February 24, 2006

Study spurs move for state meth protocol

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Lara Bratcher, a second-year medical student, talks with Christopher Greeley, M.D., in the Pediatric Emergency Department at Children's Hospital.
Photo by Dana Johnson

Study spurs move for state meth protocol

Vanderbilt University School of Medicine student Lara Bratcher 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 the second-year student'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.

Bratcher, who grew up in McMinnville, near one of the most active areas for meth labs in the state, surveyed emergency department directors and physicians at hospitals in 12 Tennessee counties where children have been deemed to be at high risk of being exposed to the manufacture of methamphetamine. Many children in those counties show up in emergency departments after their parents have been arrested for having a “meth lab” in their home.

“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 consisted of Bradley, Coffee, Franklin, Grundy, Hamilton, Marion, McMinn, Monroe, Warren, Van Buren, Meigs, and Sequatchie counties. Working through VUSM’s Emphasis Program, Bratcher started sending her survey out in June of 2005.

“Eighty-seven surveys were sent to physicians and 25 have been 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 and/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 they would collect hair samples for drug testing — and several would do chest X-rays,” Bratcher said.

Bratcher said she expected to find a lack of consistency in the treatments reported, but she was astonished to find so much variety, followed by an overwhelming majority who 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 for treating children who may have been exposed to meth.

“What really stood out was a high level of anxiety over this issue for the physicians,” Bratcher said. “Many feel they are somewhat on their own trying to make their best guess on what to do.”

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 Christopher Greeley, M.D., assistant professor of Pediatrics and an expert in child abuse and endangerment at 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 draft a treatment policy they all could agree on.

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 Children's Hospital's emergency department sees few children suspected to 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 her questions to a survey of their own they're sending to member hospitals around the state.

“The next step is for Vanderbilt Children's Hospital to work with other pediatric hospitals in our region to accept a policy we feel will work for the children in our area,” Greeley said. He pointed out that T.C. Thompson Children's Hospital in Chattanooga already has a policy of its own that they hope to review soon. “Once the medical community has agreed on what will work best, then we need to get legislators involved and work on getting one policy distributed throughout the state.”

Bratcher says the Department of Children's Services has a protocol to remove children from labs, including specialized safety gear because of the presence of toxic chemicals, so it only makes sense there should be a medical protocol for assessing and testing children found in labs for toxic exposure.

“People want to know what to do,” Bratcher said. “I would like to be part of the creation of a protocol or policy for decontamination that could be widely used and is backed by research. This work may go a long way to alleviating the fears of providers and helping kids.”