EMSC Connects

September 2021; Vol.10, Issue 9

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Pedi Points

Tia Dickson, RN, BSN

Primary Children's Hospital

Back to school means monkey bars, gym classes, and trauma, in particular fractures.

Lacerations and extremity fractures are the most commonly seen minor traumatic injuries at Primary Children’s with spikes in late summer when children are just heading back to school. EMS will often be called to respond, especially when there is a dramatic deformity. Here are a few tips to keep in mind when you are out on these calls.

Look for:

  • DOTS (deformity, open wounds, tenderness, swelling)
  • Open fracture: any opening of the skin around or near the fracture
  • CSM (circulation, sensation, movement)

Immobilization is key in alleviating pain and protecting further tissue damage during transport. It also goes a long way to calming the child when you have “fixed it” with a splint.

  • Check circulation before applying the splint. If it is compromised you may have to gently manipulate the extremity to restore blood flow. If the circulation is good, splint in the position you find it.
  • Whether you are using the vac splint, orthoglass, SAM splint, or anything else remember to assess CMS before and after placement. Use padding over joints when possible. Anchor ace wraps around the wrist or ankle and move up the extremity.

Immobilizing Fractures in the Field

Common fractures seen are the forearm, elbow, and foreleg. Initial assessment of the extremity below the fracture is important to ensure nerve and blood supplies are intact.

Many times, the child will fall onto an outstretched arm causing a forearm fracture. This may involve the radius, ulna, or both and may be located from the proximal to distal ends of either/both bones. (Figure 1) Splinting should involve the joints above and below the affected area to prevent movement and therefore discomfort. In the hospital, a sugar tong splint would be applied to stabilize the forearm. This splint will prevent flexion and extension of the elbow and wrist as well as rotation of the forearm.

A fall onto the arm causing hyperextension at the elbow often produces a distal humerus (supracondylar) or other type of elbow fracture. (Figure 2) This will often be evident by the effusion/swelling of the elbow joint on physical exam. Stabilization in this case does not need to involve joints above and below, but a simple long posterior arm splint from mid-humerus to distal forearm. In the field a sling is sufficient.

Now for tibia/fibula fractures. (Figure 3). For scene transport, immobilization with a stirrup or posterior leg splint would be appropriate. For tibia/fibula fractures, the posterior splint should extend from mid-thigh to the bottom of the foot (to the toes). This method will stabilize ankle, mid-shaft, or proximal foreleg fractures. A stirrup splint of the lower extremity may end at the proximal foreleg for a distal (ankle) fracture, or above the knee for mid-shaft or more proximal foreleg fractures.

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Pain Management

The ER at PCH uses intranasal fentanyl at triage for all obvious deformities. With this treatment you can treat the child’s pain before splinting or placing an IV.

Fentanyl Dosing for Children
IV 1mcg/kg IN 2mcg/kg
Remember, if you place an IV for pain medication administration avoid the affected extremity. Children may not complain of much pain immediately after the injury but once the “shock state” wears off the pain will set in. Pain management is especially important for long transports.

Consider the Circumstances

Unfortunately, fractures are a common occurrence in children who are abused. EMS providers are the eyes on scene. If the circumstances or environment do not add up document your impressions and report it in accordance with Utah state laws. As always, reserve judgment. There are conditions such as Osteogenesis Imperfecta (OI) or brittle bone disease that can mimic signs of abuse, but if there is ever a question, always report. You protect your license and more importantly your patient.

The Doc Spot

Pediatric Fracture Patterns, Dislocation, and Pain Management

Sydney Ryan, MD

Join us for PETOS on September 13th https://zoom.us/j/98193757707?pwd=UzdNeXppQUdtZ01KZUp2UFlzRk9vdz09. We will dive into the differences between adult and pediatric bone structure. Due to these differences, we will discuss the resulting fractures that occur in the pediatric population and some management/treatment plans. Since pain is a big component during initial evaluation and treatment, we will discuss best approaches to medication management.


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Pediatric Skills Refresher—Fundamentals of Splinting

Fundamentals of Splinting

Pediatric Skills Refresher - Handtevy minute: Ketamine Clarity

Handtevy Minute: Ketamine Clarity

News From Utah EMSC

EMSC and the Bureau of EMS just celebrated the annual EMS awards

2019-2020 EMSC Distinguished Person of the Year Award—Rebecca Ethington

One of the unique things about being part of EMSC is watching how great people are drawn to it. This attraction usually starts with someone taking a class like PEPP, PALS, or Handtevy (by which EMSC coordinators are involved in teaching) and at the conclusion of the class they want to know how they can be a part of teaching something that they are passionate about that will impact pediatric outcomes. The ironic thing about their attraction is these people are already so busy in their agency(s) doing so many other different things they are still able to find time to become an EMSC Coordinator.

This year’s candidate is just that, very busy in her EMS career. She started in EMS in 1994, took a little break, and got back into EMS with everything she could muster. She raised her own bar and became an AEMT, EMT Instructor, CPR Instructor, teacher, and a Handtevy instructor (after a little coercion). With life and its changes, she has been able to work at many different departments from Lehi, to Spanish Fork, Payson and now Santaquin learning the ropes of each department. Because of the great compassion, treatment and care she has for her patients, she is model to follow for those who have any interaction with her. Her dedication to best practices for her patients has put her on the path of a fulfilling career. She is currently in the process of becoming a paramedic. Her ultimate goal is becoming a critical care nurse.

When the Bureau and EMSC introduced the idea to include Handtevy in our state, she was on

board immediately. Being a pediatric care advocate, she could see the benefits this tool had to offer and how it could improve the outcomes our pediatric patients. She now actively seeks to make sure those she works with are properly trained in the assessment and treatment of pediatric patients and that all equipment for kids are up-to-speed and ready to go. Sometimes change can be difficult, but she has challenged agencies throughout her county to see the benefits of Handtevy and has been encouraging them to adopt it and improve pediatric emergency care.

When the request goes out for instructors to teach in an EMSC class, this coordinator tends to be one of the first to say “I’ll do it, I would love to go teach.”

2020-2021 EMSC Distinguished Person of the Year Award—Isabel Shimanski

Isabel Shimanski - Mountain West Ambulance

Isabel has been in EMS for 5 years. She began her career with Gold Cross Ambulance in Salt Lake City as an EMT. While working full-time she obtained her Paramedic License to advance her knowledge in EMS. She then took her skills to working in the Emergency Department at the University of Utah where she learned the importance of prehospital care transitioning to in-hospital care. From there, she landed a full-time paramedic position at Mountain West Ambulance in Tooele.

In a short time at Mountain West Ambulance, Isabel established herself as a passionate EMS provider, especially when treating children. This made her a perfect fit for the Pediatric Emergency Care Coordinator (PECC) position at Mountain West. Once in this position, she established bi monthly pediatric specific training, identified the importance of appropriate pediatric equipment, and was a strong advocate for Handtevy (pediatric resuscitation system). She is an active participant in Mountain West Ambulance’s CQI process specifically conducting case review on pediatric patients and presenting data to the agency Medical Director, Director, and Training Officer.

Recently, Isabel helped establish the Mountain West Ambulance Peer Support team and the Tooele County Peer Support Team. The goal being to support the mental health and wellbeing of its employees. Isabel currently sits as the Peer Support Team Coordinator.

Isabel currently holds the position of Supervisor at Mountain West Ambulance where she is respected and trusted. She recently worked on the creation/update of the agency’s medical

protocols working closely with staff and agency leadership.

In between her great achievements at her agencies, Isabel was able to find time to research. Working with Dr. Hilary Hewes and Primary Children's, Isabel researched and wrote a protocol for hypothermic pediatric patients in cardiac arrest. The protocol established clear guidelines to provide safe and emergent transport to Primary Children’s Hospital where they may receive extracorporeal membrane oxygenation (ECMO).

Isabel is in the process of applying to medical school to advance her medical career with aspirations of becoming a Medical Director of an EMS agency in the future.

Isabel is the role model of what a PECC should be in Utah EMS.

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How did Utah do on the National Pediatric Readiness Survey? WE HAD A 100% RESPONSE RATE!


Seasonal Safety

September is National Preparedness Month! This year’s theme is “Prepare to Protect. Preparing for disasters is protecting everyone you love.”

As you prepare for emergencies, think about fall weather threats. The National Weather Service’s fall safety presentation offers tips on staying safe from all kinds of hazards.

Here’s a week-by-week plan to help you prepare for any emergency this month and all year long:

September 1-4: Make A Plan: Talk to your friends and family about how you will communicate before, during, and after a disaster. Update your plan based on COVID-19 recommendations from the Centers for Disease Control and Prevention.

September 5-11: Build A Kit: Gather enough supplies to last for several days after a disaster for everyone in your home. Don’t forget to consider the unique needs each person or pet may have in case you have to evacuate quickly.

September 12-18: Prepare for Disasters: Limit the impacts disasters have on you and your family. Know the risk of disasters in your area and check your insurance coverage. Learn how to make your home stronger in the face of storms and other common hazards; act fast if you receive a local warning or alert.

September 19-25: Teach Youth About Preparedness: Talk to your kids about how to prepare for emergencies and what to do in case you are separated. Reassure them by providing information about how they can get involved.

To learn more about National Preparedness Month and the steps you can take to prepare all year long, visit https://www.ready.gov/september.

The Latest on Covid-19 and kids

During the first 10 days of the current school year, cases among school-aged children were 4.8 times higher than they were during the first 10 days of the last school year. The new school year is starting with a higher baseline of cases, limited safety protocols in place, and the highly transmissible Delta variant. Cases could continue to increase dramatically over what was experienced in schools last fall.

The Utah Department of Health has added new, school-specific data to the coronavirus.utah.gov/case-counts web page. By clicking on coronavirus.utah.gov/case-counts/#schools users can see school-level case data, case counts by elementary, middle, and high school-aged youth, hospitalizations and vaccinations among school-aged youth, and information on MIS-C cases.

Covid-19 Trackers

Johns Hopkins Global tracker (desktop)

Johns Hopkins Global tracker (mobile)

Utah Department of Health

Ask Our Doc

Do you have a question for our EMSC Medical Director, Hilary Hewes, MD, PCH, ER Attending Physician about this newsletter topic or anything related to pediatrics? Shoot an email to the following address tdickson@utah.gov.

PCH has a new Outreach and Education Coordinator

Lindy Kartchner, BSN, RN, CPEN recently started as Primary Children's Outreach and Education Coordinator. Lindy has been in healthcare for 20 years, working in PCH's ED for 15 of those years. Lindy has a passion for teaching and teaches ENPC, ATCN and PALS. In her spare time Lindy loves to go on adventures with her husband, their four kids, and their dog. You can reach Lindy via e-mail at lindy.kartchner@imail.org or phone at 801.891.2672.

Have you met the PCH EMS Liaison?

You have the right to close the loop on care you provided. For follow up on patients brought to Primary Children's Hospital, contact the PCH EMS Liaison, Lynsey Cooper at Lynsey.Cooper@imail.org.

Looking for a PEPP class?

Pediatric Education for the Prehospital Provider

Register online at www.peppsite.com. Look up classes in Utah and find the one that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($18.95). Return to peppsite.org to register for the class and follow the prompts.

If you have any questions, please email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.

Pediatric Education and Trauma Outreach Series (Petos)

Monday, Sep. 13th, 2-4pm

This is an online event.

Utah EMS for Children (EMSC), Primary Children's Hospital (PCH), and Utah Telehealth Network (UTN) have partnered to offer the Pediatric Emergency and Trauma Outreach Series (PETOS) to EMS providers.

This course provides one free CME from the Utah Department of Health Bureau of EMS and Preparedness for EMTs and paramedics. The lectures are presented by physicians and pediatric experts from Primary Children’s Hospital. The format is informal, inviting questions and discussion.

Join us on Zoom each 2nd Monday at 02:00 PM Mountain Time (US and Canada)

Join Zoom Meeting

Meeting ID: 981 9375 7707

Password: EmscPCH

Archived presentations can be viewed and also qualify for CME. Access at https://intermountainhealthcare.org/primary-childrens/classes-events/petos

To obtain a completion certificate

  • For live (virtual) participants: To receive a certificate of completion for attendance be sure to include your email address when the host requests it in the chat during the live presentation. Certificates are e-mailed out after verification of attendance and processing.
  • For archived viewing: After viewing archived presentations (link above) e-mail utah.petos@gmail.com with the date and title of presentation viewed, you will receive a three question quiz to verify participation and once the quiz is returned, certificates are e-mailed out.

We try to have certificates out within a week but will occasionally have delays.

18th Annual Utah Trauma Network 2021—Save the Date

Thursday, Sep. 16th, 8am to Friday, Sep. 17th, 4pm

This is an online event.

Join us for this annual event to learn about the recent advances in trauma care from speakers who are experts in the field. The Utah Trauma Network brings together trauma care providers from around the state of Utah.

Register Today

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First Annual PECC Conference

Thursday, Sep. 30th, 8am-12pm

This is an online event.

This conference is for designated agency Pediatric Emergency Care Coordinators (PECCs). If you are the PECC for your agency please register here: https://forms.gle/2c3PLrBes6ipQ7CTA

Contact EMSC Program Manager, Mark Herrera Mark.Herrera@utah.gov with any questions
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30th Annual Issues in Pediatric Care Conference—Save the Date

Thursday, Oct. 7th, 7am to Friday, Oct. 8th, 4pm

This is an online event.

Designed for registered nurses and other pediatric healthcare providers.
  • Discuss current pediatric healthcare issues
  • Review new best practices and pediatric treatments
  • Discuss common pediatric nursing and care concerns
  • Network with other pediatric healthcare providers

Register Here

Utah Pediatric Trauma Network

Friday, Oct. 8th, 8am

900 Round Valley Drive

Park City, UT

The Utah Pediatric Trauma Network Conference is scheduled for Oct 8, 2021 and features educational and performance improvement activities. The target audience includes physicians, clinical nurses, nursing leadership, administrators, emergency medical services providers, data analysts, and registrars. The conference will be held at the Blair Conference Center at the Park City Hospital in Park City, UT. The address is 900 Round Valley Drive, Park City, Utah 84060.

To register: https://utahptn.org/conference-registration/

University of Utah's EMS Grand Rounds (Offered every 2nd Wednesday of even months)

Wednesday, Oct. 13th, 2pm

This is an online event.

Virtual-Zoom Meeting Meeting

ID: 938 0162 7994 Passcode: 561313

Emergency Medical Services for Children, Utah Bureau of EMS and Preparedness

The Emergency Medical Services for Children (EMSC) Program aims to ensure that emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure that the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, no matter where they live, attend school, or travel.