Understanding Pediatric Emergency Medicine and Emergency Medical Services with Sylvia Owusu-Ansah MD, MPH, FAAP

Sylvia Owusu-Ansah MD, MPH, FAAP is a board-certified pediatrician, pediatric emergency medicine, and emergency medical services (EMS) physician who is currently an attending at UPMC Children's Hospital of Pittsburgh and Director of Pre-hospital and EMS. Dr. Owusu-Ansah has been extremely involved in pediatric advocacy and education of EMS providers at all levels, locally, regionally and nationally. She currently sits on the Pediatric Emergency Medicine Advocacy and EMS Committees with the American Academy of Pediatrics, and additional regional and national committees related to her work. One of the contributions she is most proud of is advocating for pediatric health on Capitol Hill in Washington D.C. office on federal, state, and community pediatric advocacy issues including the School Access to Emergency Epinephrine Act, signed into law by President Barack Obama in 2013. She is proud mother of two girls and wife a transitioning paramedic.

Released: 8/27/19

Read the Full Podcast Episode Transcript

Carolyn Coyne: This podcast is for informational and educational purposes only and is not to be considered medical advice for any particular patient. Clinicians must rely on their own informed clinical judgments when making recommendations for their patients. Patients in need of medical advice should consult their personal healthcare provider. From UPMC Children's Hospital of Pittsburgh, welcome to That's Pediatrics. I'm Carolyn Coyne. I'm a scientist in the division of pediatric infectious diseases, and I will be your sole host for this edition of That's Pediatrics for the first time. Joining me is Sylvia Owusu-Ansah. Sylvia specializes in pediatric emergency medicine with a sub-specialty in emergency medical surface services, which is also known as EMS. She is the director of EMS and pre-hospital care, and her interests lie in pediatric EMS research. Thank you for joining us today, Sylvia.

Sylvia Owusu Ansah: Thank you Dr. Coyne for having me here, and thanks for this opportunity. I'm really excited to be here.

Carolyn Coyne: So, one of the things I always like to do is get a little bit more kind of background information. What brought you not just to Pittsburgh, but also to emergency medicine? Kind of a little bit of just a history of yourself.

Sylvia Owusu Ansah: Yes. Great. I was born in Boston, that town up North that's not very popular to Pittsburgh, but interestingly enough, I grew up all over the country, secondary to my parents' jobs. So I grew up throughout new England, in Kentucky, and most interestingly, Namibia, Southwest Africa. My dad worked for the World Health Organization and was an advisor to the health minister of Namibia on HIV/AIDS in the early 90s. He really sparked my interest in health overall, as he sought to make lives better for Southern Africans during the height, I would say, of the HIV epidemic. I saw him going out to do predominantly education workshops, and it always intrigued me, the stories that he had coming back about homeless kids who had to deal with HIV, pregnant widows who had to deal with HIV and the up Hill battle of providing healthcare from a political standpoint, when that wasn't everybody's first interest or priority. My interest first sparked there.

Sylvia Owusu Ansah: Then I came back to Boston, my hometown, and after that kind of spread my wings to other places for higher levels of education. I initially wanted to be an immunologist after being in Southern Africa and witnessing how devastating the HIV epidemic was, especially on the African continent, and then coming back home and seeing more of that in the United States. Excuse me. Especially with patients such as Ryan White. He left a huge imprint on me. He was a young gentleman who was a hemophiliac, who had a blood disorder, who got a blood transfusion, and it HIV, and died at a very young age, as a teenager, but lived a very impactful life in a short amount of time and had to deal with a lot of prejudice regarding the disease.

Sylvia Owusu Ansah: With all of that, I decided I'm going to save the world. I'm going to become an immunologist. I'm going to be the one that cures HIV. I love the immune system, because too me it's like the body's army and military. I was gonna write novels about it. All of those were initial footprints for going into medicine. I went to college and University of Rochester, not too far from here, and I majored in biochemistry with the hopes of, excuse me, becoming an immunologist, but I decided I could maybe do more, from the perspective of what I wanted to do, by being a physician and doing public health work, as well as clinical work.

Carolyn Coyne: Then what brought you to Pittsburgh, so from Boston to Pittsburgh? I'm guessing it was not the Steelers.

Sylvia Owusu Ansah: It definitely was not the Steelers. I shouldn't say that too loudly. But Pittsburgh is a great town. Interestingly enough, I had a long road with medicine, as lot of people do nowadays. They really try to think about what they want to do and how they want to make an impact in medicine. Initially, I was a pediatrician. Then I worked at an emergency department. I decided I wanted to focus on emergency medicine, and so went back to school to do a fellowship. I was a general pediatrician. I Went back to do a fellowship to focus on how to take better care of kids.

Carolyn Coyne: What was it about sort of the emergency medicine aspect of it? Was it the ability to sort of be on the front line for care for children, or was there something in protect?

Sylvia Owusu Ansah: Yes. It was the ability to be on the front line, and play detective right then and there, and even fix things, fix certain aspects of things right away and not kind of have to wait and see the progression, and to witness the excitement on parents' faces when a broken arm was fixed within a few hours, and their kid was jumping around or feeling better, or just having to scratch my head real hard about particular patient that came in with fever and a rash that had recently traveled, wasn't quite sure what was going on with that patient. So, all of those things. Also, from a personal standpoint, I've always wanted to have a family. I knew that. Emergency medicine gives you the ability, the flexibility to be home during the weekdays, in the afternoons to watch your kids play their softball game or take your kids to gymnastics. I like that flexibility.

Carolyn Coyne: Nice. One of the things I mentioned was that you were the director of EMS. That's not something I'm familiar with. Perhaps for the listeners out there who are also not familiar, could you tell us a little bit about what that is?

Sylvia Owusu Ansah: Right. EMS stands for emergency medical services. It's what we know as 911, but it's actually greater than that. As individuals we know EMS to be, you call 911, you have an ambulance show up and a paramedic come take care of you and transport you, whether you're at home, or on the road, or wherever that may be. But EMS is a huge health system within itself that has people that take care of you, known as EMT and paramedics. It may be confined with the fire department, so it may be combined with firefighters, who are also paramedics or EMTs that do the medical side of things. It involves dispatch, which are the group of folks that take care of the phone calls when you call 911. It has a public health aspect to it. If there's a disaster in the area, it's the EMS systems that are responsible for responding, for things like hurricane Katrina, for any kind of disaster preparedness things, like 9/11, excuse me, the 9/11 terrorist attacks. EMS is involved in the width and breadth of all of those things.

Carolyn Coyne: Your role as director is to keep all of those parts moving smoothly?

Sylvia Owusu Ansah: Yes. To keep all those parts moving smoothly.

Carolyn Coyne: It's a big job.

Sylvia Owusu Ansah: Thank you. But even more importantly, to not lose the focus on the children. My job is to make sure that the folks who take care of kids in the EMS system know how to take care of them, feel comfortable in taking care of them, and know the latest standard of care or the latest means of medically taking care of them, so that they provide the utmost best care outside of the hospital, as we aim to do inside of the house.

Carolyn Coyne: Is that because, again, as sort of a non-clinician perhaps, I think sometimes there's this assumption that a child is nothing more than just a smaller adult. Right? And everything works the same, and everything should be the same. I guess, having said that, what are the specific challenges within EMS, either if it's just a 911 call or even a greater sort of level of an emergency, of taking care of a child versus if this were just an adult only type situation?

Sylvia Owusu Ansah: Right. So, that's a great question. I get asked that quite a bit. One is that there's the frequency of a child being transported to the hospital is very low. Only 10% of kids get transported via EMS. So, that leaves us with 90% of EMS transports are adults. A lot of these folks don't see kids that often. Usually when they do ... So, we call it low frequency, high acuity. Usually when the child is transported, a lot of times they're very, very sick, which can be very, very scary, because they're children and, and people think about their own children, or their nephews and nieces, or whomever when they're taking care of them. It can be extremely scary.

Sylvia Owusu Ansah: Yes. You bring up a good point, that a lot of times we think of children as little adults, but in essence they're really not. They're built differently. Their anatomy, the way they work on the inside is markedly different. If you think about it, you can imagine a baby is very different than an adult. There are certain ways that you have to take care of those children. There are certain types of medications, for instance. Sorry. Medication delivery is different. For instance, for kids we weight base dose kids. What does that mean? For every kid that needs medication, we need to know their weight, and we have to calculate their medication based on weight, whereas an adult, there's usually a standard one or two doses that we use for each medication. So, that in itself could bring about or allow for a significant errors in what we call medication dosing.

Sylvia Owusu Ansah: Also, the build of a child is a little bit different. Little children have bigger heads, smaller necks, bigger bellies. In the case of, for instance, trauma, like in a motor vehicle collision, considerations and focuses of care are different when taking care of a kid that you pull out of a motor vehicle collision than an adult. There's certain areas of the body that you need to focus on more readily, more quickly than you would on an adult.

Carolyn Coyne: Is part of then your role just educating the physicians that are on, again, the front line of maybe the local emergency room, not here at the children's hospital, where obviously there's going to be an appreciation for ?infants and children and their needs. Is it going out there to make sure that those sort of providers understand these rules and regulations?

Sylvia Owusu Ansah: Yes. That is a good part of what I do is outreach. Since I've been here at UPMC Children's of Pittsburgh, I've gone as far as Manheim, PA. I've gone up to Erie, Johnstown, Uniontown, so throughout the Western Pennsylvania area, even to Central Eastern Pennsylvania, educating EMS agencies. Now, throughout the United States, there are numerous EMS agencies, from rural to urban, and some of them work a little bit differently. A lot of times if you want to educate folks, you'll have to go to them, as opposed to them coming to you, which I enjoy. EMS personnel that I've met and staff are so eager to learn for the sake of health care. It's really an honor to teach those ladies and gentlemen that are out there, day in and day out, taking care of us outside of the hospital.

Carolyn Coyne: This just switched gears at least sort of slightly, as I know one of your research focuses, in addition to sort of all the EMS work that you do, is looking at conditions of children when they come into the emergency room. I know one of the things that you've, in the last year in particular, really focused on is acute flaccid myelitis, AFM, which is something that, for listeners out there, we've had a dedicated podcast to. Would you give us a little bit of background, and sort of the research that you've done in this, and kind of what piqued your interest in this as a condition?

Sylvia Owusu Ansah: Yeah. Part of what I really want to emphasize for myself is that to holistically take care of a patient I think you need to know what's going on clinically, but I think you also need to know the evidence behind what you're doing clinically. The reason why I bring up all that is because, I actually had the first three patients that presented to you UPMC Children's Hospital of Pittsburgh with AFM, and I didn't know what it was. So, I based my knowledge based on the types of diseases that I thought it was. One of the children I kept in the hospital, because they were sick enough to keep in the hospital, but another child I will admittedly say I sent home, because I really didn't know what was going on with them, and they didn't really fit into my box of diagnoses. I worked that child up extensively. Nothing came of it. The child got a little bit better, but then came back. Then that gave me even more impetus to find out what's really going on, or what is this disease process, which led me to learning a little bit more about AFM.

Sylvia Owusu Ansah: AFM in the media has been described as non-polio, and I want to emphasize that, non-polio-like paralysis, in which is transferred via a few different types of viruses, predominantly, so far that we know, Enterovirus, Coxsackieviruses are specific strains. It tends to come more in the late summer, early fall. We're seeing kind of the patterns of that. Every other year we're seeing surges and peaks, as opposed to every year. We're still not quite sure why and what the actual main source is, outside of the viral transmission. From a clinical standpoint, patients, usually they can present with a limp. They can present looking very sick and tired and what we call lethargic.

Sylvia Owusu Ansah: But the one of the classic findings that we find when we examine a child is that they have no reflexes. What does that mean? Usually when we examine children, we check to see if their nerves are working properly. As many people probably remember going to the doctor's office, doctors usually put a hammer to your knee. And your knee just jerks upward very quickly, and we call that a reflex. That's the nerve responding to the hammer. Children with AFM do not have that response when you put the hammer to the knee or to the heel. They lack what we call reflexes. That's one of the significant signs that we see.

Sylvia Owusu Ansah: In addition to that, lot of the symptoms are not very specific. They may come with flu-like illness or cold-like illness before, but the key is usually these children complain of trouble walking to some degree, limping. To confirm the diagnosis they need what's called an MRI, in which that is a type of imaging that we do, that we were able to see not only bones, like in X-rays, or specific matter, like in a CAT scan, but we can see the details of tendons and nerves, such as the spinal cord. Certain patterns on the MRI let us know, along with the clinical diagnosis, that this child likely has acute flaccid myelitis, which is also known as AFM.

Carolyn Coyne: Some of your interest then, just getting out better definitions then, presumably, for providers, so that if a patient, child in particular, of course, which is obviously where AFM usually seems to be most dramatic, is to educate them on, so if they have a child that comes into the ER, you can say, "X, Y, and Z. We think this is a suspected case of AFM"?

Sylvia Owusu Ansah: Yeah. That is correct. In essence, to bring about a better outcome from what I learned, having missed that diagnosis by not being aware of the diagnosis. Not only do we want to let other physicians know out in the community or even in academic centers, but again, like with my EMS work, inform the paramedics, any healthcare provider, school nurses, any healthcare provider that may come across these kids before they enter the hospital.

Carolyn Coyne: Right. Well, thank you so much for joining us today, Sylvia. I learned a lot.

Sylvia Owusu Ansah: Well, thank you for having me. This was an enjoyable time.