EMSC Connects

March 2020; Volume 9, Issue 3

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Pedi Points - Tia Dickson, RN, BSN, Primary Children's Hospital

Children love water. Traditionally the top counties in Utah to report drowning Patient Care Reports in Utah are Salt Lake, Washington, and Utah but it can happen anywhere. These calls begin in the spring (which seems to be coming early this year) and continue into September. Are you ready?

PETOS - Highlights from Pediatric Drowning

Presented in Aug 2019 by Katie Russell, M.D., Trauma Medical Director and Pediatric Surgeon, Primary Children's Hospital

Drowning Stats

  • An average of 3,536 fatal drownings occur every year in the U.S.
  • 20% are children <14 years of age.
  • Nationally, drowning is the 2nd leading cause of unintentional pediatric death after Motor Vehicle Crash. In Utah it is the leading cause of death for children ages 1-4 years.
  • In Utah, 30 people die each year from drowning.
  • In Utah, April - September is the most active risk time.

Below is the typical pathophysiology of drowning.

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Drowning, especially in cold water can cause a cardiac arrhythmia. These arrests can be corrected, many times simply by oxygenating. They will usually present with long QT, ventricular fibrillation is rare. Ninety percent of the time drowning causes a hypoxic arrest. Fluid in the lungs causes alveolar collapse making the patient hard to bag. Any aspiration can lead to pneumonia, abscesses, and ARDS but fewer than 10% of victims die from lung failure. Heart and lung issues are manageable if you can get the child to the hospital but the brain is a different story. This is why cold vs.warm water determination is important.

CPR is really important!

"Children with good outcome 4.75 times more likely to have had immediate bystander CPR than those with poor outcomes " - Kyriacou et al. Pediatrics, 1994

In Utah we are at high risk for cold water drowning because of snow pack runoff, high altitude mountain lakes, and cold weather recreational activities. This risk increases during the spring.

Primary Children's Hospital (PCH) has standardized the use of bypass in re-warming a cold water drowning victim. This bypass is called Extra Corporeal Membrane Oxygenation (ECMO). If a child's core temperature (rectal, esophageal or bladder) is less than 30 degrees C (86F) they are a candidate for ECMO. If you can not obtain a core temperature but they feel cold, you should report that to PCH. Also minor trauma does not exclude anyone.

Studies seem to indicate that certain circumstances improve the chance of survival in these cases:

  • If they got cold before becoming hypoxic (such as immersion)
  • The faster they are put on ECMO the better
  • If they got cold fast
  • If they have a normal or near-normal pH and potassium
  • They wake up quickly after ECMO

Primary Children's protocol for determining use of ECMO in a drowning case

30 degrees Celius = 86 degrees Fahrenheit

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Primary Children's encourages pre-hospital providers to begin CPR and establish an airway. You should attempt Epi x 3 total and if you think you can defibrillate, make up to three attempts. They strongly recommend that if you have a child who is hypothermic and has no pulse, bypass any other hospital and come directly to PCH. They need ECMO. If you have a "near-drowned" patient, encourage transport. The child will be observed in the ED for at least six hours to ensure they are not going to develop complications.

Expert Input

Drowning Prevention
Reprint from Cambree Applegate, MS, CHES Safe Kids Utah Director Violence and Injury Prevention Program Utah Department of Health

Toddlers (ages 1-4) wandering off. The most common scenario involves an under-supervised child wandering off during a weekend family gathering – with several adults present but none designated as the official “child watcher” – and falling into a body of water (like a pool, stream, pond, creek, or irrigation ditch). In some cases, the child was thought to be indoors but had managed to get out of the house undetected.

Teens (frequently males) swimming with friends at a reservoir or lake. Many of these deaths are “witnessed” drownings, where friends or family members see the victim go under the water and are unable to rescue them. Overestimating swimming abilities and peer pressure to take risks are thought to be factors in these deaths.

Infants left unattended in bathtubs. These drownings also include cases where an infant was left alone in a bathtub with an older brother or sister.

Drowning can happen even when a child is being supervised. Many people don’t realize that drowning is often silent. This means someone who is drowning is not able to shout for help or grab onto something. When they come above water they only have time to inhale and exhale. It is important, especially for parents of young children, to be able to identify signs of a drowning child.

Tips to keep kids safe in the water:

  • Children can drown in as little as one inch of water. Make sure to prevent children from gaining access to areas of the house where water is present (i.e. bathtubs, sinks, and toilets). Never leave an infant or young child alone in the bathtub or with “older” siblings.
  • When not in use, drain and keep kiddie pools and buckets out of reach from children.
  • Actively supervise children in and around bathtubs, pools and open bodies of water, giving undivided attention, and watching for signs of drowning.
  • If several adults are present, designate a "child watcher" to watch children in and around the water. Adults should take turns so everyone can have fun and stay safe.
  • No matter where children might swim, teach them to always swim with an adult. Even older, more experienced swimmers should swim with a partner. Teach kids when they are young that they should never go around water without an adult present.
  • Warn teenagers of the risks of overestimating how well they swim. Even experienced swimmers can drown.
  • Learn CPR. Being able to perform CPR if needed is an essential skill that every parent should have to be able to use if needed.
  • Wear a life jacket. Especially out in open water a life jacket will help give children and adults extra support in the water. Even expert swimmers should wear a life jacket.
  • Have everyone wear a Coast Guard-approved life jacket while on a boat or during water sports. Children should also wear a life jacket when near open bodies of water.
  • If you are having a hard time locating your child, check areas where they might gain access to water first.
  • Install a carbon monoxide detector aboard houseboats.
  • Never dive into unknown or shallow waters.
  • Enclose pools and hot tubs with self-closing and locking gates/fences.
  • Visit Safekids.org for more age appropriate tips for your child.

Protocols in Practice - Drowning or Submersion

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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 pediatric related? Shoot an email to the address below and look for her response in our next newsletter.


From Our Medical Director Hilary Hewes

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), will be launching two national surveys in 2020.

The 2020 EMS Annual Data Collection started on January 7, 2020. The survey for your state is now open for respondents at emscsurveys.org. This survey asks 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 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.

June 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 with 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 better understand the state of pediatric preparedness in Utah.

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Please take our survey, let your agency be heard!

Want Follow up on Patients brought to Primary Children's?

Contact PCH EMS Liasion Lynsey Cooper and Lynsey.Cooper@imail.org

OR use the dedicated EMS Follow up email PCH-EDRTU-EMS@imail.org


The all-new Fourth Edition of Pediatric Education for Prehospital Professionals (PEPP) will be available soon! Check out free sample content or pre-order your copy today: https://hubs.ly/H0mQGRV0. If you have any questions about the new Fourth Edition materials please email pepp@aap.org. Continue to watch www.peppsite.com for additional information.

Are you interested in joining our EMSC team?

If you are a pediatric advocate within your agency, we need you. Please contact our program manager, Brianne Glenn (brianneglenn@utah.gov) to find out how you can help.
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Pediatric Education and Trauma Outreach Series (Petos)

Monday, April 13th, 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.

MVH EMS In-service - Capnography Presented by Brandon Howard

Wednesday, March 11th, 7pm

5353 South 960 East

Salt Lake City, UT

Join Zoom Meeting


Meeting ID: 354 702 650

To communicate to the presenter, use the chat box for questions.

2020 Zero Fatalities Safety Summit March 31-Apr 2nd

Tuesday, March 31st, 8am to Thursday, April 2nd, 4:30pm

1651 North 700 West

Layton, UT

The Zero Fatalities Safety Summit The Zero Fatalities Safety Summit is the premier safety event in Utah. The Summit occurs once every two years and is a unique opportunity for safety officials and advocates to network with each other and share best practices that enhance safety on our roads.

There is a fantastic EMS track at this conference, lots of swag, and registration is open now.

2020 EMSC Coordinators Workshop

Thursday, June 25th, 8am to Saturday, June 27th, 12pm

1731 South Convention Center Drive

St. George, UT

EMSC Coordinators put this date on your calendar and make those vacation requests now. We look forward to our annual Coordinators Workshop and hope you will be there!

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 eandersen@utah.gov 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.