When Mary E. Fallat, MD, FACS, from the University of Louisville in Kentucky, takes the podium to deliver this afternoon’s Scudder Oration on Trauma, “Optimizing Strategies to Improve Trauma and Burn Care for US Children,” she will bring decades of experience as a pediatric surgeon and trauma leader to one of the most urgent conversations in American healthcare: how to build a coordinated system that reliably delivers high-quality trauma and burn care to children.
Bridging the Gaps
According to Dr. Fallat, trauma and burn care in the US are fragmented, particularly for children. Burn centers are verified by the American Burn Association, while trauma centers are verified by the ACS or state systems (or both). Meanwhile, pediatric services often are siloed from adult care.
“Ideally, we will develop an action plan for the emergency and initial care of injured children and facilitate transfer to definitive care,” she said. “The goal is to ‘raise all boats’ and make sure the initial emergency care for kids becomes an imperative for all hospitals across all disciplines.”
This message carries urgency in the current global climate. Conflict, whether abroad or at home, can lead to complex injuries involving burns and trauma in adults and children alike. Yet, Dr. Fallat warned: “Our everyday system of pediatric care is ill prepared for large-scale emergencies in all geographic areas except those contiguous to pediatric hospitals and integrated adult/pediatric trauma centers. In addition, many of our children’s hospitals and trauma centers are often boarding patients in the emergency department (ED), so the prognosis for pediatric or adult disaster preparation is guarded at best, and its integration into a population-based system varies but is not optimal in most parts of the US.”
Pediatric Readiness: A National Imperative
Central to Dr. Fallat’s lecture will be the National Pediatric Readiness Program, supported by the Health Resources and Services Administration and the Emergency Medical Services for Children Program. The initiative aims to ensure that emergency medical services (EMS) providers and EDs across the country are prepared to care for children, regardless of geography.
Pediatric readiness, she explained, is an initiative to make sure that prehospital care clinicians (i.e., EMS) and EDs have “all the right stuff” to care for kids, including supplies, education, training, quality improvement, policies and procedures, and a way to access a higher level of care if needed.
“Most of the nation’s children are seen in rural or underserved areas, where hospitals may see fewer than 10 children a day,” Dr. Fallat said. “Only 8 out of 100 EMS runs involve children.”
That limited exposure makes pediatric readiness an issue of training, simulation, and repetition. “Repetition is revelation,” she shared, emphasizing that consistent education and drills are vital to elevate care for children who may arrive in facilities unaccustomed to managing pediatric trauma.
Common-Sense Solutions
While her insights may not be “groundbreaking” in a scientific sense, Dr. Fallat said they are “grounded” in common sense. Among the points she will share during the Scudder Oration are:
- Use of existing guidelines. Despite national evidence-based triage guidelines for trauma patients, including children, many states lack mandatory EMS protocols, and some services choose not to use them.
- Affordable readiness. Making every ED “pediatric ready” is not prohibitively expensive but requires annual investment from hospitals and states.
- Integration. Pediatric and adult trauma communities, burn centers, and children’s hospitals must commit to working together more effectively, as sharing the needs of children is a higher-level expectation.
- Communication. Regional Medical Operations Coordination Centers, where experts can provide real-time guidance and coordinate transfers, represent an ideal model of integrated care.
- Military involvement. Pediatric readiness must extend to military environments, where children may be treated in austere or conflict settings.
Dr. Fallat also will acknowledge the human side of care. Fatigue, loss of resilience, and high patient loads can strain even experienced clinicians. Empathy, communication, and feedback loops between referring and receiving centers, she said, are essential to strengthening trust and improving outcomes.
Challenges and Controversies
Dr. Fallat does not shy away from the systemic hurdles that hinder progress. For decades, children have been treated as an afterthought in emergency planning.
Children are only 22% of the population and “we’ll include them later” has too often been the refrain. Rural hospital closures, the loss of pediatric units during COVID-19, and clinicians’ discomfort in caring for children also contribute to a fragile system.
Instead, she said, “Children are 22% of the population and a special population that needs to be included from the beginning. Adding children’s interests later has been the round peg in a square hole for generations.”
She cautioned against the mindset that “children are not small adults” becoming an excuse for adult providers to “abdicate their responsibility to care for children.” In the lecture, Dr. Fallat will call for a team-based approach in which every ED invests in pediatric readiness, supported by bidirectional collaboration with pediatric specialists, including surgeons.
Call to Action
Dr. Fallat plans to underscore that every child’s outcome depends on the system in place at the moment of injury—whether that occurs in an urban hospital, rural community, or remote summer camp.
“Most children at some point in their lives are risk takers and may be in some remote place when they experience an injury. The ability of a child to have a good outcome is dependent on the system of care in place wherever they experience this injury,” she said. “What kind of preparation would any surgeon want the closest emergency department to have to take care of the child who is important to them?”
Quoting James K. Styner, MD, FACS, founder of the ACS Advanced Trauma Life Support® program, she concluded: “You can’t blame them until you train them.”
The Scudder Oration on Trauma, sponsored by the ACS Committee on Trauma, will be from 12:45 to 1:45 pm in Room W-375b. The lecture will be made available for on-demand viewing shortly after the live presentation.
