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Making the ED Less Scary for Kids –and Parents Too!

Even for adults, the Emergency Room can be a scary place. For children, who may not understand where they are, what’s happening or why, the experience can be terrifying. That's why the MarinHealth Medical Center Emergency Department has adopted an “ouchless” approach to emergency pediatric care. As an "Ouchless" ED, MarinHealth Medical Center's Emergency Team uses child-friendly protocols to make visits to the ED less stressful, and more effective, for children and their families.

In this segment, Michelle Tracy, RN, Director of Emergency & Trauma Services at MarinHealth Medical Center, provides an overview of our Ouchless ED. Learn about the emergency room staff’s training in kid-friendly, ouchless care and age-appropriate communication. Find out what a difference tools like needle-free injections and interactive educational toys can make to a frightened youngster and the care they receive.
Making the ED Less Scary for Kids –and Parents Too!
Michelle Tracy, RN
Michelle Tracy, RN, is the Director of Emergency & Trauma Services at MarinHealth Medical Center.

Bill Klaproth (Host): Anyone who’s been to the Emergency Room knows it can be a scary, anxiety-filled experience, so it’s not difficult to imagine how much more terrifying it can be for a child. That’s why Marin General Hospital has introduced an Ouchless approach in their Emergency Department. Here to talk with us about the Ouchless Emergency Department, is Michelle Tracy, a Registered Nurse, and the Director of Emergency Trauma Services at Marin General Hospital. Michelle, thank you for your time. What goes into making an Ouchless Emergency Department?

Michelle Tracy (Guest): Good morning. Well, an Ouchless Emergency Department is just that. It is trying to take away pain and anxiety while children visit the Emergency Department, and take away anxiety from the parents while they’re watching their children – who are very sick sometimes – go through all of the traumatizing experiences that most children go through when they come into a hospital.

Here at Marin General Hospital, we had a goal. We wanted to give family-centered care, and we really wanted to minimize the pain and anxiety of children. Our nurses went through a four-hour training course where they learned about pediatric emergency care with the help from the experts at UCSF Benioff Children’s Hospital. They came in, and they taught us all about sensitivity training – how to meet children’s needs using distraction techniques, how to talk to children using their own language at different age levels. Also, what children see when they actually enter into an Emergency Department. At their level – if they were five years old, what do they actually see when they walk in? What do they see when they’re laying on a bed? This gave all of the nurses a different outlook on the difference between a child and an adult.

Then, after they had that training, we put all of our nurses through a two-day course, and they became certified in what’s called an Emergency Nursing Pediatric Course. That basically is on how to treat children for every illness that they have when they come into the Emergency Department. In total, these nurses have had twenty hours of pediatric nursing education. Then what we did, is we went and remodeled three rooms – pediatric friendly – so that children feel like they’re in a play area rather than a hospital room.

Bill: And what about the role of a Child Life Specialist.

Michelle: Child Life Specialists are like play therapists. They come in, and they educate children using toys and dolls and iPad programs to teach them all about what it’s like to be in the hospital, what the procedures are like that they may have, and what is going to happen to them while they’re here. That lets the nurse focus on the actual procedure on making the child comfortable.

We use many techniques here in the Emergency Department. We have what’s called numbing medicine that we put on the skin of the child before we are actually going to use any kind of shots or any kind of IV placement. This numbs the skin, and the child doesn’t feel anything when we do the shot or the IV. The Child Life Specialist is in the room at that time, and she continues to play with the child so that they don’t even know what is happening. It’s been very successful.

We also have the ability to give medications into a child’s nose. Those are rapidly absorbed through the tissue in the nose. We can give medications for pain. We can give medications for anxiety. That is really wonderful because you don’t have to give any shots at all. The other thing that we do is that we have a special air-injected syringe, which pushes lidocaine – which is a numbing medicine – right through into the tissue of a child’s arm where they may have to have a shot or an IV. The numbing medicine that we use with the cream takes about 30 minutes to work. This numbing medicine with the syringe only takes 30 seconds to work. If we rapidly need to use something like that – say a child comes in after being in a car accident, and we really need to get an IV in them very quickly, we can use this air-compressed lidocaine, and be able to put in an IV and they still won’t feel the pain, which is very helpful.

Bill: I love how you’ve rethought this whole process trying to see things from the child’s perspective, putting things at their level. What a great way to gain insight into their experience – and then developing processes around it to make it, as you say, anxiety and pain-free. I love this. Will more hospitals be going to this Ouchless Emergency Department approach?

Michelle: That’s what we are hoping. We’re hoping to be able to take our approach and talk about it enough so that other hospitals hear about and we can share it. We don’t want this just to be our program. We want this to be every ED’s program. As a mother myself, having to go into an Emergency Department and even doctors’ offices, and watch my children go through shots and have to have procedures done, I wish this was available back then. We are actually reaching out to our community pediatric offices and doing training with the pediatric nurses so that they can bring this into the offices and actually use these techniques.

Bill: Michelle, as a parent myself, I certainly would have appreciated this Ouchless approach to the Emergency Department.

Michelle: And we allow the parents actually to participate in the care of the child. It used to be that the parents would just sit on the sidelines and kind of watch what was happening. Here, at Marin General Hospital, what we do is we actually encourage them to please come over and let’s have Johnny sit on your lap. We’ll put the IV in while you hug them and the Child Life Specialist is reading a story or playing with the doll. It just gives the overall feeling of comfort and safety, and it doesn’t make the experience a bad one for the parent or for the child.

Bill: It just makes common sense. I love this new process. What should a parent know, Michelle, ahead of time when bringing their child to the Emergency Department at Marin General Hospital? Do you have any tips to share on that?

Michelle: If the child is on any kind of medication before they come in if they could grab the bottles or remember what medication on the list so that we can properly treat, that’s the first thing. The second thing is to remember any allergies, to write them down on a list, so we know what the allergies are. We want to be able to properly treat the child to whatever is going on with them.

The other thing is, is that you can be encouraged that when you come into the Emergency Room here at Marin General, you’re going to get specialized pediatric care from nurses and doctors who have been educated to pediatric care. I think that’s something that’s very special and unique to Marin County as we have not had this in the County. Most people who want that specialize care usually go into the city to a Children’s Hospital. Now, we actually have this right here in our community, and people don’t need to go over the bridge to seek that kind of pediatric care any longer.

Bill: What a wonderful program this is, and great service to the community. Michelle, thank you for talking to us about the Ouchless Emergency Department at Marin General Hospital. For more information, you can go on over to, that’s This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.