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American Family Children's Hospital (copy)

Pediatric specialists at American Family Children's Hospital, connected to UW Hospital, have joined Project ECHO, an international program based in New Mexico that aims to spread medical expertise throughout regions.

When children in the street are hit by motor vehicles, their injuries can be worse than for adults, a pediatric trauma expert from Madison recently told health care workers from around Wisconsin.

Children’s ribs are softer, so their lungs can more easily bruise, said Ben Eithun, pediatric trauma program manager at UW Health’s American Family Children’s Hospital.

Kids usually have less fat to protect their abdomens, so their livers and spleens are more likely to bleed, Eithun said. Their heads weigh more in proportion to their bodies, so they typically hit the ground head first.

“We see a lot higher incidence of head injuries in pedestrians who are younger,” he said.

Eithun’s tips on pediatric pedestrian injuries last month weren’t delivered at a Wisconsin Dells conference room or another typical venue for statewide continuing education.

He shared the information by teleconference through Project ECHO, an international effort to spread medical knowledge, which UW Health joined this year.

Telemedicine has increasingly connected patients in outlying areas with specialty doctors in bigger cities. Project ECHO extends the concept to medical instruction for health care workers, in a format called “telementoring.”

“It gives us a chance to talk to these people without driving all the way out there,” said Dr. Jonathan Kohler, head of UW Health’s Project ECHO program and a pediatric surgeon at American Family Children’s Hospital, where many children who suffer traumatic injuries are sent from around the state.

“The real value is in reaching out to primary care providers and emergency departments who are seeing these kids before and after we take care of them surgically,” Kohler said.

Project ECHO, which stands for Extension for Community Healthcare Outcomes, started in New Mexico in 2003. Dr. Sanjeev Arora was frustrated that patients with hepatitis C had a hard time getting treated in many parts of the state. He started training primary care doctors to treat the disease in their communities.

Today, Project ECHO, founded by Arora, has more than 120 hubs in 23 counties that disseminate medical expertise.

UW Health became a hub this year, with a focus on pediatrics. Monthly sessions have addressed burn care, emergency transport and radiology for children, along with autism and epilepsy.

The lessons are welcome, said Joy Erb-Moser, a clinical educator in emergency medicine at Mayo Clinic Health System in La Crosse, who has participated in most of UW Health’s Project ECHO sessions.

“The thing that concerns emergency workers the most is the pediatric population,” Erb-Moser said, because the workers have less exposure to young patients and cases involving children are emotionally sensitive.

“It tends to set people on edge,” she said. “I don’t think we can be prepared enough for kids.”

Some of the sessions have drawn up to 20 people, including nurses and other health care workers from Baraboo, Beaver Dam, Lancaster — and even Escanaba, Michigan. During last month’s session on pediatric pedestrian injuries, eight people took part, from places including Eau Claire and Green Bay.

Eithun told the group that even though some adults shouldn’t be transported on backboards because their skin can break down, it’s often better to put children on the immobilization devices to prevent further injury to their spines, which are softer and more flexible.

Kohler talked of a 3-year-old boy he treated who was hit in the chest by a golf cart. The boy came into the emergency room with a small bruise on his chest but otherwise seemed OK. Doctors considered releasing him before doing additional tests that revealed a major injury to his heart.

The boy recovered. But in some places, children are occasionally let go before the seriousness of their injuries is recognized, Eithun said.

“It’s easy to miss these things,” he said.


David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.