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Opinion: No clear standards for NICUs

Monday, March 7, 2005

If you have a question, e-mail factorfiction@semissourian.com or call Speak Out (334-5111) and identify your call as a question for "Fact or fiction?"

Q: My question is about neonatal intensive care units. Here in Cape Girardeau, one hospital regularly advertises that it has the region's "only" Level III NICU. Meanwhile, the other hospital also says it has a Level III NICU. What exactly is a Level III NICU, and who decides whether a unit qualifies for such a designation?

A: Saint Francis Medical Center was the first hospital in the region to have a Level III neonatal intensive care unit. With the addition of neonatologists at Southeast Missouri Hospital -- one of the requirements for designation -- it, too, now qualifies. But I put your question to representatives at both hospitals for their explanation.

"Missouri is a self-designation state when it comes to neonatal intensive care units," said Dr. Richard J. Flaksman, medical director of neonatology services at Southeast Missouri Hospital. "In the past, guidelines have been available by which hospitals can designate their level of care depending on technical capabilities and availability of subspecialties such as neonatologists, pediatric cardiologists and pediatric surgeons.

"According to the American Academy of Pediatrics recommendations, both Southeast Missouri Hospital and Saint Francis Medical Center qualify as Level III NICUs," he said.

"Unfortunately, there is not a consistent designation of levels for tertiary services like NICU or trauma," said Barbara Thompson, vice president of marketing for Saint Francis Medical Center. "Levels are assigned sometimes by states, sometimes by professional organizations, and typically are not consistent. For NICU, two sources would be the Academy of Pediatrics and the Vermont Oxford Network.

"The Vermont Oxford Network has three categories: A, B, C. Level IIIA are centers which have restrictions on assisted ventilation and perform minor surgeries; Level IIIB are centers which have no restrictions on assisted ventilation and which perform major surgery; Level IIIC centers perform cardiac surgery requiring bypass. The American Academy of Pediatrics has different breakdowns within their Levels 1, 2, and 3.

"Saint Francis falls between Level IIIA and Level IIIB (VON) or between a Level III 1 and a Level III 2 (AAP)," said Thompson.

Q: There's an e-mail going around that, if you have an emergency, you should dial #77 on your cell phone for help instead of 911. Is there any truth in this?

A: If you are in Maryland, #77 will connect you to the state police. But in most parts of the country, this number will do little good. According to the Missouri State Highway Patrol, you should dial *55 if traveling in this state and need its attention. In some parts of Illinois, the number 911 or 511 or *999 will connect you with help. Other states have other numbers.

To lessen the confusion, the federal government has mandated that 911 work from cellular phones, so this remains your best number to call if you need emergency aid. But not all areas and cellular providers have enabled this yet.

In Cape Girardeau County, dialing 911 will connect you to law enforcement. Depending on how your call is routed from the towers, however, you may need to be transferred to a different jurisdiction once your call has been answered. It's helpful if you are prepared to immediately tell your location.

Jon K. Rust is publisher of the Southeast Missourian. He can be reached at jrust@semissourian. com.


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Jon K. Rust
Jon K. Rust is publisher of the Southeast Missourian and co-president of Rust Communications. He serves on the board of directors for the Associated Press. A native of Cape Girardeau, he has lived and worked in New York City, Boston, San Francisco and Moscow, Russia.