Each year, almost 90 percent of the 30 million kids 18 years or younger who end up in the Emergency Department are treated in general community hospitals. Unfortunately, many emergency rooms are not equipped well enough to treat children, and doctors and nurses there may not have training in pediatric care.

EDs which cared for 14 children or less per day, had a median weighted pediatric readiness score of only 69, out of a 100 point scale. The median score jumped to 90 for EDs which cared for more than 27 children per day, according to the results of a national assessment of 4,000 U.S. hospitals on the readiness of their pediatric EDs published in JAMA Pediatrics earlier this summer.

The assessment was based on if the hospitals were in compliance with revised guidelines issued in 2009 by the American College of Emergency Physicians, the American Academy of Pediatrics and the Emergency Nurses Association. Almost 83 percent of hospital EDs responded to the Web-based survey in 2013.

The good news is that these scores have improved, compared to a median score of 55 from a similar survey conducted in 2003. In this recent study, all the EDs that responded to the survey were open 24 hours a day, seven days a week, in all 50 states, the District of Columbia, and eight US territories. EDs were categorized by the reported number of pediatric visits per year, as low volume (up to 5 patients per day are seen), medium (6 to 14 patients per day), medium to high (15 to 27 patients per day), and high (more than 27 patients per day).

Readiness was better in higher-volume EDs, and those that had a designated physician and nurse pediatric emergency care coordinators. Overall, EDs stock 91 percent of the recommended pediatric equipment, but more than 15 percent of the EDs did not have some of the more advanced equipment to help assess and manage a child who is having severe breathing difficulty.

About 67 percent reported weighing kids in kilograms only. All medications, including life-saving ones, are calculated based on a child's weight per kilogram. Recording weight in pounds can easily lead to potentially dangerous dosage medication errors. Only 47 percent of the EDs reported having a disaster plan that includes the specific needs of children.

Which ED should you take your child when he or she is experiencing an emergency? It's best to know ahead of time which ED is best equipped for children.

Ask your child's doctor which ED is better prepared for children in your area. Familiarize yourself with that ED. Know the quickest way to get there, especially if you have to rely on public transportation. You should always call 911 if you believe your child's emergency is life threatening. Here's a list of situations from KidsHealth of when you should call 911.

Here are a few other things to keep in mind:

Children's hospitals probably have the most pediatric staff, specialists, and facilities. It's a good choice if it's an emergency and a children's hospital is located nearby.

Some community EDs are staffed with pediatric physicians and pediatricians with experience in treating emergencies. Most of these have an inpatient pediatric service should your child need hospitalization. In our region, these hospitals include Temple University Hospital, Bryn Mawr Hospital, Cooper University Hospital, all Virtua hospitals, and St. Mary Medical Center.

Emergency medical services providers will take your child to the nearest appropriate facility if you dial 911. The local hospital nearest you will provide the initial medical care needed. If for any reason the hospital isn't equipped to treat your child's specific condition, the doctors there will arrange a transfer to a facility equipped for your child.

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