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ROCKY MOUNTAIN KIDS SUMMER 2011

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A HEALTH PUBLICATION FOR PARENTS 5RFN\0RXQWDLQ+RVSLWDO)RU&KLOGUHQFRP

Presbyterian/St. Luke’s Medical Center North Suburban Medical Center Rose Medical Center Sky Ridge Medical Center The Medical Center of Aurora Swedish Medical Center


REGINALD WASHINGTON, MD, FAAP, FACC, FAHA CHIEF MEDICAL OFFICER ROCKY MOUNTAIN HOSPITAL FOR CHILDREN

A Note from

Dr. Washington

Dear Parents: “Children requiring emergency care have unique and special needs. This is especially so for those with serious and life-threatening emergencies.” These introductory sentences to the American Academy of Pediatrics Care of Children in the Emergency Department: Guidelines for Preparedness are the foundation for Rocky Mountain Hospital for Children’s development of superior pediatric emergency care for the communities we serve. During the past year, more than 50,000 children were seen in HealthONE’s Rocky Mountain Hospital for Children’s emergency departments throughout the metro area. Because we see so many children in our emergency departments, this issue of Rocky Mountain Kids focuses on injury prevention—to help keep children safe. And, it features information about our innovations in emergency service, particularly our initiatives to minimize a child’s pain and to reduce wait times through coordinated care. Any parent who has made the trip to an emergency department with a sick or injured child knows the anxiety of wanting their son or daughter to feel better faster. But they also want to be sure that their child will receive quality care. That’s why the pediatric emergency rooms at HealthONE’s Rocky Mountain Hospital for Children locations are staffed with fully trained, board certified pediatricians and pediatric emergency physicians. Specially trained nurses, pediatric pharmacists, pediatric equipment and all other components required for pediatric emergency services are in place to provide quality support for a child’s care. We hope you and your family have a safe summer full of healthy fun. But if you do need emergency care for your child, we have the “right stuff” for your summertime accidents and illnesses.

3HGLDWULF(5V'HVLJQHGWR &$5()25.,'6 As a parent, there’s nothing worse than seeing your child sick or in pain. And when your son or daughter has a serious medical emergency, you want nothing less than the best care available. That’s why bringing your child to a hospital with an emergency room (ER) designed especially for kids is a good decision. There, doctors and nurses will provide your child with top-quality care and offer you peace of mind. SPECIALLY TRAINED STAFF Pediatric ERs are specially designed and staffed to handle the medical emergencies of babies, children and teens. Doctors receive extra training in pediatric emergencies and must pass a test that certifies them as pediatric emergency physicians. They are trained to deal with emergencies that may require unique techniques or procedures, or use special equipment. Also, they have expertise in easing the pain and anxiety that children’s emergencies can cause families. Board certified pediatric emergency specialists, nurses and social workers are skilled at:

• Explaining what is happening to your child during treatment • Understanding that children might react differently than adults • Providing instructions on how to care for your child when you get home • Assessing the unique treatment needs of children and teenagers KID-SIZED AND KID-FRIENDLY Crowded adult ERs can lead to long waits and a scary setting for young patients. But pediatric ERs are specially outfitted with kid-sized equipment, beds and supplies, including: • Lifesaving defibrillators customized for children • Child-sized blood pressure cuffs • Systems that quickly identify equipment and medicines appropriate for a child’s age and weight The waiting areas, hallways and examining rooms are also decorated and designed to be kid-friendly and put your little one at ease. COME PREPARED Develop an emergency plan with your child’s doctor and get familiar with the pediatric ERs in your community.

50+&(PHUJHQF\/RFDWLRQV Presbyterian/ St. Luke’s Medical Center 19th Avenue and High Street Denver, CO 80218 ER: 720-754-4115 q Open 24/7 Sky Ridge Medical Center I-25 and Lincoln Lone Tree, CO 80124 ER: 720-225-1900 q Open 24/7

The Medical Center of Aurora Potomac and Mississippi Aurora, CO 80012 ER: 303-695-2780 Rose Medical Center 9th and Clermont Denver, CO 80220 ER: 303-320-2455 North Suburban Medical Center Grant and Thornton Parkway Thornton, CO 80229 ER: 303-450-4519

Swedish Medical Center Hampden and Logan (three blocks east of Broadway) Englewood, CO 80113 ER: 303-788-6911 Swedish SW ER Wadsworth and Bowles Littleton, CO 80123 303-932-6911

Visit www.RockyMountainHospitalForChildren.com/maps_and_directions for a map of our locations. 6XPPHU52&.<02817$,1.,'6 6XPPHU


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Through the kitchen window, you hear a scream, a thud, then crying. Your child has just fallen out of the elm tree while playing with friends. After comforting and taking a quick look, you believe an arm was broken. Here comes your child’s first trip to the emergency room.

Help!!

• Understand their worry about being separated from you and reassure them. • Be honest about what’s happening— if an upcoming test will be painful, let them know.

You may want to consider filling out a Consent for Treatment of a Minor form. This form helps your child-care provider find you quickly in case of an emergency. It also gives permission for emergency hospital care when you’re away from home.

BEFORE AN EMERGENCY Before an arm breaks or a fever spikes, there are a few actions parents can take to make a visit to the emergency room less stressful. • Organize your family’s medical histories. Keep track of any medications taken, allergies, previous visits to the hospital, operations and pre-existing conditions. • Post emergency numbers near a telephone. • Have health insurance information on hand.

MOM!!

Emergencies Don't Wait— Neither Should You

WHAT TO EXPECT IN THE ER Generally, if you go to the hospital by ambulance, your child will be assigned to a bed in the emergency department. If not, your child will be assessed in a waiting room. A nurse will evaluate your child’s symptoms and vital signs—a practice called triage. The nurse will also ask for your child’s medical history, name and address. Triage may take some time, unless your child’s condition is severe. Emergency rooms are often busy. But the more information you bring with you, the quicker it can go. You may want to bring toys or books along to keep your child occupied. After triage, a doctor will examine your child in an examining room. At this time, tests might be ordered. The doctor will decide whether your child needs to stay at the hospital or go home with treatment, such as a cast or medications.

Find the closest HealthONE pediatric ER and average wait times with the HealthONE Fast LocatER tools. You can access ER wait times in four convenient ways: 1. Check out our website: www.healthonecares.com/er. 2. Download the app for iPhone and iPad. 3. Text “ER” to 720-523-3888. 4. Call 720-523-3888 for automated wait time updates. Visit www.healthonecares.com/er to view ER wait times right now. Or, scan this icon with your smartphone to access the website instantly! Download the free mobile scanning app with easy-to-follow instructions at http://gettag.mobi.

HOW TO HELP YOUR CHILD Going to the hospital can be frightening for young children. Here are some tips on how to help them: • Remain calm. If they see Mom and Dad staying calm, children in turn feel calmer. 5RFN\0RXQWDLQ+RVSLWDO)RU&KLOGUHQFRP

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When a Child Needs an IV, It’s Pain-Free with the J-Tip Taking your child to the emergency room is stressful enough. Now we have a way to take some of the pain out of the experience. Placing IVs or drawing blood hurts even when we use the smallest of needles. Thanks to a new technology called the J-Tip, patients at Rocky Mountain Hospital for Children at Presbyterian/ St. Luke’s Medical Center are able to get treatment without feeling the stick of a needle. The J-Tip allows us to numb the skin without a needle before placing an IV or drawing blood. We’ll still use the tiniest needle to insert the IV or collect the blood, but now without pain. We’re proud to be the first and only pediatric hospital in Colorado to offer this revolutionary treatment to families in our community.

Babies and young children explore the world by putting objects into their mouth. Gulp.

Pennies, Batteries, Toys, Oh My! When Your Child SWALLOWS Something The small items children most commonly swallow include coins, batteries, pins, crayons, buttons, small toys, paper clips and marbles. When an object gets inhaled and caught in your child’s windpipe, it can be lifethreatening. If swallowing makes your child suddenly start to wheeze, choke or have trouble breathing, treat it as a medical emergency. Perform the Heimlich maneuver, and immediately call your community’s emergency number. Rocky Mountain Pediatric Gastroenterology, whose five physicians cover a majority of the Denver metro area emergency departments, remove approximately two esophageal or gastric foreign objects each week. “No swallowed foreign object is safe,” explains Ted Stathos, MD, of RMPGI. “However, there are certain objects that are more concerning than others and may require immediate attention. Button batteries, sharp objects and multiple magnets are items that, if swallowed, should be treated as a life-threatening medical emergency.

These objects are more likely to cause a perforation or tear, which is a very serious matter.” Babies and young kids aren’t the only ones at risk. Small magnetic balls called Buckyballs, popular among school-age children, can stick to intestines and cause serious injury or death if swallowed. Many schools have banned them. RMPGI has removed some quite unusual objects over the years, including a plastic dinosaur, Lego man, toothbrush, golf tee, nuts and bolts and even a sewing needle. Here’s how you can help prevent your child from swallowing or inhaling foreign objects: • Watch your kids carefully when they eat and play. • Baby-proof your house by bringing yourself down to your child’s level. Get on your hands and knees and search for dangerous items your child might find. • Keep small household items and toys with small removable parts out of toddlers’ reach. • Never give children younger than age 4 small foods like whole grapes, nuts, seeds or large chunks of meat or cheese.

Things That Go Buzz in the Summer: All About Insect Stings Itching, redness, swelling—they’re all normal reactions to a run-in with a bee, hornet or wasp. But for some people, insect stings could be severe or even life-threatening. Signs of anaphylaxis—a potentially deadly reaction—include feeling confused or anxious; trouble breathing; coughing or wheezing; nausea and vomiting; and a rash, itching or hives. If your child experiences anaphylaxis, call 911 right away. Scrape any visible stingers off the skin within 30 seconds using 6XPPHU52&.<02817$,1.,'6

something firm, such as a fingernail or credit card. Your child might only have a mild reaction the first time he or she is stung. But the second sting could cause an allergic reaction. After a severe reaction, have your child see an allergist. Teach kids to walk calmly and slowly away if they spot flying insects. Keep food covered and check inside straws or canned drinks before sipping. Avoid perfumes and floral-patterned clothing, which can mimic pollen sources and attract bugs.


Presbyterian/St. Luke’s Medical Center

RMHC at P/SL Offers Safe and Accurate Emergency Room Diagnostics The accuracy, speed and efficiency of computed tomography, or CT, procedures make it a valuable tool in diagnosing emergency room patients. However, while CT is making a positive difference, there are inherent risks for pediatric patients with this imaging technology, most notably radiation exposure and sedation. That’s the last thing you want to worry about when your child is in the emergency room.

Fortunately, Rocky Mountain Hospital for Children at Presbyterian/St. Luke's Medical Center uses the Toshiba Aquilion® ONE CT system to improve diagnostic capabilities and patient safety in pediatric imaging. This advanced technology allows us to significantly lower radiation dose and limit the number of pediatric patients who require sedation. We can perform certain exams in 0.35 seconds, whereas conventional CTs can take four or five seconds on a similar procedure. Faster, safer technology translates into more comfortable patients and parents. This system reduces radiation exposure by 30 to 40 percent, making the scan much safer for children. Also, the quick scan time has reduced our need to sedate patients.

Lowering radiation and eliminating sedation are critical in the safe imaging of pediatric patients with CT. “A typical CT scanner acquires a slice of information that’s about 3.2 centimeters in thickness, and has to do several rotations around a patient,” says John Gerhold, MD, P/SL radiology medical director. “The Aquilion® ONE acquires a 16-centimeter-thick slice in a single rotation, sparing a lot of them radiation exposure. It’s pretty exciting.” With the system’s abilities, we can conduct all exams using lower radiation doses. The clinical benefits, combined with the patient safety features to minimize radiation and limit sedation, are dramatically changing the ways we treat pediatric patients. As the only facility in the region providing the highest level of CT imaging equipment for pediatric patients, RMHC at P/SL is a leader in fast and safe diagnosis of patients in our pediatric emergency room.

This system reduces radiation exposure by 30 to 40 percent, making the scan much safer for children.

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Patient Deborah Kisakye (right) pictured here with her mother, Mariam, was given a second chance at life thanks to the generous support and expert care offered at RMHC at P/SL.

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Colorado Uganda

ALL HEART:

ONE GIRL’S UPLIFTING STORY She was born prematurely with a hole in her heart, a common, treatable condition here at P/SL. But in Uganda, where Deborah Kisakye was born, doctors and hospitals don’t have the capability or knowledge to help. In Uganda, she would not survive, but the universe has a way of bringing the right people together for the right reasons. As the pastor of a small church in Uganda, Deborah’s grandfather realized his precious granddaughter wouldn’t live without surgery. He and his church went to work, finding a hospital in India that could help Deborah; but they couldn’t raise the thousands of dollars needed. Deborah’s grandfather kept searching and found a medical mission group from Dallas. One of that team’s surgeons knew Steven Leonard, MD, pediatric cardiac surgeon at Rocky Mountain Hospital for Children at Presbyterian/St. Luke's Medical Center, and suggested he be contacted. Dr. Leonard responded when he heard Deborah’s story. He persuaded RMHC and his P/SL colleagues to donate care and medical costs and

applauds them for stepping up, “knowing there is absolutely no compensation.” A timetable was set. A church in Dallas sponsored the family and provided travel money for Deborah and her mother, Mariam. They arrived in Denver on April 9. P/SL social worker Erin Motzer had everything ready, arranging housing at the Ronald McDonald House and working with There With Care to provide clothing. She even found a translator. All of the coordination, effort and people who came together gave Deborah a chance to live. Deborah had open-heart surgery on April 19. She is recovering and doing very well. When her mother tried to express her feelings about all the amazing people who worked to get them to this place, she couldn’t find words, bowing her head as tears of joy and thankfulness ran down her cheeks.

Mending Young Hearts The pediatric cardiologists at Rocky Mountain Hospital for Children offer a supportive environment for young heart patients and their families, from diagnosis to recovery. Visit www.RockyMountainHospitalForChildren.com/heart-center to learn more.

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IN CASE OF AN EMERGENCY: YOU CAN COUNT ON US When your child has an emergency, you can rest assured that he or she is in good hands at Rocky Mountain Hospital for Children at Presbyterian/ St. Luke's Medical Center. That's because we are now certified as a Level IV Trauma Center. This designation means that our facility is recognized by the state of Colorado for meeting the standards necessary to treat pediatric Level IV trauma patients. We have protocols and processes in place to mobilize staff in the event of a trauma, including accidents, sports injuries, cervical spine injuries and concussions. And we have the largest neonatal intensive care unit in the area that focuses on newborn care. Also, should your child need the support, RMHC at P/SL is one of a small percentage of hospitals in the country that uses ECMO (extracorporeal membrane oxygenation) treatment, a treatment for infants whose hearts and lungs do not respond to conventional therapies. As a Level IV trauma center, we provide initial evaluation, stabilization, diagnostic capabilities, surgery and critical-care services. Trauma-trained physicians and nurses are immediately available upon the patientâ&#x20AC;&#x2122;s arrival to the emergency room. We have the full range of pediatric medical and surgical specialists available to provide the most advanced pediatric clinical care on site. â&#x20AC;&#x153;We operate with a mindset focused on trauma. The additional training prepares us to mobilize our team to spring into action in their predefined roles,â&#x20AC;? explains Daniel Gutmann, MD, Trauma Service medical director for P/SL and RMHC at P/SL. We also have transfer agreements with other higher-level trauma centers, in case conditions warrant a transfer to a higher level of care.

First Call ÂŽ for Children Your doctor's office is closed, but you have questions about your child's health and you want answers now. Our Nurse Advice Line is here to help. Open Monday through Friday from 5 p.m. to 8 a.m. and 24 hours on weekends and holidays, the Nurse Advice Line is ready to answer your after-hours questions. Call 303-563-3300 in the Denver Metro Area, or toll-free at 877-647-7440. For medical emergencies, ALWAYS call 911. 10334MA

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“Children have a remarkable power to heal hand injuries and return to a lifetime of full function. Timely treatment can make the difference.”—Laurel Benson, MD, orthopedic surgeon

“Watch Your Fingers” Is Still Good Advice Little fingers are constantly exploring—and getting in the way. And when it comes to pinched fingers, accidents can be serious. According to a study published in Pediatrics, about half of all childhood amputations treated in U.S. emergency rooms occur to fingers that have been slammed or pinched in doors. Children ages 2 and younger are at greatest risk. Older kids are vulnerable to door injuries, too. But they’re more likely to lose a finger from a lawn mower. Prevent injuries with these tips: • Hang a towel over the top of doors and close to the hinges so they can’t close completely. • Buy doorstops or door guards to prevent doors from slamming. • Be watchful when children play together. In one study, about half of door-related finger injuries occurred when another child shut the door.

• Make sure all riding mowers have a no-mow-in-reverse (NMIR) feature to prevent injuries. • Don’t let kids use a push mower until age 12 or a riding mower until age 16. “Children have a remarkable power to heal hand injuries and return to a lifetime of full function. Timely treatment can make the difference, though, in the length of recovery and the cosmetic result,” says Laurel Benson, MD, orthopedic surgeon. “We prefer seeing our little patients within a week of the injury, as most hand injuries have more favorable outcomes if the treatment is completed within 10 days. The patient and the family can then be assured that they are on the road to get up and go!”

PULL OUT AND SAVE! KEEP THIS CHECKLIST HANDY AND HELP KEEP YOUR KIDS SAFE.

10 Ways to Keep Windows Safe Approximately 4,700 children ages 14 and younger require treatment each year for window fall-related injuries. (National Safe Kids Campaign) While some falls occur from windows, it is important to realize that in the event of a fire, a window can also save a child’s life by providing a secondary means of escape or rescue.

About 18 children ages 10 and younger die each year from falls from windows

WINDOW SAFETY CHECKLIST 1. Make sure windows are not painted or sealed shut.

2. Keep windows closed and locked when children are around. 3. Don’t allow kids to play near windows, balconies or decks. 4. Install and maintain window and door safety devices. 5. Do not consider a window screen to be a safety device; screens keep bugs out, but don’t keep children in. 6. Make sure the window safety devices have emergency release mechanisms in case an emergency escape or rescue is needed.

7. Don’t install window air conditioner units in bedroom or other windows that may be needed for escape or rescue in an emergency. 8. Keep furniture and other climbing hazards away from windows, balconies and decks. 9. Make sure landscaping underneath windows will help lessen the impact of a fall if one does occur. 10. Do not underestimate children’s mobility and/or ability to learn how to release safety devices.

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Visit www.youthsportsmed.com to learn more about children’s sports injuries and tips for parents on preventing injury.

Prevent Common Sports Injuries Doctors treat about 8,000 kids for sports injuries every day. But many of these mishaps can be prevented. This chart shows the most commonly hurt parts of the body for 10 activities and ways to make playing safer.

BASEBALL BASKETBALL BICYCLING FIELD HOCKEY FOOTBALL IN-LINE SKATING SKATEBOARDING

SOCCER

TENNIS VOLLEYBALL

{ { { { { { { { { {

Commonly Hurt

Required or Recommended Gear

Shoulder, ankle, head/face

Batting helmet with face guard, safety-release bases

Little League mandates pitch count limits that vary by age (see www.littleleague.org).

Ankle, foot, knee

Sport-specific footwear, mouth guard

After jumping, land with knees bent, not straight.

Arm, wrist

Helmet*

Avoid riding at night or on uneven or slippery surfaces; consider taking a riding skills course.

Ankle, face, head

Mouth guard, shin guards

Sticks should be kept below shoulder level at all times.

Ankle, knee, head (concussion)

Helmet, mouth guard, shoulder pads

Strength training and stretching can help prepare for this contact sport; don’t lead with the helmet when tackling.

Arm, wrist

Helmet**, wrist guard, knee and elbow pads

Skate on smooth surfaces, away from traffic.

Ankle, head/ face, wrist

Helmet**, wrist guard, knee and elbow pads

Using a skate park or other controlled environment may increase safety; children younger than 5 should not skateboard.

Ankle, knee

Shin guards, sport-specific footwear, mouth guard

Collisions with other players, not heading the ball, cause most concussions, but some leagues prohibit heading by players younger than age 10.

Elbow, shoulder, wrist

Sport-specific footwear, racquet with proper grip size

Strengthening the muscles used to extend and bend back the wrist can help prevent common injuries.

Ankle, fingers, shoulder

Ankle brace or taping

Use resistance training to strengthen lower back, legs and shoulders; avoid jumping on hard surfaces in practice.

Safety Tip

* Some form of bicycle helmet legislation is enforced by 21 states, the District of Columbia and more than 140 local governments. ** Children are required to wear helmets while using in-line skates, scooters or skateboards in eight states and the District of Columbia.

What Parents Should Know About Clavicle Fractures The clavicle is one of the most frequently fractured bones during childhood, according to John Polousky, MD, medical director of Rocky Mountain Hospital for Children’s Youth Sports Medicine Institute. Clavicle fractures most often happen when a child falls on to an outstretched arm. This injury is most frequent in athletes who participate in football, hockey and soccer, or in sports with a high risk of falling, such as biking or horseback riding. Initial treatment is focused on making the child more comfortable by immobilizing the injury and giving pain medication. 6XPPHU52&.<02817$,1.,'6

Wearing a sling with the arm in a cradled position is often the most comfortable position for most people with this type of injury. Clavicle fractures in children and adolescents rarely require surgery. However, surgery may be needed if the fracture breaks the skin or if there is nerve or blood vessel damage. Young children tend to heal fractures very quickly and are often able to return to sports more quickly than adolescents and adults with the same type of injury. After allowing enough time for the bone to heal, most children don’t experience pain or limited movement, and they can gradually return to full activity.


TIPS FOR A GOOD HELMET FIT A helmet can reduce a biker’s risk for head injury by up to 85 percent. Buy a helmet with the U.S. Consumer Product Safety Commission sticker inside. Make sure the helmet fits and your child knows how to put it on correctly: • The helmet should be level on the head, so the front of the helmet rests just above the eyebrows. • Straps should fasten under the chin so the “Y” of the side straps comes just below the ears. Straps should be tight enough so that the helmet cannot rock back-to-front or side-to-side. • The chin strap should fit comfortably and securely under the chin. If the strap is uncomfortable and cuts into the chin, it’s too tight and should be loosened slightly. • Replace the helmet after an accident where the rider’s head hits something.

75%

HELMETS COULD PREVENT AN ESTIMATED 75 PERCENT OF FATAL HEAD INJURIES AND UP TO 45,000 HEAD INJURIES TO CHILDREN WHO RIDE BIKES EACH YEAR. —Safe Kids USA

Biking Do’s & Don’ts Bicycling is a great way for children to stay active this summer. To keep their cycling safe, review these important do’s and don’ts:

Do

• Make sure children wear helmets designed for bicycle use every time they ride, even if the law doesn’t require helmets where you live. If you ride, wear a helmet, too—to protect yourself and set an example. • Dress cyclists in bright, fluorescent-colored or reflective clothing so drivers can easily see them. • Teach your child to avoid bicycling at night. • Explain the proper hand signals and make sure children use them. • Make sure cyclists check the bike’s brakes and tires before riding.

Don’t

• Let any rider wear a helmet that fits poorly. • Buy a bike for your child to “grow into.” There should be about an inch between the child and the bike frame when the child’s feet are flat on the ground. • Ride against traffic or let kids do so. Teach children to ride with the traffic flow, as far to the right as possible. • Ride into a street or through an intersection without stopping and checking for traffic—even if there’s no stop sign or stoplight. • Let children ride without supervision until they’ve shown they can always follow the rules.

RIGHT

STOP

LEFT

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ROCKY MOUNTAIN KIDS

PRESORTED STD US Postage

PAID

Rocky Mountain Hospital for Children

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),567$,'&+(&./,67 A well-stocked first-aid kit is your first line of defense in treating injuries and scrapes. Keep one in your home and each car, and stash one away in your suitcase. Prepackaged kits can be purchased at drugstores or you can assemble one of your own in a durable, waterproof case (plastic tackle, sewing or art supply boxes work well).

Keep your first-aid items in one convenient place with this FREE zippered pouch from Rocky Mountain Hospital for Children. To get yours, visit www.RockyMountainHospitalForChildren.com. Offer available to the first 250 applicants in the four-state region only (Colorado, Wyoming, Nebraska and Kansas).

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