intro: Welcome to Pediatric Voices, Duke Children's
Podcast about kids healthcare. Now, here's our host, Dr. Angelo Milazzo.

Angelo Milazzo, MD (Host): Hello and welcome to
Pediatric Voices, a podcast that dives deeply into conversation with the people
who make up the Duke Children's Healthcare team. I'm Dr. Angelo Milazzo, a
Pediatric Cardiologist and Professor of Pediatrics at Duke Children's, and a co-host
of the show. My friend and the other co-host is Dr. Richard Chung. Richard is a
Pediatric and Adolescent Medicine Specialist and a Professor of Pediatrics here
at Duke Children's. We're both here to bring you expert insights about timely
topics in children's health.

On this episode of Pediatric Voices, let's look at the topic of
summer safety. As we're recording this, it's the first official week of the
summer season. To pediatricians, summertime means the end of the school year.
It means vacations, some time with family and friends, and of course, in
contrast to all that fun, some potentially dangerous situations as well. Kids
will be swimming, biking, traveling, going to parties, doing all sorts of
things, and of course not to mention some of the potentially dangerous things,
which we will talk about with our guest today.

And so to help us understand this, I'm talking with Dr. Emily
Greenwald, a physician and faculty member here at Duke Children's. Dr.
Greenwald is a Pediatric Emergency Medicine Physician. In other words, a
physician with training both in pediatrics and in the care of children with
medical emergencies. Dr. Greenwald is an Assistant Professor of Pediatrics in
the Duke University School of Medicine. She's a key member of our division of
emergency medicine and the Medical Director of the Pediatric Emergency
Department at Duke University Hospital here in sunny Durham, North Carolina.
Dr. Greenwald teaches in our Improvement Science Leadership course.

She's widely published. She's won several professional awards,
and she serves as a mentor to other pediatricians, to our trainees, and to our
medical students. And that's only some of what Dr. Greenwald does. So without
further ado, welcome Emily. It's a pleasure to have you today on Pediatric Voices.

Emily Greenwald, MD: Thanks. I'm thrilled to be here.

Host: How does it feel to be an early guest on this
still very new show.

Emily Greenwald, MD: Yeah, it's an honor really. I've
never been on a podcast before, although I've listened to plenty of them and
enjoy them. So it's interesting to be on the other side of things and
contemplating what I want to share with the world about pediatric emergency
medicine and summer safety.

Host: Well, I'm excited to have you here, of course. So
let's start with your origin story, Emily. How did you get interested and
involved, just generally with the care of children? Let's start there.

Emily Greenwald, MD: I've always been sort of a child at
heart, I'll admit, which I think many pediatricians are. And I actually was a
paramedic before medical school. And so I was involved in the emergencies that
occur for all sorts of people, right from the start. But I found that I was
drawn to children and thankfully as a paramedic 911 service, I didn't have to
respond to too many pediatric emergencies because they can be terrifying when
you don't have specialty training to take care of children in those situations.

But then in medical school I realized that there was training
to be had. I could become a Pediatrician and then further sub-specialize to be
prepared to take care of children with all sorts of medical emergencies and
injuries. And I feel proud to be able to help children and their families, when
those things occur. I wish they didn't, but I feel proud to be there with the
team that can take care of them.

Host: Emily, I think it's very interesting that you were
a emergency medical technician in a previous life. That is, from my
perspective, not the most common route into medicine. Can you talk a little bit
about how one thing led to the next?

Emily Greenwald, MD: So I had an interest in going to
medical school actually and pursuing medicine, but I had eight years off. I say
off, but I was certainly working hard. I actually ran my own company in between
undergrad and medical school, building houses, buying hundred year old row
homes in Philadelphia, and ripping out the guts of them, so to speak, and
redoing them.

And it was physical work and it was creative work and I loved
that, but I wanted to do something more. And so I became a volunteer EMT, and
just an EMT basic, which they don't have as many skills and don't do quite as
much as a paramedic. And found that I really loved that. And then as I found,
you know, I really want to do something different and more with my life, I went
ahead and went to paramedic school, while I did what I would call a dust off of
all of my books from college, organic chemistry, et cetera. And then took the
MCAT and applied to medical school. So absolutely true that this is not the
usual route that many folks take to medicine. But, I think it made me a unique
applicant and definitely I have a different perspective than other physicians
at times.

Host: And that, ladies and gentlemen, is why I enjoy
being a member of the Duke Children's team because I get to work with people
who just have amazing experiences and backgrounds outside of medicine. So I
really appreciate you digging into that a little more deeply for us. So let's
jump into the topic at hand.

And I want to start, Emily, by getting your overall perspective
on the scope and the extent of the problem of summer safety for children.

Emily Greenwald, MD: Yeah, I mean, the scope is huge. I
was thinking about what should we talk about for the limited time during a
podcast and probably we could do an entire podcast series on summer safety and
break it up into individual sessions. And so what I'd like to do is hit some of
what I think are the most important points, from the perspective of seeing the
result of some of these emergencies, and pediatric patients coming to the
emergency room from summer safety events and injuries, I will call them. And
then also potentially if there are any show notes that we could add, we could
put some resources in for families, pediatricians alike, for further resource
and reading that have to do with this.

And when I think about summer safety and when I think about the
summer, even as a pediatric emergency medicine physician, we kind of have two
seasons in our emergency room. One is winter where we have a lot of respiratory
viral illnesses, and really medical or illness based emergencies are showing up
more than any other kind. People aren't outside as much, they aren't at the
pool, they aren't going across monkey bars, things like that; versus in the
summer, the type of patients that we see actually changes quite a bit.

And so we see many more injury based emergencies. Some of them
are preventable. And some of them aren't. And so talking through today how I
think we can reduce the risk for children, I don't want to come on here and say
that a child should never go across the monkey bars cause that's a whole lot of
fun.

But there are certain things, when we think of safety, that are
higher risk and certain things I don't think any child should ever do. And then
certain things where a parent can step in or a caregiver can step in and really
put certain things in place to help lower the risk or mitigate the risk for
partaking in that fun activity.

Host: Emily, our audience is probably more familiar with
the emergency department than most other areas of the hospital, both through
personal experience and also through the media. I mean, every medical show or
movie seems to include something about what it's like to be an emergency
physician. Can you give us your perspective on a typical summer day or night in
the emergency department? What is it actually like?

Emily Greenwald, MD: It's busy. It takes a lot of
energy. I'm constantly up out of my chair seeing patients, meeting families,
advancing the care of each individual patient and family, and trying to figure
out who is the most sick or injured who needs my attention first, and who is
second, who's been waiting a long time that maybe has a more minor injury, but
we need to take care of and so it's exhilarating. It sometimes can be
heartbreaking. There's certainly emotions involved from the point of view of a
family, it can be scary. And so part of my job and part of the job of the
entire team of the emergency department is to try to help patients and families
understand what each step is, understand what their illness or injury is, and
make them feel as comfortable as they can in what is, by definition, a very
uncomfortable environment.

But I would say the word bustling, is a word that probably
characterizes the average summer evening.

Host: So if we think about what some of those common
injuries are that bring children and their families to the emergency
department, what can families do by way of prevention, by way of thinking ahead
so that, you know, they don't wind up in your care if they can avoid it?

Emily Greenwald, MD: So when I think about this, even
for my own children, I have three of my own children and I'm thinking about
always the balance between having fun and doing summer activities and keeping
them safe. I think that that's in the front of any caregiver's mind for
children. And so the biggest riskiest activity for children, one of them is
swimming, being exposed to water. And certainly I want my own children to be
able to have fun in the water. But I also want to think of how do I keep them
safe? And I have, in my family everything from an infant up to an eight year
old who's a very good swimmer. And so water safety is a huge topic for the
summer.

And then you break it down into further categories. There's the
ocean where you've got rip tides and currents to be aware of. You've got
swimming pools with lifeguards. You've got buckets full of water left out that
a toddler could fall into, actually. And then you've got things like lakes
where you can't really see below the surface unless you've found the most
crystal clear lake, which I'm sure a few exist in North Carolina, but I haven't
seen many.

And so thinking through how can I keep my child safe? The major
thing for me is, any child who is not an extremely strong swimmer should have
what's called touch supervision. And so that literally means that there is an
adult caregiver in the water with that child within a touch reach. And even at
the swimming pool, there is a lifeguard that needs to keep track of many
children in the pool, and that's a real challenge.

So touch supervision. Appropriate life jackets if you're on a
boat or in a lake. Talking with your kids about the boundaries and limits
within the water, coming out for breaks, those sorts of things. I saw recently
an idea about a water watcher card where if there are a number of adults that
are going to help watch the children, you can pass this card because when
adults are distracted, they can't watch children as closely in the water.

You may have a conversation with a friend and suddenly you've
lost track of the children you're supposed to be keeping an eye on. And so if
you have this card in your hand, it's your turn to have complete supervision of
your kids and then you could pass it to the next adult. Cause it can be
exhausting the level of supervision it requires to keep children safe in the
water.

Host: Emily, can you say a few things about specific
activities that children should avoid and I mean avoid altogether? So I'm
thinking about things like firearms, fireworks, riding a bicycle or a
skateboard without a helmet, those types of activities. Which would you point
to as these so-called unavoidables?

Emily Greenwald, MD: So while there are a number of
things that we can participate and have our children participate in that are
fun and that can be safe if done properly, like swimming, monkey bars, even
trampolines, when you've got one kid jumping; there are a number of items that
I like to mention to families and that I am very careful about with my own
children, such as; fireworks. It's good to view them from a distance in a
public display, but they can be very dangerous for children if they're anywhere
close to them, and there's really no way to reduce that risk. Another is
firearms. So guns, and so when my children go to a friend's house to play, I actually
text the family a list of questions, just a few.

And I say, you know, my children are really curious, and I've
been advised by my pediatrician to ask if there's any unsecured firearms in
your home. And that's a safety question that you should feel free to ask,
before your children play at any person's house. And certainly if you have any
firearms yourself, making sure that they're very secure. Because nothing is
more heartbreaking to me as a pediatric emergency physician than a injury to a
child that really is preventable. And then finally, just always remembering to
have your kids wear a helmet, doing things like biking and following the
traffic rules when biking. Biking can be a lot of fun, but it should always be
done with a helmet.

Keeping that in mind for the summer, and then have a ton of fun
this summer. There's a lot that you can do safely. Just take that moment to
think, is there anything I can do to make this activity more safe? And if so,
take a moment to do it.

Host: Emily, you mentioned earlier that you have ideas
for additional resources for patients and families, and we will try to add
those to the show notes for this episode and make those available to our
audience. I want to take you out with this question, close out with getting a
little bit of a sense of what your inspirations are.

So, tell me, Emily, what inspires you most in your day-to-day
work and life?

Emily Greenwald, MD: I think in general, whether I'm at
work or whether I'm at home with my own children, it's the resiliency of
children in general, how resilient children are. And, while we take care of
many children in Duke's Pediatric Emergency Department that are even severely
injured; what I'm constantly inspired and amazed by is how they can heal and bounce
back and go on to live very productive lives, all while keeping the best
attitude. And I'd say the other thing that really inspires me really at work is
the teamwork and the team in the pediatric emergency department. I work with a
number of just really incredible nurses, respiratory therapists, pharmacists,
just the team is incredible and every day I feel proud to be part of that team
and we really couldn't deliver the high quality care that we do, without every
single member of that team. And so that inspires me every day at work.

Host: Emily, thank you so much for being a guest on the
show. I hope you'll come back and explore this topic with us again, as you
said, we could do many shows about the pediatric emergency department and your
work. I hope you do not have a busy summer season. Pediatric Voices is brought
to you by Duke Children's Hospital and the Department of Pediatrics at the Duke
University Medical Center in sunny Durham, North Carolina.

The show was created by Dr. Richard Chung and by me, Dr. Angelo
Milazzo. Rebecca Casey provided a huge assist. And Rebecca, if you're
listening, congratulations on your retirement. Our podcast is produced by Dr.
Podcasting. Thanks to Dr. Anne Reed and the team at Duke Children's for their
support. You can find the show and hit the subscribe button wherever you find
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We'd love to hear from you, so leave us a review. Thanks for being a part of
the show.

We'll see you next time.