EMERGENCY CARE FOR EMERGENCY CARE FOR THE ADOLESCENTTHE ADOLESCENT

S. ZAMPOGNA, M.A. IEMBO4th Joint Meeting on Adolescent Medicine 14-16 October 2010

ADOLESCENCEADOLESCENCE

Critical stage in a person’s life: on one side ideals and anxieties pressions, on the other side the

comparison with physical, cognitive and social changes starts.

PUBERTYPUBERTY

Genetically determined phenomenon but also

psychodynamic:

The adolescent makes own the new sexed body, that is its desires

and functionality transforms the biological program in existential

project

This delicate phase makes at Emergency Level This delicate phase makes at Emergency Level the adolescent problems more various and the adolescent problems more various and

complicatedcomplicated

Besides pathologies, that typically affects this age, have higher incidence of complications

It is also necessary to make a comparison with problems related to the psychological and

behavioral condition of the adolescent

High incidence problems in PSHigh incidence problems in PS

1)1) Complications and degenerations of chronic conditionsComplications and degenerations of chronic conditions already knownalready known

- Respiratory crisis in Asthmatic Patients

- Metabolic Emergencies in Diabetic Patients

- Severe infectious complications in Cystic Fibrosis Patients

- Hematologic Emergencies in Thalassemia Patients

- Worsening in Muscular Dystrophy Patients

2) 2) Neurological disordes typical of the initial Neurological disordes typical of the initial phase of adolescencephase of adolescence

- Juvenile Epilepsies

- Juvenile-Onset

- Headaches

3) 3) Correlation between EmergenciesCorrelation between Emergencies and Psychopathologies in Adolescenceand Psychopathologies in Adolescence

- Food Conduct Disorders (i.e. anorexia)

- Mood disorders (suicide and attempeted suicide) - Morbid consequences related to violent dangerous behavior in needy adolescents

4) 4) Severe situations correlated with risky adolescent Severe situations correlated with risky adolescent sexual behaviour sexual behaviour

- STD (Sexually Transmitted Diseases)

- Pregnancy

- Medico-legal and ethic problems related to suspected sexual abuse and emergency contraception “The morning after pill” to minors

5) 5) Traumatology and toxicologyTraumatology and toxicology

- Traumatic accidents

- Severe effects of alcohol abuse and/or drugs

This last context represents the main reason This last context represents the main reason for the emergency accessfor the emergency access

need of adolescents need of adolescents with worrying age lowering!with worrying age lowering!

Intentional and not intentional accidents: Intentional and not intentional accidents:

20% of 20% of all all medical examinations performed medical examinations performed in Emergency Department in the majority of in Emergency Department in the majority of

the European Member Statesthe European Member States

WHY?WHY?

1.1. The typical teen behavior of The typical teen behavior of “risk taking “risk taking and sensation seeking”and sensation seeking”

(i.e. sensation-seeking or alcohol abuse (i.e. sensation-seeking or alcohol abuse drug, reckless driving, dangerous drug, reckless driving, dangerous recreational activities or sport etc.)recreational activities or sport etc.)

2. 2. Particular nowadays lifestyle increases Particular nowadays lifestyle increases the possibility of risky situationsthe possibility of risky situations

3. 3. Risk seeking behavior is associated to Risk seeking behavior is associated to the particular the particular emotional vulnerability of emotional vulnerability of the adolescentthe adolescent

In the 27 Member States of the EUIn the 27 Member States of the EUthere are 63 millions of adolescentsthere are 63 millions of adolescents

15 - 24 years of age15 - 24 years of age((~~14% of the population)14% of the population)

In Europe:In Europe:

65% of teen deaths65% of teen deathsis caused by accidentsis caused by accidents**

About 20.000 teens 15-24 years of age About 20.000 teens 15-24 years of age die every year for injuries. die every year for injuries.

* * Car crash injuries and suicide are the main death causesCar crash injuries and suicide are the main death causes

P. Biban, 2008 Seminar of the National Commission for Youth Malise Prevention

TO COMPLICATE MATTERS….TO COMPLICATE MATTERS….

- In Italy in the recent past years it has been consolidated the habit of alcohol consumption among teenagers - Increase in alcohol consumption under fasting under fasting conditions conditions among teens - Considering teens 14 -17 years of age, between 1999 and 2009, alcohol consumption habit has increased from 15,4% to 18,9%

WHAT CAN WE DO?WHAT CAN WE DO?

PREVENTION AT ALL LEVELS!PREVENTION AT ALL LEVELS!

I Level: actions that can prevent the accident happening (i.e. information and awareness campaigns)

II Level: actions that can reduce car accidents damages while happening(i.e. protection devices)

III Level: actions that can reduce car accidents damages produced (first aid, advanced aid, emergency wards)

1. It is a high priority to develop emergency facilities and to identify and prevent teen risky behaviors

- Rehab centers in PS- Counseling service- Trauma Center

2. At the same time it is necessary to train adequately health staff operating in emergency rooms and territorial units

3. It is necessary to invest in prevention campaigns- Role of Scientific Society- Collaboration with Istituto Superio di Sanità- Media

IN OTHER WORDSIN OTHER WORDS

Thank you for listening

SIMEUP SIMA Synergy = Adolescent Safety Alliance SIMEUP SIMA Synergy = Adolescent Safety Alliance

“ …“ …necessity to dedicate greater attention to a new necessity to dedicate greater attention to a new citizen class (the pediatric adolescents), no more citizen class (the pediatric adolescents), no more

children but also not adults yet …”children but also not adults yet …”Silvano BertelloniSilvano Bertelloni