First off, ask your pediatrician, of course. But do some detective work, too. Start by calling or stopping by the hospital to speak with the director of emergency services and asking these questions:
1. Do you have a pediatric emergency-care specialist on staff -- or at least pediatricians available 24/7? About 40% of ERs in the United States don't even have round-the-clock access to pediatricians, according to the Centers for Disease Control and Prevention. You want to be sure that your child's ER is staffed with pediatricians, pediatric nurses, and, ideally, pediatric emergency-medicine specialists (not just general emergency physicians). If it is, it's the strongest indication that they'll have the right equipment.
2. Do you have medications in doses appropriate for children? Are they available in chewable or liquid form? This is important. Many hospitals don't have pediatric medications, and it can cause life-threatening complications.
3. Does your ER have child-sized resuscitation equipment? Are there beds, IVs, and oxygen masks made for children? They need to be well stocked in extra-smalls.
4. Do you have a separate area just for pediatric patients? A good pediatric ER will have a kid-friendly section that will look more like a Chuck E. Cheese restaurant than an acute medical care facility. You should find a TV, cartoon DVDs, a few toys, and coloring books (though try to remember to bring comforting favorites from home, too). While the distractions are helpful, here's the real benefit: Your child will be shielded from the drama in the average ER. As a bonus, so will you. When it comes to germs, stress, and sanity, this is better for everybody. Unfortunately, many hospitals don't have a special emergency area for children.
5. How many children under the age of 5 years do you treat every week? More than 50 is a good answer; 3 is not. You want an ER staff that's adept at dealing with screaming babies, frantic toddlers, and -- not that you'll need this angle of their expertise, of course -- hysterical parents.
6. Do you have a separate urgent-care satellite center? If a nearby hospital doesn't have a dedicated pediatric ER, at least you're likely to get treated faster in the satellite center than the general ER. Similarly, the ER will be less crowded with non-life-threatening cases because of the satellite center.
7. Is the hospital accredited by the Joint Commission? If so, it means the hospital has voluntarily met national health and safety standards. You don't need to interrogate an ER staffer to find this out; you can use the Joint Commission's Quality Check to see whether the hospital is accredited (as well as how it's performing in several key areas).
8. Are there translators on site? You may speak English, but -- and this is a big point that many people dangerously overlook -- does your child's nanny, babysitter, or grandparent who watches her every day speak English? Believe me, this can be critical.
Once you've identified your best emergency option, map out how to get there, and do a couple of dry runs before you actually have a crying little one gushing blood in your backseat. In a real emergency, you might not be driving -- you might not even be in your own vehicle -- but at least you'll know how to get there. Someday, that might also help you decide whether to drive yourself and your child to the ER or to call 9-1-1. But don't throw away your list of other choices. If an emergency strikes when your daughter is at a sleepover four towns away or your son is playing Little League in a neighboring community, it may come in handy. Unfortunately, by their very nature, emergencies are unplanned. Be prepared. Have backups.
