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EMSC Connects
January 2024; Vol.13 , Issue 1
Pedi points
Tia Dickson, RN, BSN
Primary Children's Hospital
While our rodeo season hits in the spring and summer, extreme sports are everywhere year-round in Utah. Since trauma still accounts for the highest number of pediatric calls for EMS, we'll start 2024 off with several trauma topics.
The doc spot
Rodeo (livestock) injury
Sydney Ryan, MD
Pediatric Emergency Medicine
University of Utah, Department of Pediatrics, Primary Children's Hospital
Excerpts from December 11th, 2023 PETOS
Pediatric rodeo athletes are generally believed to be more prone to injury than adult athletes due to inexperience and physiologic differences. The literature shows the prevalence to be around 8-19 pediatric injury events per 1,000 competitor exposures. Bull/steer riding has the highest incidence followed by bareback and saddle bronc events.
Prevention
- Helmets reduce the incidence and/or severity of head injuries
- Getting "hung up" is one of the most dangerous situations that cause injury so it's important to teach children to get down quickly and get away from the animal properly. Matching appropriate animal size and performance level with that of the athletes is also important.
- Do not leave small children unattended with livestock
On scene
Trauma is trauma, whether you use the ATLS, PALS, or MARCH algorithms, using a systematic approach will guide your through assessment.
Case study #1—bull riding
The call: 16-year-old male was bull riding. He got caught in the rope and was trampled. He has shortness of breath; abdominal, and chest pain.
The scene:
- Airway was patent, C-collar was placed
- Breath sounds were diminished on the right, oxygen sats were 89%, they placed him on 2L NC oxygen
- Circulation, heart rate, and blood pressure were normal
- GCS was 15
- He was transported to the hospital in stable condition
The trauma bay:
After the primary assessment proved to be unchanged from the scene, the trauma team went on to the secondary survey.
- They noted bruising to the chest and abdomen
- Significant abdominal tenderness and shortness of breath
- A CT scan was obtained showing:
- a right hemopneumothorax
- grade 3 liver laceration
- grade 2 splenic laceration
- right 8th rib fracture
- right lower lobe pulmonary contusion
- They gave him morphine for pain and then sedated the patient with ketamine to placed a right chest tube
His CT showing the pneumo
Chest tube placed
X-ray post chest tube placement showing reinflation of lung
When there is a there is a suspected blunt injury to the chest and abdomen, you should think of pulmonary contusions, pneumothorax, and (of course) cardiac contusions. Symptoms of a pneumothorax in children would be irritability and restlessness, rapid breathing, grunting, nasal, retractions, or bluish skin color. Children do tend to tolerate even larger pneumothoraxes and they can do well on supplemental oxygen during transport. If they don't seem to be oxygenating well or become unstable, bagging is appropriate even if it causes a larger pneumo. Maintaining the airway is your priority until you can assess and treat the pneumo.
Interventions to think about
- A/B: secure and support the airway.
- C: "stop the bleed," resuscitation as needed (20cc/kg NS and blood products), watch the heart rate. If it starts to creep up it could indicate shock and nearing decompensation.
- D: hypertonic saline and keep the head of the bed up.
- E: expose to fully evaluate but keep them warm. Children can get cold very quickly.
- Other: C-spine precautions, preventions of hypothermia, treat pain, splinting, and early antibiotic administration.
Stay and play or scoop and run
Children compensate until they don't. The mechanism of livestock injury with these large animals is significant. The mechanism alone should expedite transport.
Skills refresher—stop the bleed
Protocols in practice—hemorrhage control, extremity, and crush injuries
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.
Simulation training
For this issue, perform a pediatric trauma simulation using Simbox
News from national EMSC
EMSC Pulse
National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!
Introducing the pediatric pre-hospital recognition program
The federal EMS for Children (EMSC) program works to expand and improve emergency care for children across the country through the promotion of research, partnerships, and evidence-
based practice, with a goal to improve access and quality of emergency care for children and reduce serious injury or death.
Each state and territory is now required by the federal EMSC program to develop a pediatric
pre-hospital recognition program. These programs aim to empower and prepare EMS agencies
to provide high-quality care for children in accordance with national recommendations, which is
also known as being “pediatric ready.” This month, Utah EMSC launched a workgroup to design our program. We have chosen representatives from all over the state.
News from Utah EMSC
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.
Stories from the field: the efforts put in by Jeff and his family with regard to autism education has been noticed. There was an article recently featured in the UFRA Straight Tip Winter issue! We are so happy to be a part of such an impactful program. Great work Jeff!
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
2024 Update
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, Feb 20, 2024, 10:00 AM
Southern PECC workshop
PECCs are encouraged to attend an in-person PECC workshop yearly 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. Our next planned workshop is March 15, 2024 in St. George, Utah.
Friday, Mar 15, 2024, 08:00 AM
St. George, 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
January—Traumatic brain injury
February—Safe transport
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, Jan 8, 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
Icy hot: rise of the phoenix statewide virtual tabletop exercise
Icy hot: rise of the phoenix statewide virtual tabletop exercise
February 6–7. 2024 Noon–2 p.m. each day
Join us for a 2-day, virtual tabletop exercise to test Utah's
ability to respond to a burn mass casualty incident. Nearly
all aspects of an ESF-8 response will be tested, including
command and control, partner coordination, triage,
patient distribution, telehealth, resource sharing, patient
care, vulnerable and pediatric considerations, patient
transfer, tracking, follow-up, and contingency care.
Players include Utah hospitals, first responders, healthcare
coalitions, public health, emergency management, and
other ESF-8 partners.
Tuesday, Feb 6, 2024, 12:00 PM
University of Utah injury prevention learning series
University of Utah trauma/injury prevention learning series
January 16, 2024 11:30 AM, February 20, 2024 11:30 AM, March 19, 2024 11:30 AM, April 16, 2024 11:30 AM, May 21, 2024 11:30 AM, June 18, 2024 11:30 AM
To view previous sessions for all these series visit this link.
Tuesday, Jan 16, 2024, 11:30 AM
University of Utah pediatrics ECHO 2023
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.
January 10, 2024: Bright futures: late adolescence with Zainab Kagen, MD
January 17, 2024: Bright futures: strategies to support pediatric medical home implementation with Quang-Tuyen Nguyen, MD
February 7, 2024: Bright futures: strategies to implement bright futures within your practice with Kathy Franchek, MD and Elizabeth Smith, MD
You can view previous session recordings and other programs on the Project ECHO page. CME is available for participation in these classes.
Wednesday, Jan 17, 2024, 11:30 AM
EMS-focused education
UBECC
Uintah Basin Emergency Care Conference—NO COST to attend
Register at www.eventbrite.com
Friday, Feb 9, 2024, 08:00 AM
Uintah Conference Center, East 200 South, Vernal, UT, USA
University of Utah's EMS grand rounds
University of Utah's EMS grand rounds (Offered every 2nd Wednesday of even months)
Wednesday, Feb 14, 2024, 08:00 AM
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, Jan 11, 2024, 08:00 AM
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