMed Health & Hospitals is pleased to announce it is moving  forward with plans to expand the existing WakeMed North Healthplex into Wake County’s fifth hospital – WakeMed North Hospital.  WakeMed expects to break ground in Fall 2011.

With an anticipated opening date of October 2013, WakeMed North Hospital will be a 61-bed acute care hospital with a focus on inpatient women’s specialty services, offering a full range of obstetric and gynecological services, including comprehensive preventive, diagnostic, and therapeutic care. The facility will continue to serve men and children through the existing emergency department, outpatient surgery, imaging, lab, and physician services already offered at the facility.

“Since opening in 2002, WakeMed North Healthplex’ consumer-driven volumes have consistently outpaced projections, demonstrating the great demand for health care services in this community,” explained Dr. Bill Atkinson, WakeMed president & CEO. “Currently WakeMed North Healthplex offers a full-service, 24/7 emergency department, ambulatory surgery center, imaging and laboratory services, and a host of additional clinical capabilities.  The campus also features an 85,000 square foot medical office building.”

“Transitioning to a hospital is the next logical step as the infrastructure is already in place and the community has a critical mass of 262,000 residents living within a seven mile radius of the facility.  While the hospital will initially open with a women’s focus, our plan is for it to continue to expand to meet the needs of women, men and children alike.”Atkinson continued.

The addition of a hospital to any community is always a significant boost to a community’s economy.  Construction of the North Hospital is predicted to create 500 construction jobs and will increase the current 150 employees to 442 full-time equivalent employees by the second year of hospital operation with an average salary of $48,760.

WakeMed received approval to add 41 licensed acute care beds to WakeMed North Hospital in 2009. These beds were in addition to the 20 acute care beds already approved for relocation from WakeMed Raleigh Campus, making the total bed count for WakeMed North Hospital 61. The inpatient beds will be constructed in an approximate 90,000 square foot addition to the existing North Healthplex.  The cost of the project is estimated to be nearly $62 million.

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Volunteer Recognition

During this National Healthcare Volunteer Week, we would like to take this special opportunity to recognize the support that volunteers provide to WakeMed patients and their families, to hospital staff, and to the community. It is the perfect occasion to focus on the many significant contributions our volunteers make individually and collectively every day to the WakeMed system.

In fiscal year 2010:

  • 1,408 individual volunteers gave a combined 123,973 hours of service throughout the WakeMed Health & Hospitals system to patients, staff and families.
  • Volunteer-sponsored fund raisers resulted in over $59,000 of profit used to support WakeMed programs and services.
  • 102 departments system wide received support from WakeMed volunteers.
  • 6,783 Patient Relations Ambassadors patient visits and surveys were completed, recorded, reported and analyzed.
  • 44 teams of Hospitality Pets completed 6,772 visits to patients and made untold numbers of physician, staff and family “touches” in the process.
  • Hundreds of huggables and dolls for children and adults, quilts for palliative care and adult patients, booties and caps and burial gowns and blankets and outfits for babies are hand-made by volunteers every year.

WakeMed volunteers escort and guide patients and guests, discharge patients, visit patients, read to children, coordinate visits for families, offer diversionary activities for patients and families, survey patients, and deliver mail and flowers. WakeMed volunteers represent each generation between 14 and 95 years of age. In fact, the WakeMed Board of Directors and members of the WakeMed Foundation are volunteers, contributing invaluable expertise and many hours of support through leadership development, fund-raising and educational awareness.

WakeMed volunteers represent health care providers of the future, the workforce of today, the workforce of yesterday, and those who are dedicated to community support who have either never required nor had an opportunity for monetary compensation. Volunteers are part of WakeMed’s story, part of our success and excited about the vision that they share with us about our future. For all of this and more we simply cannot thank our volunteers enough!

Interested in learning more about volunteering at WakeMed click here.

Susan Hester is WakeMed Director of Community Services.

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NC Seasonal Sensation – Strawberry Recipes

Continuing our series on seasonal eating in North Carolina, this month’s seasonal sensation is the strawberry.  We North Carolinian’s take pride in our strawberries. In fact, North Carolina is the fourth largest producer of strawberries in the country, and almost all strawberries grown in North Carolina are eaten right here in our state.

What better way to eat healthy than with a bowlful of sweet strawberries? Strawberries are a wonderful source of antioxidants and vitamin C. Delicious on their own or paired with your favorite low fat yogurt, granola or salad, eat them by the handful completely guilt-free.  Just in time for grilling season, try this recipe’s sweet spin on grilled shrimp.

Grilled Honey Glazed Shrimp with Strawberry Cocktail Sauce

WakeMed’s HeartSmart Cooking Series – Recipes compliments of Rocky Top Hospitality

Serves 4, 3 oz of shrimp and 3 oz of cocktail sauce per serving

12 oz large shrimp, peeled, deveined
2 tbsp honey
1 tbsp olive oil
1 lemon, juiced

For the Shrimp
In a small bowl, wisk the honey and lemon juice until well combined. Set aside. Brush shrimp with olive oil and grill until done, about 1 minute per side. Toss the shrimp in the honey mixture and place in the refrigerator to cool.

For the Strawberry Cocktail Sauce
1 cup fresh strawberries, cored and sliced Pinch of cayenne pepper Zest and juice of a lemon
1 tbsp honey
2 tbsp chopped mint

In a food processor or blender, combine the strawberries, cayenne pepper, lemon juice and honey and puree until smooth. Pour into a small bowl and stir in the lemon zest and mint. Serve along side the shrimp.

Per serving: 280 calories; 8 g fat, 1 g saturated fat; 1 g polyunsaturated fat; 5 g monounsaturated fat; 127 mg sodium; 35 g carbohydrates; 0 g dietary fiber; 30 g sugar; 17 g protein

Here’s a little more trivia to go along with the brain boosting powers of the strawberry.
• The Romans hailed wild strawberries for their medicinal properties.
• Ounce for ounce, strawberries have more Vitamin C than citrus fruit.
• According to the American Cancer Society, foods rich in Vitamin C may lower the risk of cancers of the gastrointestinal tract.
• Strawberry growers set about 17,500 plants per acre, and one acre can yield as much as 20,000-30,000 pounds of strawberries over the season.

But wait! There’s another recipe. Try this spinach, strawberry salad along side the honey glazed grilled shrimp for an even healthier and well-rounded meal.

Almond Strawberry Salad

Serves 4 side salads or 2 entrée portions

4 cups fresh baby spinach
1/2 cup sliced fresh strawberries
1/4 cup sliced honey-roasted almonds
1 tbsp cider vinegar
1 tbsp honey
1 1/2 tsp sugar

In a large bowl, combine the spinach, strawberries and almonds. In a jar with a tight-fitting lid, combine the vinegar, honey and sugar and shake well. Drizzle the dressing over the salad and toss well. Serve immediately.

Per Serving (3/4 cup): 74 calories, 4 g fat; 0 cholesterol; 98 mg sodium; 9 g carbohydrate; 1 g fiber; 2 g protein.

This post is part of the NC’s No Diet Diet series.  View previous posts here: February Sweet Potato, March Lettuce

Tina Schwebach is a clinical dietitian at WakeMed Cary Hospital.

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On This Day 50 Years Ago

On April 9, 1961, a dedication ceremony was held for Wake Memorial Hospital, and a legacy of care and caring for the Wake County community began.
In 1955, the Wake County Board of Commissioners had asked the voters to authorize a $5 million bond issue to supply funds for construction of a general hospital system that would provide health care services for all Wake County citizens. An additional $3.2 million grant from the federal government was approved, and work began on a central facility in Raleigh and four division hospitals to be located in Apex, Fuquay-Varina, Wake Forest, and Zebulon.

Today, WakeMed Health & Hospitals features two hospitals (with a third on the way in North Raleigh), two stand alone emergency departments (and another opening in Brier Creek in late 2011), 870-beds, more than 1,000 physicians on staff, 7,600 employees, 1,000 volunteers and more than 600,000 patient contacts each year.

As the only hospital system based in Wake County and the county’s largest employer, we are proud to have called Wake County home for the past 50 years and look forward to the next 50 and beyond.

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Alternating Fever Reducers

Fever is a word that most parents dread.  Just the first hint of a fever sends the worried parent to the medicine cabinet to find the fever and pain reliever. In many cases this is an appropriate response, but not for the reasons parents think. 

Fever in and of itself is not dangerous to the vast majority of children. Fever actually has the beneficial effect of fighting infection.  A pediatrician’s goal in recommending treating a child with acetaminophen or ibuprofen is actually to simply improve the child’s overall comfort and be in a better position to assess the child’s wellbeing.

It also surprises many parents to learn that pediatricians only define a fever as anything over 100.4° F for a rectal temperature.  In recent years, many pediatricians have been recommending alternating acetaminophen and ibuprofen as a treatment for fever as it has been shown that they may work better to lower fever when used together.  But this is not a practice that parents should regularly employ without a visit or call to a pediatrician.  The reason is simple; errors in dosing are very common and you may be accidentally over-medicating your child.

So, what is a parent to do?  The best thing to do if your child has fever is to give them a dose of acetaminophen or ibuprofen to make them more comfortable and monitor their intake, activity level, and for resolution of the fever.  The exact temperature really doesn’t matter or tell you anything about the illness, but monitoring temperature shows the response (or lack of response) to acetaminophen/ibuprofen and presence or absence of a temperature is helpful to know when deciding it an illness is resolving.  It does not matter whether you choose acetaminophen or ibuprofen because they have both been proven equally effective in treating fever in children.

Never wake a child from a slumber to give them a dose of fever/pain reliever.  Since the primary reason for the medicine is to improve overall comfort, by definition if they are sleeping then they are comfortable.

Always consult your primary care physician if your child is less than two months old (because we always evaluate every infant less than 2 months old if they have a fever), if the fever persists for more than several days, your child has trouble feeding, seems exceptionally lethargic, has a febrile seizure, or if you have specific concerns or questions.  It is also important to note, that although very scary for the parent, a febrile seizure is not in and of itself dangerous, but by all means if you feel your child is having an emergency, never hesitate to bring your child to an emergency department.

Dr. Betty Witman is a WakeMed pediatrician and Medical Director of the SAFEchild Advocacy Center.

WakeMed Children’s is dedicated to providing answers to common questions parents have about children’s health and wellbeing.   Learn more by subscribing to WakeMed’s Families First newsletter.  Have a specific question you would like answered?  Post a comment or email us directly.

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WakeMed Stroke Centers Receive Quality Awards

WakeMed Raleigh Campus and WakeMed Cary Hospital. the only Joint Commission certified Stroke Centers in Wake County, have received quality awards from the American Heart Association/American Stroke Association. 

WakeMed Raleigh Campus received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Performance Achievement and Gold Plus Quality Achievement Awards for exceptional performance for 24 months.  WakeMed Cary Hospital received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Silver Performance Achievement Award for exceptional performance for 12 consecutive months.   

Award quality measures include aggressive use of medications, such as t-PA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol reducing drugs and smoking cessation, all aimed at reducing death and disability and improving the lives of stroke patients.

The press release announcing this exciting news can be found here.

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Drug Shortages and You

Did you know that currently if a manufacturer decides to stop making a drug, they can just stop without alerting anyone? Additionally there are no rules dictating when companies have to tell the FDA that there is an issue found in the manufacturing process.

This often leaves patients, pharmacies, and clinical providers in tight spots. Frequently, there are substitute medications available, but for some medically necessary drugs these shortages can mean the difference between life and death.

For example, over the past year we have had shortages of medically necessary drugs like dexamethasone that reduces inflammation when a breathing tube is removed and it helps reducing swelling in the brain. And there are hundreds of other prescription drugs that are currently shorted.

The American Society of Health System Pharmacists is hoping that a bill working its way through Congress will require manufacturers to notify the FDA of any discontinuance, interruption or adjustment in the manufacture of a drug that may result in a shortage. If manufacturers are required to alert the FDA of potential problems sooner or discontinuation of certain medications, then the FDA could give advance notice to other companies making the drug to ramp up.

Read more about the issue here, and take this opportunity to encourage Congress to regulate drug makers to ensure that patients always have access to the lifesaving medications they need by sending a letter to your Senator.

Lynn Eschenbacher is manager of WakeMed Raleigh Campus inpatient pharmacy and is a member of the American Society of Health System Pharmacists.

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