EMSC Connects

November 2021; Vol.10, Issue 11

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Pedi Points

Tia Dickson, RN, BSN

Primary Children's Hospital

The respiratory illness season is in full swing. EMS crews have probably seen an uptick in pediatric transports for respiratory illness. We have dedicated past newsletters to management of the pediatric airway during a medical emergency. Now, we want to focus on the care of the traumatically injured pediatric airway. While the principles of good airway management are the same in both medical and trauma patients, there are some things in trauma to keep on your radar.

Airway & breathing

The overall goals of airway management in the trauma patient are to:
  1. Provide a secure patent airway
  2. Supply supplementary oxygen
  3. Support ventilation
  4. Prevent hypoxia and aspiration

These goals are the same for the pediatric and the adult patient. Accurate assessment of the respiratory status is especially important in children. A known pitfall in trauma management is under-resuscitation and resulting hypoxia. Hypoxia is the main reason children go into cardiac arrest.

Trauma-associated deaths may be prevented with early recognition and treatment of inadequate ventilation. The majority of pediatric trauma involves some degree of head injury and preventing hypoxia (and hypercapnia) is critical in protecting the brain. In pediatrics, once respiratory arrest leads to pulseless cardiac arrest, survival as well as neurologic outcome is dismal. You are first on scene, here is where you influence outcomes!

Assessment of the Pediatric Respiratory Status

  1. Pediatric vital signs must be compared with age-related normal values. The Handtevy App is useful here.
  2. Pulse oximetry is a useful adjunct for monitoring a child's respiratory status but the gold standard is end tidal CO2 (ETCO2) monitoring. We should let ETCO2 drive management on all our patients with respiratory issues.
  3. Evaluation of overall general appearance (e.g., posture, level of alertness, or responsiveness) and other organ systems such as CNS (e.g., lethargy, agitation, or other altered mental status) and skin (e.g., pallor, cyanosis, or delayed capillary refill) also will aid the recognition of respiratory distress and impending respiratory failure in a child because a child's brain consumes a lot of oxygen and hypoxia may result in alteration here.
  4. Assess respiratory effort for the following:
  • Tachypnea, an early sign of distress. This is how a child preserves minute volume.
  • Chest rise or abdominal excursion (the way the diaphragm moves) can reveal the adequacy of the trauma patient's respirations and tidal volume.
  • Listen for respiratory noises (e.g., snoring or stridor indicating upper airway obstruction; wheezes indicate lower airway obstruction; and grunting, ominous for severe respiratory distress) are indications of work of breathing and airway obstruction.

The Bureau will soon be providing agencies with high flow nasal cannula devices and we look forward to protocol direction on how to best use these in the prehospital pediatric realm.

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Chest injury in children is rare but often deadly. Blunt or penetrating, numerous potential complicating diagnoses can result from chest trauma. Some require more emergent interventions than others. Scene times should be as short as possible for severely injured patients. Transport should not be delayed to perform procedures that are not life threatening.

There are cases when a life threatening injury does need immediate intervention.

  • Blunt chest trauma, shortness of breath, asymmetric lung sounds, deviated trachea, crepitus, hypotension, or a hemodynamically unstable patient are all suspicious for tension pneumothorax. Needle decompression should be considered.

Tension Pneumomediastinum

This 9- year old was kicked in the chest by a horse in a rural Utah community. The medics performed a needle decompression after this film was taken at the local clinic. As you can see, the organs are under extreme pressure and cannot function properly. Needle decompression saved her life.

"Prehospital management often depends on the level of service of the transporting team; in the United States, this consists of basic life support (BLS) and advanced life support (ALS). Basic interventions include non-invasive airway management, cardiopulmonary resuscitation and defibrillation, hemorrhage control, spine immobilization, and splinting/stabilization of extremity fractures. More advanced techniques include advanced airway interventions (including endotracheal intubation), administration of select medications, cardiac monitoring, and needle decompression. Availability of transport services, as well as the capabilities of destination hospitals, vary greatly throughout different geographic settings, and special considerations must be taken based on local resources and facilities."3

Join us on Zoom today for PETOS at 2pm. Dr. Katie Russell, the trauma medical director at Primary Children's will present an in-depth bronchial injury case.

Additional Resources on the Topic

November 18th from 0730-0830 MST: Trauma Grand Rounds–Dr. John Skaggs will present on Airway Management in Trauma (see below)


  1. The Pediatric Airway and Rapid Sequence Intubation in Trauma
  2. Managing the Airway of the Pediatric Trauma Patient: Meeting the Challenge
  3. EMS Chest Injury

Protocols in Practice—General Trauma Management

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Pediatric Skills Refresher—View a rare endoscopic view during needle thoracostomy & Chest Needle Decompression

Tension Pneumothorax and Needle Thoracostomy
How To: Chest Needle Decompression

News from Utah EMSC

We are pleased to announce that EVERY EMS agency in Utah now has a designated Pediatric Emergency Care Coordinator (PECC)! Utah EMS are AMAZING!

News From National

November 18, 2021

Injuries are the leading cause of death and disability to U.S. children from one to 18 years old. Every day, 20 children die from preventable injuries, resulting in more deaths than all other diseases combined. In fact, injury is the leading cause of death for people through 44 years of age.

On Thursday, November 18, 2021, the Injury Free Coalition for Kids and the country's leading injury and violence prevention organizations will join forces for the 2nd annual "National Injury Prevention Day," a day designed to raise awareness about the burden of injury, violence, and a need for change. Joining doctors, nurses, and community outreach personnel at Trauma Centers across the country will be Safe Kids Worldwide, Safe States Alliance, the American Trauma Society, the American Academy of Pediatrics, Everytown for Gun Safety, The Society for Advancement of Violence and Injury Research, the Trauma Center Association of America and Juvenile Products Manufacturers Association Cares.


NASEMSO Annual Meeting

Set for November, the pandemic forced cancellation of 2021 NASEMSO Annual Meeting.

PECC Plotting and Planning

Pediatric Mental Health Advocacy Kit

PECCs, in the United States, suicide is the second leading cause of death for youths ages 10-18. Increasingly, the emergency care system has become a safety net for treating pediatric mental health issues: from 2007 to 2015, ED visits for suicide attempts and ideation doubled among the nation’s youth. Is this an issue in your area?

In light of the urgent need to address pediatric mental health, and with today as World Mental Health Day, we are pleased to share the latest Pediatric Education and Advocacy Kit (PEAK): Suicide. PEAK: Suicide includes multidisciplinary resources that are created, synthesized, and vetted through the EIIC Knowledge Management Domain working with numerous collaborators. All resources are free and open access.

We encourage you to share these resources widely; more will be added over time and they will be iteratively updated.

The Latest On Covid-19 and Kids

FDA authorizes Pfizer COVID-19 vaccine for ages 5-11

Pfizer’s COVID-19 vaccine for children ages 5 to 11 was given emergency use authorization by the Food and Drug Administration (FDA) last week. The agency said clinical trials have shown the vaccine is 90.7% effective in the age group and no serious side effects were detected. The Centers for Disease Control and Prevention (CDC) has released clinical recommendations for the vaccine and the shot is now available for kids ages 5 to 11.

The Utah Department of Health is sharing the attached COVID-19: Response Report detailing caseloads and vaccination rates among Utah's school-aged children, COVID-19 related hospital and ICU capacity, and monoclonal antibody treatments. This report provides a high-level overview of where we are as a state in these key areas.

The report can be found in the blue box at https://coronavirus.utah.gov/education. The report is also available in Spanish at https://coronavirus.utah.gov/educacion.

We also encourage you to visit coronavirus.utah.gov/case-counts/ where you can find a searchable database for information on individual schools throughout the state as well as additional information on caseloads, vaccinations, testing, hospitalizations, and more. You may also wish to visit your local health department or local school district COVID-19 dashboards for information on cases in your local schools.

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 teaches ENPC, ATCN, and PALS. 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, Nov. 8th, 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.

U of U Health Trauma Grand Rounds

Thursday, Nov. 18th, 7:30-9:30am

This is an online event.

Via Zoom

Meeting ID: 914 0684 6449

Passcode: 424158

Airway Management in Trauma Presented by: John Skaggs, MD Assistant Professor, Anesthesia

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

Wednesday, Dec. 8th, 2pm

This is an online event.

Virtual-Zoom Meeting Meeting

ID: 938 0162 7994 Passcode: 561313

30th Annual Issues in Pediatric Care Conference—Save the Date

Thursday, May 19th 2022 at 8am to Friday, May 20th 2022 at 4pm

This is an online event.

This conference originally planned for October 7th has been postponed to May 2022 due to the current Covid surge.

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.