December 2019; Volume 8, Issue 12
Pedi Points - Tia Dickson, RN, BSN, Primary Children's Hospital
- 1 in 5 children are abused in this country.
- Utah DCSF reported in their 1st Quarterly Report FY2020 they have received 10,648 Child Protective Service (CPS) referrals (see below).
Bruising is the most common presenting injury in abused children
Location, location, location
Bruise coloring changes as blood/hemoglobin is broken down
Bruising of different colors and ages, patterned bruising, or stories that don't make sense are all red flags
This mnemonic should be a staple in your assessment tools
Injury to torso, ears, and neck
Any injured child younger than 4 months (those who don't cruise, don't bruise)
Injury to frenulum, angle of jaw, cheek, eyelids, or subconjuctival hemorrhage
Bruise coloring changes as blood/hemoglobin is broken down
Involve law enforcement at the earliest opportunity. Collect evidence and ensure chain of evidence as this can make or break a case.
Describe the scene rather than interpret it
- Avoid words that imply opinion or judgement
- Document who is present, their condition, and any actions they have taken
“parent slurring words, smells of alcohol” is more useful than “parent drunk”
- Document direct quotes when possible
EMS providers should indicate suspicion of abuse or neglect to emergency department personnel. However, this does not discharge the need to also report it.
- Have demographics of patient, including address and location of the alleged events, ideally have parents’ names
- Tell them who you are and provide your contact information
From the Scene - Cory Oaks, EMSC Box Elder Coordinator
Pediatric abuse calls affect us not only during them but in many years to follow. My mind can automatically recall the pediatric patients I have taken care of over the course of my career. How quickly, clearly, and vividly abuse calls come back to me, even though in some cases it's been well over twenty years.
We are seeing a national epidemic among responders, one that is not exclusive of any department size, location, provider level, or paid/volunteer status, that of responder suicides. A google search for “responder PTSD resources” yields approximately 1.1 million results, yet even with all of these available resources, the problem is growing. The first question is: Do we have the RIGHT resources?
This profession puts us in a unique position. We may think we aren't allowed to be human. If your neighbor happens upon an auto/ped fatality on the way to work it may take them months to process and cope. As first responders, we don't allow ourselves that same courtesy. In a "not-so-rare" day you may wake up to a SIDS baby call, deliver the baby to the hospital, and grab breakfast on the way home. Later that day, after training, you head to a drug overdose fatality, or a rollover ejection, and then try to decide what Redbox movie you'll grab on the way back to the station. These compounding events, along with an inability to properly decompress, contribute greatly to our suicide epidemic.
I have to wonder if our problem is a resource problem or a cultural problem? Do we add too many roadblocks to working our way through the experiences we encounter? Are we perpetuating the stigma that asking for help is a sign of weakness? Often we wear being “broken” as a badge of honor and fear labels such as "PTSD" or "mental illness. These may deter many from seeking the help they need.
When a group of EMS managers and directors was recently polled, the consensus of the group was that those who ask for or seek help are a liability. Additionally, all of those polled expressed concerns about their fitness to return to duty after receiving mental health care, citing potential liability to the department or agency should an event occur. When team members suffer a broken limb, we have the ability to verify their condition with an x-ray and determine whether they can return to work. Adversely, when we suffer a mental issue no x-ray or lab testing can verify the condition is "healed."
As leaders, managers, mentors and peers we must change this unhealthy culture. Early help and intervention is not a sign of weakness. We should admire the strength it takes to ask for help. It is time we allow ourselves to be human.
Protocols in Practice - Non-Accidental Trauma/Abuse
Ask Our Doc
Happenings - Hilary Hewes EMSC Medical Director and PCH ER Attending Physician
Help improve your agency and emergency department’s readiness to take care of pediatric patients and participate in a national quality improvement project!
The national EMS for Children program, with the help of the National EMSC Data Analysis Research Center (NEDARC), is preparing to launch two national surveys in 2020.
The 2020 EMS Annual Data Collection will start on January 7th, 2020. On that day, the survey for your state will be open for respondents at emscsurveys.org. This survey will ask basic demographic information about each agency including number of staff, level of certification, annual number of calls, number of pediatric calls, as well as critical information about whether your agency has a Pediatric Champion or Pediatric Emergency Care Coordinator (PECC). It will also ask what kind and how often agencies do skills checking on pediatric equipment. Please help to ensure someone in your agency completes this survey. It is important for us to see how Utah agencies are doing in general and how we compare with similar agencies across the country.
The data collection will run through March 31, 2020.
On June 1, 2020, the National Pediatric Readiness Project will launch the 2020 Assessment. This assessment will be sent to nurse managers and medical directors of all emergency departments across the country to evaluate structural processes and policies in place to be ready for pediatric patients. Those who take the assessment will get immediate feedback with a gap report comparing your score with previous scores (if taken in the past) and comparing you to similar emergency departments across the country. These scores have been linked to outcomes such as mortality from critical illness, and participation in the project is very important for the Utah Department of Health to understand the state of pediatric preparedness in Utah.
News from National EMSC and the Children's Safety Network
Pediatric Education and Trauma Outreach Series (Petos)
Monday, Jan. 13th 2020 at 2-4pm
475 300 East
Salt Lake City, UT
Pediatric lectures for EMS. Face time with PCH attending physicians. These lectures occur on the 2nd Monday of each month from 2-3 p.m. You may attend in person or watch the webinar. It will qualify for pediatric CME from the Utah Department of Health Bureau of EMS and Preparedness. Access at https://intermountainhealthcare.org/locations/primary-childrens-hospital/classes-events/petos/
RSVPs are enabled for this event.
42nd Annual Current Concepts in Neonatal and Pediatric Transport Conference
Wednesday, Feb. 19th 2020 at 8am to Friday, Feb. 21st 2020 at 5pm
100 Mario Capecchi Drive
Salt Lake City, UT
2020 Zero Fatalities Safety Summit March 31-Apr 2nd
Tuesday, March 31st 2020 at 8am to Thursday, April 2nd 2020 at 4:30pm
1651 North 700 West
There is a fantastic EMS track at this conference, lots of swag, and registration is open now.
2020 EMSC Coordinators Workshop
Thursday, June 25th 2020 at 8am to Saturday, June 27th 2020 at 12pm
1731 South Convention Center Drive
St. George, UT
Looking for a PEPP Class?
EMSC Pediatric Education for Prehospital Providers
Register online at peppsite.org. 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 firstname.lastname@example.org or text/call 435-597-7098. Continue to watch the website for additional classes.
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.