Could $2.4M prevent Montana children from dying in the ER? Some experts say yes.

Montana’s Public Health and Human Services Department is encouraging hospitals to take steps to better prepare their emergency rooms to treat pediatric patients, following new recommendations from a coalition of health care professional groups. 

Hospitals can apply for the state’s “pediatric prepared” status, which is based on a national readiness program that identifies which hospitals are most capable of treating young patients. 

On its website, the state health department wrote that it hopes to ensure “the right care, in the right place, at the right time and with the right resources no matter where the child lives.” 

Many of the changes suggested by the coalition — which includes the American Academy of Pediatrics and American College of Emergency Physicians — are fairly simple and low cost. Some involve straightforward steps such as keeping equipment closets stocked with kid-sized medical devices or implementing a consistent protocol for dispensing medication which in pediatrics is dosed by weight. 

Montana is one state where changes could have the greatest impact on the number of children’s lives saved in emergency rooms, according to a recently released study. That’s in part because so many of the hospitals are small and rural, which means they are less likely to have specialized health care providers or high-tech equipment. 

“From a physician standpoint, there’s a huge opportunity to save lives,” said Bobby Redwood, an emergency department doctor in Bozeman and past president of the Montana chapter of the emergency physician professional group. “But you have to know about it and hospitals have to participate. So, on the one hand this is all very voluntary; on the other hand, it is mandatory because it saves pediatric lives.” 

Although Montana’s network of small, rural hospitals relies on being able to stabilize patients and transfer them to larger facilities with more specialized care, a child who dies in the emergency room is most likely to die within three hours of their arrival. That is often faster than transport can occur, especially with long travel distances and sparse EMS resources. 

Children who receive care at emergency rooms with high pediatric readiness were about 75% less likely to die than those who were treated elsewhere, according to the 2024 study from JAMA Network. 

“I have worked in emergency rooms that are not pediatric ready, and you can tell the difference,” Redwood said. “When a sick child comes in, is it a streamlined, smooth process where everybody knows their role and knows the equipment, or is it stressful? In a well-run emergency department, everything has its place and everything is in its place”

Central to the recommendations is an understanding that pediatric patients are fundamentally different from adults in everything from their anatomy to how they need to be communicated to. 

“They’re not just little adults,” said Lily Anderson, a nurse at St. Vincent in Billings, which has been certified as pediatric prepared since 2008. “They are a unique population.” 

Other benchmarks include making sure pediatric-specific equipment is readily available and properly labeled to emergency room staff, keeping a child-specific resuscitation cart on the floor, appointing a pediatric care coordinator who oversees protocol when dealing with young patients and measuring and recording pediatric weights only in kilograms so that it can be more easily translated to prescription quantities. 

“It isn’t about spending a bunch of money on the best medical equipment,” said Lisa Foley, the St. Vincent trauma program manager. “It really is doing those guidelines that are pediatric specific involving your blood bank, your lab, medication…any size facility really can do it.” 

A cost estimate in the JAMA study suggested that every hospital in Montana could achieve pediatric readiness for a grand total of $2.4 million. That’s $10.84 on a per child basis, one of the higher tallies in the country, driven by the state’s small population, though still a a modest investment if it means saving lives, study authors wrote. 

“Saving children’s lives benefits families, communities, and society at large, which suggests the need for societal investment. High ED pediatric readiness is highly cost effective, demonstrating the value of such an investment,” they wrote. “Plausible funding options include state and federal subsidies, public and private insurers, regionalized health care systems, taxpayer initiatives, and reimbursement incentives. Ideally, funding ED pediatric readiness would be done at the federal level to avoid the uneven patchwork of health care services that already exists across states.”

Starting March 3, hospitals can apply for the state’s pediatric prepared designation. In Montana, 11 facilities have earned the status already, including St. Vincent Health Care and Billings Clinic in Billings; St. Patrick/Providence Hospital and Community Medical Center in Missoula; and St. James Healthcare in Butte. A full list can be found here.