EMSC Connects

June 2021; Vol.10, Issue 6

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Pedi Points

Tia Dickson, RN, BSN

Primary Children's Hospital

With summer comes hay fever, bugs, and other triggers for allergic reaction. EMS providers respond to more respiratory distress calls for the pediatric population than any other complaint. Here are a few things to keep in mind on an allergy or anaphylaxis call for a pediatric patient.

An allergy is an overreaction of the immune system to a substance that's harmless to most people. In someone with an allergy, the body's immune system treats that trigger (called an allergen) as an invader and reacts inappropriately. This results in symptoms that can be anywhere from annoying to life threatening.

Fortunately, severe or life-threatening allergies occur in only a small group of kids. In fact, the annual incidence of anaphylactic reactions is small—about 30 per 100,000 people (those with asthma, eczema, or hay fever are at greater risk). While the numbers are small, children are more vulnerable to anaphylaxis than adults because they are inconsistent in avoiding their triggers or in carrying Epi-pens.

Common triggers associated with anaphylaxis in children are food and insects. In the general population most anaphylactic reactions—up to 80%—are caused by peanuts or tree nuts.

Normally an allergic reaction does not prompt a 911 call. Those that do are often because the patient is experiencing a bronchospasm.

Definition: Bronchospasm is a sudden constriction of the muscles in the walls of the small airways. Bronchospasm occurs as a symptom of asthma, bronchiolitis, and/or anaphylaxis. It may cause significant respiratory distress, hypoxemia, respiratory arrest, and apnea in infants.

Clinical Presentation: Symptoms may include: wheezing, altered level of consciousness, tachypnea, abnormal skin color, nasal flaring, retractions, grunting, apnea, and cyanosis.

When you arrive on scene you need to determine if the child is in anaphylaxis.

What is anaphylaxis?

  • Anaphylaxis is a LIFE-THREATENING allergic reaction.
  • Anaphylaxis is an ALLERGIC EMERGENCY.
  • Anaphylaxis is defined as a reaction involving at least two organ systems (or a drop in blood pressure).
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The first line treatment for anaphylaxis is epinephrine because it:

  • Constricts blood vessels to increase blood pressure
  • Relaxes smooth muscles in the lungs to reduce wheezing to improve breathing
  • Stimulates the heart (increasing heart rate) and works to reduce hives as well as swelling that may occur around the face and lips

Your Utah EMS Protocol Guideline (attached below) will guide further treatment and remember your new Handitevy App will help you figure medication dosing.

Provider Tips

Taking a great history will lead to a better response

· Onset and location

· Insect sting or bite

· Food allergy/exposure

· Medication allergy/exposure

Don't overdose on Benadryl and other meds

Use caution with over-the-counter medications. Read dosage instructions carefully; frequent use of these medicines should be avoided. Encourage parents to consult their doctor when symptoms persist.

Handtevy Minute - Epinephrine Epiphany

Since we are talking allergic reaction to environment, food, and bugs let's include a few thoughts on summer safety from other pests

Expert Input—Take Precautions Against Mosquito Bites

Utah Department of Health

Higher temperatures have led to a surge in the mosquito population. Public health officials across Utah are reminding all residents to protect themselves from mosquito bites. Taking simple precautions to avoid mosquito bites are the best ways to reduce your risk for infection.

Follow these tips:

  • Wear long-sleeves, long pants, and socks while outdoors and use an insect repellent with 20%-30% DEET, which is safe to use during pregnancy. Repellents are not recommended for children younger than two months of age.
  • The hours from dusk to dawn are peak biting times for many mosquitoes. Consider rescheduling outdoor activities that occur during the evening or early morning.
  • Mosquitoes lay their eggs in standing water. Remove any puddles of water or standing water including in pet dishes, flower pots, wading and swimming pools, buckets, tarps, and tires.
  • Report bodies of stagnant water to your local Mosquito Abatement District (MAD). Visit http://www.umaa.org/ for a list of MADs.
  • Keep doors, windows, and screens in good condition and make sure they fit tightly.
  • Consult with an immunization travel clinic before traveling to areas that may have mosquito-borne illness such as Zika or dengue and take the necessary precautions.
  • Remember that West Nile virus (WNV) can cause very serious illness, especially in individuals older than 50 and those who are immune compromised.

WNV is usually transmitted to humans through the bite of an infected mosquito. In Utah in 2019, there were 21 confirmed human cases of WNV throughout the state, including two people who passed away due to WNV infection.

A majority of people infected by this virus (70–80%) won’t notice any symptoms while some people may experience flu-like symptoms or worse. The elderly and people with poor immune systems are at higher risk for symptomatic disease. The most serious cases can lead to hospitalization, disability, or death. Symptoms of the severe form of WNV include high fever, severe headache and stiff neck, disorientation, and confusion. If you are experiencing symptoms of WNV, contact your healthcare provider immediately.

WNV surveillance in Utah is underway and will continue into early fall. For more information, call your local health department or visit www.health.utah.gov/wnv. Throughout the WNV season, the UDOH web site will be updated each Wednesday with available detection information.

Protocols in Practice—Reaction/Anaphylaxis

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Pediatric Skills Refresher—Handtevy Minutes—Epinephrine 1:100,000 IV (Push Dose Pressors)

Handtevy Minute - Epinephrine 1:100,000 IV (Push Dose Pressors)

News from Utah EMSC

The organizing committee of the 2021 Western Pediatric Trauma Conference is offering free registration to all EMS providers, including 14.25 hours of CE credit. To receive CE credit the attendee must log in each day and answer one question provided by each of the speakers. The final agenda is attached and more information can be found here

If you are interested in this amazing opportunity, send an inquiry to our nurse clinical consultant, Tia Dickson mailto:tdickson@utah.gov

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Utah EMSC has purchased the Handtevy App for ALL EMS Agencies in the State

Want access to yours? It has already been purchased for you! Contact your EMSC Program Manager, Mark Herrera at markherrera@utah.gov

We conducted our first Handtevy Instructor training class in Salt Lake last month. Join our second on the 25th of June (link below)

Agencies, Have you designated your PECC yet?

You will want one to facilitate your customization of the Handtevy App and keep current on all the pediatric things. Below are the agencies who have already chosen their PECC. What is a PECC? See below.
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We are still looking for PECCs to represent every agency in Utah. Care to join us?

If you are a pediatric advocate within your agency, we need you. Please contact our program manager, Mark Herrera (markherrera@utah.gov) to find out how you can help. You will want to join BEFORE our upcoming PECC Conference
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The Latest on Covid-19 and kids

As healthcare providers, please encourage your community members to get vaccinated. We are in a race between vaccination and variant proliferation. All those older than age 12 are now eligible.

Vaccine FAQ https://coronavirus.utah.gov/vaccine#vaccine-faq

Vaccine Facts https://coronavirus-download.utah.gov/Vaccine-Resources/7_Facts_About_Vaccines.pdf

Guidance for fully vaccinated people https://coronavirus-download.utah.gov/Vaccine-Resources/COVID19_FullyVaccinated_Flyer.pdf

Covid-19 Trackers

Johns Hopkins Global tracker (desktop)

Johns Hopkins Global tracker (mobile)

Utah Department of Health

The 2021 National Pediatric Readiness Project for hospitals launched May 1

WE ARE AT A 40.8% RESPONSE RATE. Keep them coming; the survey closes July 31.

What is the National Pediatric Readiness Project (NPRP)?

The National Pediatric Readiness Project is a multi-phase quality improvement initiative to ensure all U.S. emergency departments have the essential guidelines and resources in place to provide effective emergency care to children.

What is the 2021 NPRP Assessment?

The NPRP Assessment is a national assessment of America’s EDs to determine progress in pediatric readiness, identify existing gaps, promote quality improvement (QI) efforts in hospital EDs around the country, develop national collaboratives to address common and critical gaps, and identify best practices.

Why is participation in the 2021 NPRP assessment important for ED managers?

The NPRP assessment helps ED personnel be better prepared to provide quality care for patients of all ages by evaluating the QI process of EDs over time.

  • Hospitals with high ED readiness scores demonstrate a 4-fold lower rate of mortality for children with critical illness than those with lower readiness scores; thus, improving pediatric readiness improves outcomes for children and their families.

ED nurse managers, we need you!


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.

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, June 14th, 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 1 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.

Handtevy Instructor Course

Friday, June 25th, 8am

1550 Airport Road

Price, UT

This is an in-person course.

Register at https://www.handtevy.com/courses/ under Instructor Courses.

This education will also meet your Utah pediatric training requirement for license renewal.

Western Pediatric Trauma Conference

Wednesday, July 14th, 8am to Friday, July 16th, 4pm

This is an online event.

Find all the details here, https://pedtrauma.org/.

Free attendance is offered to EMS (see News From Utah EMSC above) personnel.

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

Wednesday, Aug. 11th, 2pm

This is an online event.

Virtual-Zoom Meeting Meeting

ID: 938 0162 7994 Passcode: 561313

18th Annual Utah Trauma Network 2021—Save the Date

Thursday, Sep. 16th, 9pm to Friday, Sep. 17th, 4pm

This is an online event.

Join us for this annual event to learn about the recent advances in trauma care from speakers who are experts in the field. The Utah Trauma Network brings together trauma care providers from around the state of Utah.

Register Today

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

Thursday, Oct. 7th, 9pm to Friday, Oct. 8th, 4pm

This is an online event.

Designed for registered nurses and other pediatric healthcare providers.

  • Discuss current pediatric healthcare issues
  • Review new best practices and pediatric treatments
  • Discuss common pediatric nursing and care concerns
  • Network with other pediatric healthcare providers

If you have questions call (801) 507-8470. More information coming soon.

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.