EMERGENCY CARE FOR THE ADOLESCENT S. ZAMPOGNA, M.A. IEMBO 4th Joint Meeting on Adolescent Medicine October 2010

ADOLESCENCE 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.

PUBERTY 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 the adolescent problems more various and complicated 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 PS 1)Complications and degenerations of chronic conditions already known already 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) Neurological disordes typical of the initial phase of adolescence - Juvenile Epilepsies - Juvenile-Onset - Headaches

3) Correlation between Emergencies and Psychopathologies in Adolescence and 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) 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) Traumatology and toxicology - Traumatic accidents - Severe effects of alcohol abuse and/or drugs

This last context represents the main reason for the emergency access need of adolescents need of adolescents with worrying age lowering!

Intentional and not intentional accidents: 20% of all medical examinations performed in Emergency Department in the majority of the European Member States

WHY? 1.The typical teen behavior of “risk taking and sensation seeking” (i.e. sensation-seeking or alcohol abuse drug, reckless driving, dangerous recreational activities or sport etc.) (i.e. sensation-seeking or alcohol abuse drug, reckless driving, dangerous recreational activities or sport etc.) 2. Particular nowadays lifestyle increases the possibility of risky situations 3. Risk seeking behavior is associated to the particular emotional vulnerability of the adolescent

In the 27 Member States of the EU there are 63 millions of adolescents years of age (~14% of the population) In Europe: 65% of teen deaths is caused by accidents* About teens years of age die every year for injuries. * Car crash injuries and suicide are the main death causes

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

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

WHAT CAN WE DO? 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 WORDS

Thank you for listening SIMEUP SIMA Synergy = Adolescent Safety Alliance “ …necessity to dedicate greater attention to a new citizen class (the pediatric adolescents), no more children but also not adults yet …” Silvano Bertelloni