The West End, in good weather, is almost two and a half hours from the nearest emergency departments and seven hours from Denver Children's Hospital. There are no communities of the West End's size as far from definitive medical care in Colorado. In the past, the Basin Clinic had difficulty recruiting physicians, nurses and mid-level providers, who worried about the “frontier” designation and what that means when presented with, for example, a sick child. When the roads are impossible, when a snow plow escort for the ambulance is the only possible way out — it is as if we are back to 1940 with a five or six-hour transport through ice and storm. Complete road closures with no available air evacuation do occur usually a few times a year.
Sick children are a special quandary, both for most parents and physicians. Under ideal circumstances, it takes at least an hour to get a child flown to an emergency department.
Children at first have great reserves, but then tend to "crash" suddenly when those reserves are exhausted. They are more likely to have respiratory or dehydration problems, or a dangerous combination of both. Often families can stay home from work and slowly hydrate, control fever and monitor a child through an illness, but experience and diligence may be life-saving.
Dr. Thomas Miller, MD FAAP, staff pediatrician at Pediatric Associates, of Montrose, reported as of Dec. 19, two children were currently in the hospital with RSV.
He said COVID was very active last fall, but now seems to be less of an issue. He added Colorado has some of the highest current Influenza A activity in the country, and local doctors are seeing quite a bit of flu now.
"For babies less than 8 months old, there is a very safe shot that provides them with antibodies to RSV,” Miller said. “It is very effective at preventing doctor visits, hospital admissions and ICU stays."
For the sick child, Miller lists three things to watch for that would require a parent to call 911 or the clinic. The first is trouble breathing or working hard to breathe; for example, if a child is breathing like they just ran a race and can't catch their breath.
The second is dehydration. If an infant or child is peeing at least three or four times in a 24 hour day, then they usually don't need IV fluids.
Thirdly, also to consider is a secondary bacterial infection that might need antibiotics, and that would include things like ear infections, pneumonia or sinus infections. Fever can be telling in bacterial infections.
"If a child gets a fever late in their illness after being sick for a few days, it is always worth going in to have them checked,” Miller said. “If their fever goes away for 24-48 hours and then returns, it is always a good idea to have them checked."
He said fever is generally not as big of a problem as dehydration and breathing issues, which are more important than a number on a thermometer. Still, having a thermometer is helpful, although rectal temperatures are the most accurate, and feeling the forehead is often misleading.
Miller said CPR knowledge is important.
"I think it's a good idea for every parent to take a basic CPR class, so they know what to do in an emergency,” he said.
