EMSC Connects
April 2024; Vol.13 , Issue 4
Pedi points
Tia Dickson, RN, BSN
Primary Children's Hospital
Awww spring! The birds are chirping and bulbs are breaking through the last of the snow to open their flowers. In the ER, while still mired in the remains of respiratory season, the weather warms and our patients with fractures and lacerations also emerge. This summer we have a great line up of pediatric trauma topics beginning today with this overview.
Expert input
Prehospital pediatric trauma
Dave Weber, PM
Excerpts from March 11, 2024 PETOS
For most of us, the pediatric patient is terrifying and the hospital staff who are waiting to take our report on a pediatric patient are the most intimidating of the entire team we work with. Our pediatric education throughout our schooling is, at most, 5% of the curriculum. Once we are out and working, our pediatric patient load is roughly 1 in 100 patients. There is not enough volume here to get comfortable with these patients. So what can we do?
Know your resources
There are great resources to aid in the care of pediatric patients like the Broselow tape and Handitevy type apps. One important point in using these you need to know how to use them. Don't stumble over them in the field. Know what your agency endorses and practice scenarios with them. Do frequent skills checks on your pediatric equipment. Know how to size it and what to do with it. Practice dosing.
EMS stressors
There is a different mindset when you get a 6-year old cardiac arrest versus a 60-year old cardiac arrest. Half the battle in responding to a pediatric patient is setting up the right mindset. Ultimately both of these patients need the same kind of care. Master your mindset for peak performance in these stressful situations. Be prepared!
Ego and tribalism need to be set aside. EMS, fire, PD, and hospital staff; we should not be pitted against one another. Teamwork is the right approach for our pediatric patients, for all patients. If we truly want to prioritize the patient we need to support best practice care from everyone.
Trauma is trauma is trauma!
Trauma is trauma is trauma, especially in the early stages. Sure after a couple of hours, after the initial resuscitation, after all the scans are done, then things might diverge. That's not our (EMS) world. From the time of incident, all the way through those trauma bay doors and even in the trauma bay, kid trauma, adult trauma, geriatric trauma, it's all just trauma. - Dave Weber
Pediatric trauma starts where all trauma starts
The basics
Of course best practice now begins with stopping hemorrhage so we can a add a few letters to our already existing framework.
X—exsanguination
A—airway
Get kids into a neutral position to account for their larger occiput. A little padding under the shoulders is usually enough.
B—breathing
Breathing support is the same for kids as adult, just a bit faster. Oxygen fixes many child problems. Put it on. If the patient's rate is less than normal for age, assist. Learn how to bag properly.
C—circulation
Traditionally, circulation meant both controlled bleeding and maintaining a pulse. Now X has pulled bleeding to the first step but having a pulse is still essential. Do they have one? If they don't, CPR is your first line action. If they have a weak one consider fluid resuscitation. In the future we will likely see changes to using blood and blood products in the field but for now, use for fluid resuscitation protocols and progress to med support if available.
D—disability
This is another area where we see a convergence of adult and peds trauma. Studies are underway at Primary Children's (and PECARN) now to better align spinal clearance protocols so that children are not boarded unnecessarily. Life flight is encouraging the use of "vacmat" boards.
E—expose and environment
We need to look at anything that is hurt and then cover them back up (known as environment).
F—feel
This may also be a great place to consider the family. Studies have shown family presence reduces long-term emotional effects on the child during trauma.
G—go
This is the end of your initial assessment. Manage life threats and leave. Every procedure in the field takes 10 minutes and those 10 minutes add up.
Trauma is easy
The things above are basic. They are easy skills and they are the same on all traumas. When hands-on training is not available, EMS providers can take part in the virtual training opportunities. Studies show visualizing care through best practice can be as effective as hands-on training.
Do the same thing every time
- Visualize your care on the way to the scene
- Use a set and practiced process like the XABC pneumonic
- Use your resources including tapes, apps, and telehealth
- Use a standardized reporting tool (nothing reflects more on our care than a well delivered report)
- Debrief
Strive for best practice when you secure a child in your ambulance!
Protocols in practice—general trauma management
For additional guideline direction check out the UPTN website or the new app, "Utah PTN" on android and apple devices.
CME credit for this issue
Training officers may review the topic above as a team training AND perform a simulation/skills check as directed here. Once complete, send a roster of participants to Utah.PETOS@gmail.com and those listed will be issued 1-hour of CME credit from the DHHS Office of EMS and Preparedness.
Individuals who don't have a training officer can get CME credit on their own by viewing the PETOS in our archives associated with this topic and completing the instructions on the webpage.
Skills checking
- Run a hands-on simulation trauma training using SimBox EMS and your agency pediatric equipment and resources. Bonus points if you send pictures to tdickson@utah.gov.
Research round up
PERCARN network
Children who have sickle cell disease can benefit from intranasal fentanyl: People living with sickle cell disease can experience severe “pain crises,” or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. In this episode, we focus specifically on kids who present with VOE. We know these patients have usually exhausted their home pain control options and are still in excruciating pain when they arrive in the ED. We interviewed Dr. Chris Rees about his recent paper on the benefits of treating kids with VOE with an initial dose of intranasal fentanyl. The results are pretty impressive!
https://ucdavisem.com/2024/02/04/sickle-cell-in-the-ed-part-2/
Pediatric pneumonia:
Navigating pneumonia diagnosis in febrile infants: insights for emergency medicine physicians
Introduction:
Febrile infants aged 60 days and younger present unique challenges for emergency medicine physicians, with serious bacterial infections (SBI) posing a significant risk. Among the various potential infections, pneumonia is a critical concern, with prevalence ranging from 0.1% to 8% in these young infants. Current diagnostic practices, primarily relying on clinical evaluation, struggle to identify pneumonia accurately. A recent study, a secondary analysis of data from the Pediatric Emergency Care Applied Research Network (PECARN), sheds light on the demographic, clinical, and biomarker factors associated with radiographic pneumonias in this vulnerable population.
Key findings:
The study, conducted from June 2016 to April 2019 across 18 emergency departments, enrolled 568 febrile infants aged 60 days and younger. Of the febrile infants who had a CXR performed, definite pneumonias were present in 3.3% (n=19), and possible pneumonias were present in 6.0% (n=34). Notably, signs of respiratory distress, including grunting, nasal flaring, retractions, or tachypnea, were the only physical exam findings that were significantly associated with radiographic pneumonias. A higher proportion of infants with possible or definite pneumonias had influenza or RSV detected (52.9% and 36.8%, respectively) in their nasopharynx compared with those without (21%) pneumonias. There were elevations in certain laboratory markers in infants with pneumonias. In this study, the median WBC count was slightly higher in infants with possible or definite pneumonias compared with no pneumonias. The ANC and PCT concentrations were significantly higher in infants with definite pneumonias. No infant with radiographic pneumonia had bacteremia.
Implications for practice:
Radiographic pneumonia is uncommon in young febrile infants. We don’t need to get a CXR in every febrile infant without signs or symptoms of pneumonia. Consider a CXR in the febrile infant with increased work of breathing/respiratory distress. Elevated biomarkers (ANC/procalcitonin) can support the diagnosis of pneumonia, as well.
Conclusion:
Emergency medicine physicians should be attentive to signs of respiratory distress when they evaluate febrile infants aged 60 days and younger. As we strive for precision in diagnosis and care, this research is a significant step forward to enhance our understanding of pneumonia in febrile infants and refine clinical practices to ensure optimal outcomes.
Resources:
Florin TA, Ramilo O, Banks RK, Schnadower D, Quayle KS, Powell EC, Pickett ML, Nigrovic LE, Mistry R, Leetch AN, Hickey RW, Glissmeyer EW, Dayan PS, Cruz AT, Cohen DM, Bogie A, Balamuth F, Atabaki SM, VanBuren JM, Mahajan P, Kuppermann N; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study. Emerg Med J. 2023 Sep 28:emermed-2023-213089. doi: 10.1136/emermed-2023-213089. Epub ahead of print. PMID: 37770118.https://emj.bmj.com/content/early/2023/09/28/emermed-2023-213089.long
News from national EMSC
EMSC Pulse
National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!
News from Utah EMSC
Pediatric skills workshops for Salt Lake and Utah counties
Primary Children's Emergency Management received an education grant to provide pediatric skills training for EMS in Utah and Salt Lake counties. These workshops are being launched soon.
April Pediatric EMS Skills Workshop. It will be held Tuesday, April 23 from 12-1pm in the 1st Floor Lehi Education Center.
The topic is Child Life. PCH Child Life Specialist, Sheri Bothell, CCLS, will be speaking.
May will be held on Thursday, May 2nd in Salt Lake County. It is the same session on Pediatric Shock by Dr. Sarah Becker, repeated from 11am-12pm and 12:30-1:30pm at Station 64 (5443 W. Lake Avenue, South Jordan).
Lunch and EMS Con-ed provided for all workshops.
June at PCH-Lehi
The skills will be mirroring our PETOS topics each month and this is a great opportunity for those that can attend.
Contact Rebekah Hoffner with any questions
Looking for EMS representation
There is currently an open EMS position on both the Utah-Wyoming Maternal Mortality Review Committee and the Utah Infant Mortality Review Committee. These interprofessional committees review all cases of pregnancy-associated maternal deaths (death during or within 1 year of the end of pregnancy) and perinatal infant deaths (deaths of liveborn infants who die within 1 year of birth due to perinatal causes). Each committee meets 6 times per year. Interested persons may apply using this link.
University of Utah launches an EMS education website
The University of Utah has launched a new EMS education website put together by their Office Of Network Development and Telehealth. Here you can find upcoming and archived education from all of the service lines at the University of Utah Health.
Autism awareness trainings (for agencies and hospitals)
If your agency is interested in Jeff's autism training or in receiving the free John Wilson autism kits, contact Jeff @jeffwilson122615@gmail.com.
The Medical Home Portal is a unique source of reliable information about children and youth who have special health care needs (CYSHCN) and offers a “one-stop shop” for their:
· families
· physicians and medical home teams
· other professionals and caregivers
PECC development
For Utah hospital and EMS agency PECCs
First learning module kicks off PECC series
- Published February 29, 2024
The presence of pediatric emergency care coordinators (PECCs) in EDs is tied to double-digit increases in pediatric readiness scores and is widely considered the most effective strategy to improve pediatric emergency care. In essence, PECCs ensure adherence to national recommendations on pediatric care, with responsibilities that range from tracking pediatric equipment and supplies to spearheading pediatric-specific quality improvement.
To help ED providers establish the PECC role in their EDs and grow as effective pediatric champions, the first module in a free, open-access learning module series has launched. Experts recommend EDs have both a physician and nurse PECC; the modules are therefore geared toward ED nurses and physicians.
The first module provides a basic overview of the importance, scope, and responsibilities of PECCs. Upcoming modules will delve into the 7 areas of pediatric readiness and more advanced training.
Access the module for ED PECCs—along with other resources and information for both ED and prehospital PECCs—here.
The Prehospital readiness assessment launches in May
Pediatric checklists for emergency departments and EMS/fire-rescue agencies provide an easy, informal way to gauge readiness to care for children. These checklists, developed by the National Pediatric Readiness Project and National Prehospital Pediatric Readiness Project (PPRP), have been updated with a new look and format. Access the redesigned checklist for EDs here and the checklist for EMS/fire-rescue agencies here.
The checklists are especially helpful to prepare for national assessments, such as the PPRP Assessment launching in May.
Preview of the Prehospital Pediatric Readiness Project
Is your EMS agency ready for children? While the majority of EMS and fire-rescue agencies provide emergency care to children, pediatric calls are rare. In fact, because many agencies see fewer than 8 pediatric patients per month, EMS clinicians often don’t feel capable or confident when they care for children. Pediatric readiness can reduce anxiety and increase confidence, and research suggests it may also improve outcomes. But what is pediatric readiness and how do you know if your agency is really ready to take care of children? The Prehospital Pediatric Readiness Project (PPRP) can answer these questions—and more. The goal of this national project is to improve prehospital care for acutely ill and injured children, which translates into EMS and fire-rescue agencies being trained, equipped, and prepared in accordance with national recommendations.
Help us spread the word about the Prehospital Pediatric Readiness Project.
- Assessment preview (.pdf)
- Overview brochure (.pdf)
2 new learning modules
Improving pediatric mental health: new toolkit and collaborative
A new toolkit has launched to guide pediatric primary care and other providers in enhancing pediatric mental health care in emergency situations. The initiative also welcomes new teams to the ED Expansion QI Collaborative. Read more.
New learning module on agitation for EMS!
Access a self-paced learning module on how to manage agitated pediatric patients in prehospital settings. Get started.
The Western Pediatric Trauma Conference 2024
July 10-12, 2024 in Sundance, UT.
Did you get the PECC newsletter and resources?
Did you receive the PECC newsletter and resources email sent out on Feb 26th? If not, contact us at jaredwright@utah.gov
Understanding the PECC role
For hospital PECCs
- EMSC has launched its first pediatric emergency care coordinator (PECC) learning module for ED-based PECCs. You are invited to view the module and provide feedback.
For EMS PECCs
- EMS PECC resources can be found on the EIIC website here.
Upcoming PECC events
PECC quarterly meeting
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.
Tuesday, May 21, 2024, 10:00 AM
Northern PECC workshop
PECCs are encouraged to attend an in-person PECC workshop each year to receive up-to-date pediatric training, direction for your PECC role, and to participate in networking with other PECCs statewide. These workshops are free to designated hospital and agency PECCs. We will offer 1 in the northern part of Utah and 1 in the southern part each year.
Friday, Sep 6, 2024, 08:00 AM
Primary Children's Hospital, Mario Capecchi Drive, Salt Lake City, UT, USA
Pediatric education from Utah EMSC
Pediatric emergency trauma outreach series (PETOS)
PETOS (pediatric emergency and trauma outreach series)
This course provides 1 free CME credit from the DHHS Office of Emergency Medical Services 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.
Upcoming topics
4/8/2024—Child Life with Sam Hensel
5/13/2024 - Cancelled
6/10/2024 - Peds abdominal trauma with Tia Dickson
7/8/2024 - Pediatric mass transfusion protocol with Chance Basinger
02:00 PM Mountain Time (US and Canada)
Join Zoom Meeting
https://zoom.us/j/98193757707?pwd=UzdNeXppQUdtZ01KZUp2UFlzRk9vdz09
Meeting ID: 981 9375 7707
Password: EmscPCH
Archived presentations can be viewed and also qualify for CME credits. You can access them at https://intermountainhealthcare.org/primary-childrens/classes-events/petos. To obtain a completion certificate—follow the instructions on the website
Monday, Jun 10, 2024, 02:00 PM
PEPP classes
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, email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.
Other pediatric education for all
The Western Pediatric Trauma Conference—with a $25 virtual option for EMS
Emergency and Trauma Outreach Symposium—Grand Junction, CO
University of Utah injury prevention learning series
University of Utah trauma/injury prevention learning series
The decision has been made to change these offerings to quarterly at this time.
To view previous sessions for all these series visit this link.
Note the University has a new EMS education website.
Tuesday, Jun 18, 2024, 11:30 AM
University of Utah pediatrics ECHO 2024
University of Utah Pediatric ECHO
The Pediatrics ECHO fall series is in progress and registration is open. 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.
April 10, 2024 Medical Home—Eric Christensen, Utah DHHS
April 17, 2024 Nephrology Topic (TBD)—Matt Grinsell, MD
May 1, 2024 Eosinophilic Esophagitis—Jake Robson, MD, MAS
May 8, 2024 Pediatric Hearing Topics Part 1— Shannon Wnek & Adrienne Johnson (EHDI)
You can view previous session recordings and other programs on the Project ECHO page. CME is available for participation in these classes.
Note the University has a new EMS education website.
Wednesday, Apr 10, 2024, 12:00 PM
EMS-focused education
University of Utah's EMS trauma grand rounds
University of Utah's EMS trauma grand rounds (Offered every 2nd Wednesday of even months)
Click here to join
Virtual—zoom meeting
Meeting ID: 938 0162 7994 Passcode: 561313
Note this month is not the normal date.
To view archives link here https://admin.physicians.utah.edu/trauma-education/ems-grand-rounds
Note the University has a new EMS education website.
Wednesday, Apr 10, 2024, 02:00 PM
RSVPs are enabled for this event.
Hospital-focused pediatric education
Primary Children's pediatric grand rounds
Primary Children's pediatric grand rounds (offered every Thursday, September-May)
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.
Thursday, Apr 11, 2024, 08:00 AM
ENA Annual Conference
ENA Annual Conference
Friday, Apr 19, 2024, 08:00 AM
Blair Education Center, Round Valley Drive, Park City, UT, USA
Need follow up from PCH?
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.
Email: tdickson@utah.gov
Website: https://bemsp.utah.gov/
Phone: 801-707-3763
Facebook: facebook.com/Chirp-UtahDepartmentofHealth