EMSC Connects

February 2023; Vol.12, Issue 2

Utah Emergency Medical Services for Children

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Pedi Points

Tia Dickson, RN, BSN

Primary Children's Hospital


  • Nationally, 1 in 69 births are an autistic child and that number is on the rise
  • In Utah in 2021, 1 in 46 children were born with autism
  • Boys are 4 times more likely to be born with autism than girls
  • Most children with Autism Spectrum Disorder (ASD) are diagnosed by the age of 4 years

Chances are high that a first responder will come into contact with an autistic person. Most often EMS encounters these children in wandering circumstances.


There is a saying in the autism community; "If you've met 1 person with autism, you've met only 1 person with autism." No two are alike. There is no single physical characteristic and no universal trait that distinguishes someone with autism. Identifying a person with autism can be a challenge. Special training and understanding is important for positive interactions with these youth.

The core symptoms of autism are

  1. Deficits in communication
  2. Deficits in social understanding
  3. Narrow, restrictive, or repetitive interests and behaviors

https://autismsociety.org/

Expert Input

Expert Input

Understanding Autism; autism, and neuro-diversities for medical professionals

Jeff Wilson NREMT-PM

Excerpts from January 9th PETOS


Jeff is a paramedic who works for Gold Cross and his 6-year old son is autistic. Jeff and his wife, Heather, are dedicated to helping medical professionals understand autism.


As of 2019, neuro-diversity, asperger's, and autism are one in the same. Autism Spectrum Disorder (ASD): is a developmental disability caused by differences in the brain. As a spectrum, the symptoms of ASD may range from mild to severe. But for all people with ASD, life can be challenging.


Severity is often broken into 3 sections

  • High functioning: can function in everyday life
  • Moderate functioning: needs some help with activities of daily living
  • Severe: need 24/7 care
Expert Input

Common symptoms

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Think of extremes: new experiences or overstimulation can trigger aggressive behaviors. These children often exhibit ritualistic behaviors, focus in on specific topics of interest, and they are unwavering in their routines. About half of the children with ASD like to wander and will "bolt" when something attracts their attention and most are fascinated by water.

Common ailments and emergencies

EMS are called to respond to an ASD youth for the same reasons they are for the general pediatric patient but their presentation can be more extreme.
  • Epilepsy
  • GI issue related to their eating habits or rituals
  • Overdoses
  • Falls
  • Drowning
  • Dehydration (forgetting to drink or too busy)
  • Behavioral issues

EMS Considerations

Children with ASD are often teased or bullied. They are different and targeted for that reason. This is often related to fear and a lack of understanding. Protect them rather than add to the problem when you respond to these patients. They want to be accepted.


Be aware that family may be injured. These children have behaviors which can cause harm. Headbutting, punching, scratching, and other aggressive behaviors occur. When you respond to a call, look for injuries among caregivers. Also look for emotional injury. Parents may be at their breaking point. Look for signs that a caregiver needs help.

Autism acronym for Your Approach

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Jeff also included these:


  • Use a monotone voice and mirror their energy level
  • Instead of open ended questions, use direct, simple yes or no questions
  • Let them "play" with your equipment
  • Turn an exam into a game. Example: play The Floor in Lava when you ask them to get on a stretcher.
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De-Escalation

  • Family and caregivers know best. Allow them to stay with the patient, even during transport when possible.
  • Ask the family about the child's triggers and tips on approach.
  • Determine their language capabilities. How do they communicate? Use interpreters if needed.
  • Stay composed and calm. Remove yourself if you feel overwhelmed. (Safety officers or captains should facilitate this).
  • Only use medical sedation in extreme situations as a very last resort. Get approval from caregivers before you choose this route.

Secret weapons for positive interaction

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Consider making an autism response kit for your ambulance. Items could include:
  1. Sound canceling headphones
  2. Non-verbal cue cards
  3. Sign-language cards
  4. Sensory toys (poppers)
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Don't

  • Don't let them play with gloves or other possible choking items
  • Don't use a demanding, threatening, or loud tone
  • Don't assume
  • Don't lose your patience
  • Don't try to stop repetitive behaviors
  • Don't try to stop tantrums unless there is a risk of self-harm
  • Don't rush. These calls will take time. They are not load and go.
Jeff provides on-site training for EMS agencies, schools, and communities. Contact him if you would like more training.

jeffwilson122615@gmail.com

Additional Resources for Patients and parents

https://utahparentcenter.org

Adult Autism Center in Murray Utah

Utah Autism Council

Additional 1st Responder Resources

Additional 1st Responder Resources

The University of Utah is offering a Autism 101 ECHO Module beginning 2/22/23. These courses will focus on the needs of children with ASD. Register here


Autism Society of America

National Autism Association Big Red Safety Box

Autism Speaks: Wandering Resources

Additional 1st Responder Resources

Skill refresher—Autism First Responder Training Video

Autism First Responder Training Video

Protocols in practice—Family Centered Care

Ask our doc

Do you have a question for our EMSC medical director, Sarah Becker, MD, PCH, ER attending physician about this newsletter topic or anything related to pediatrics? Email tdickson@utah.gov.

News From National EMSC

On topic


On Covid-19 and kids

News from Utah EMSC

Zero Fatalities

Zero Fatalities

Utah EMSC is participating in the upcoming zero fatalities conference which has an exclusive EMS track. We have scholarships for attendance. Save the dates April 24-27, 2023 and contact our program manager jaredwright@utah.gov if you'd like to go on our dime.
Zero Fatalities

EMS surveys

The 2023 EMS survey has launched! Utah EMS agencies and Utah PECCs, we have a legacy of getting a 100% response rate on these surveys and that's our goal for 2023. We need your help. Take the survey now and avoid the pleading phone calls from us in March. Click the pic below to get started

2022 National EMS for Children survey results

PECC development

PECCs, check out the new EIIC PEAK resource on agitation and join for quarterly PECC meeting this month (See below).

Virtual quarterly PECC meeting—save the date

Tuesday, Feb. 21st, 10am-12pm

This is an online event.

You will receive an invitation with the link through email. If you are a PECC and don't receive this invitation contact our program manager, Jared Wright

jaredwright@utah.gov.

PECC monthly office hours

Tuesday, March 7th, 9-11am

This is an online event.

EMSC offers monthly, virtual open office hours on the first Tuesday of each month. Our team will jump on zoom and go live. Anyone with questions, concerns, ideas, or needs is invited to join and discuss with our team. While this offering is focused on EMS and hospital PECCs, anyone with pediatric concerns is welcome.


Zoom link

BEMSP is inviting you to a scheduled Zoom meeting.

Join Zoom meeting
https://utah-gov.zoom.us/j/87005645259

Meeting ID: 870 0564 5259
When

Monthly from 9 a.m. to 10 a.m. on the first Tuesday from Tuesday, November 1 to Tuesday, February 7, 2023 (Mountain Time—Denver)

Pediatric education from Utah EMSC

Pediatric education and trauma outreach series (Petos)

Monday, Feb. 13th, 2-4pm

This is an online event.

Utah EMS for Children (EMSC), Primary Children's Hospital (PCH), and Utah Telehealth Network (UTN) offer the pediatric emergency and trauma outreach series (PETOS) to EMS providers.


This course provides one free CME from the Utah Department of Health and Human Services Office of Emergency Medical Services 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 second Monday at 02:00 PM Mountain Time (US and Canada) Click the pic below!


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. Once the quiz is returned, certificates are e-mailed out.


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

Looking for a PEPP class?

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 1 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 ($21.95). 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.

Looking for a PEPP class?

Other pediatric education

University of Utah Winter Injury Prevention Learning Series

Tuesday, Feb. 21st, 11:30am-1:30pm

This is an online event.

Register here

To view previous sessions for all these series visit this link

University of Utah Spring 2023 Pediatrics ECHO (multiple lectures per month 2/15, 2/22, 3/1, 3/8)

Wednesday, Feb. 15th, 12pm

This is an online event.

For those new to pediatrics ECHO, you can earn CME for participating in a case-based learning session with experts in a variety of pediatric topics. Pediatrics ECHO offers a way to connect with other pediatric practitioners around Utah and beyond.


2/15/23 Irritable Bowel Syndrome (IBS) by Justin Wheeler, MD

2/22/23 Autism 101: Early Signs


Register Here

45th Annual current concepts in neonatal and pediatric transport conference

Tuesday, Feb. 21st, 8am to Friday, Feb. 24th, 5pm

215 West South Temple

Salt Lake City, UT

Target audience: This conference is designed for advance practice providers, nurses, paramedics, physicians, and respiratory therapists, who have training in the transport of neonatal and pediatric patients to tertiary care centers.


Register Here

EMS Focused Education

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

Wednesday, Feb. 15th, 2pm

This is an online event.

Click here to join

Virtual-Zoom Meeting Meeting

ID: 938 0162 7994 Passcode: 561313

Zero Fatalities Safety Summit

Hospital Focused Education

Primary Children's Pediatric Grand Rounds (offered every Thursday, Sept-May)

Thursday, Feb. 16th, 8am

This is an online event.

Offering both RN and MD CME

The Pediatric Grand Rounds weekly lecture series covers cutting-edge research and practical clinical applications, for hospital and community-based pediatricians, registered nurses, and other physicians and practitioners who care for children of any age.

The series is held every Thursday, 8 a.m. to 9 a.m. from September through May in the 3rd Floor Auditorium at Primary Children's Hospital. The lectures are also broadcast live to locations throughout Utah and nationwide.


Connect Live

Click here for the PGR PCH YouTube Channel to find the live broadcast. Archives (without continuing education credit) will be posted here within 1 week of the broadcast.

Save the date

https://intermountain.cloud-cme.com/course/courseoverview?P=5&EID=21730
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Emergency Medical Services for Children, Utah Office of EMS and Preparedness

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

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

The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure 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, regardless of where they live, attend school, or travel.

tdickson@utah.gov 801-707-3763 bemsp.utah.gov/