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Student Spurs Statewide Move Toward Protocol for Meth Children, Beginning at Vanderbilt Children’s Hospital

Feb. 24, 2006, 10:29 AM

A Vanderbilt University School of Medicine student has documented a lack of consensus among Tennessee doctors about how to treat children who may have been exposed to the illicit drug methamphetamine and its harmful manufacturing process.

Based on second-year student Lara Bratcher’s survey, officials at the Monroe Carell Jr. Children’s Hospital at Vanderbilt are taking the lead in developing statewide treatment guidelines to help close this gap in care.

When police go into a home they know has been a lab for the manufacture of methamphetamine or “meth,” they are given strict advice to wear suits designed for exposure to hazardous materials. They are advised that areas used to “cook” meth will be coated from ceiling to floor with hazardous materials, and that clothing, carpeting and toys in the area should be considered contaminated.

Yet, when children are removed from a home known to be the site of a meth lab, they are often taken to emergency departments near their homes, where physicians are asked to treat the children, with little or no guidance about how to treat them safely and what health concerns to look for.

Bratcher, who grew up in McMinnville, near one of the most active areas for meth labs in Tennessee, surveyed emergency department directors and physicians at hospitals in 12 Tennessee counties at high risk for having children exposed to the manufacture of methamphetamine.

“I’m from McMinnville,” Bratcher said. “We live right in the middle of the meth drama. There are lots of labs near my hometown, and my mother worked for the Department of Children’s Services, so I heard a lot about it growing up. I’m interested in rural health so this survey was a natural fit for me.”

The survey area included the following counties: Bradley, Coffee, Franklin, Grundy, Hamilton, Marion, McMinn, Monroe, Warren, Van Buren, Meigs, and Sequatchie. Bratcher started sending her survey out in June of 2005.

“Eighty-seven surveys were sent to physicians, and 25 have returned to me so far,” said Bratcher. “But they’ve been trickling in. I got another one the other day.”

Bratcher came up with scenarios describing children with signs that might indicate exposure to meth, or the chemicals used to make it. Signs included a chemical smell on the child’s clothing, rapid breathing or high blood pressure. Physicians were asked to describe how they would assess the significance of the exposure and to report what they would do to test or treat the child.

“The responses ran the gamut. One would say he would do a lot, while the next might do nothing at all. Some talked about testing that most pediatric experts would say is unnecessary; one said he would collect hair samples for drug testing; several would do chest X-rays,” Bratcher said.

Bratcher said she expected to find a lack of consistency in the treatments reported by doctors she surveyed, but she was astonished to find so much variety. And an overwhelming majority reported feeling that there was little existing medical knowledge or consensus about how to treat these children when they show up in their emergency rooms. Ninety-two percent of those surveyed said they felt they would like to have a more formal protocol.

A second focus of the survey is on physicians’ belief of whether there is a meth problem in their communities (84 percent reported there was).

Armed with that survey data, Bratcher got together with Chris Greeley, M.D., assistant professor of Pediatrics and an expert in child abuse and endangerment at Vanderbilt Children’s Hospital. Greeley enlisted the guidance of Ellen Wright Clayton, M.D., professor of Pediatrics and professor of Law. Together they decided the next step was to convene a meeting of Vanderbilt experts and come up with a policy they all could agreed on to treat these children.

On Feb. 7, a group including representatives from the Emergency Department, Toxicology, Vanderbilt’s legal office and a regional pediatric emergency medicine group called the Committee on Pediatric Emergency Care (COPEC) gathered to begin drafting a protocol. They used the example of a national protocol accepted by the National Alliance for Drug Exposed Children and are modifying it to meet the needs here in Tennessee.

While Vanderbilt Children’s Hospital’s emergency department sees few children suspected have been exposed to meth or the chemicals used to manufacture it, Bratcher and Greeley hope to start the protocol here anyway.

“There are 700 kids in state custody because of meth, so while we don’t know how many kids would benefit from this type of protocol, we do have a representation, or a snapshot of the scope of the problem statewide,” Greeley said. “I think it will pan out that meth is a bigger problem than we see here at Vanderbilt, perhaps a couple of thousand children might be exposed every year and we need to be proactive in advocating for these kids.”

Bratcher’s survey is about to be distributed to a larger audience The coordinators for COPEC are adding some of Bratcher’s survey questions to a survey of their own that is going out to member hospitals around the state.

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