![page background](https://cdn.smore.com/u/backgrounds/custom_bg-642caa0a9d1547af4224ebcf-e8e82a54fd67.jpg)
EMSC Connects
March 2024; Vol.13 , Issue 3
Pedi points
Tia Dickson, RN, BSN
Primary Children's Hospital
"We have come a long way in ambulance transport. From the time of wagon wheels, to the time of hearses, to the variety of different vehicles available today, all of which were designed to transport adults."
-Cindy Wright Dunn
Our adaptations to the ambulance in order to transport children are not yet evidence-based and many providers are not familiar with best practice. What we do know about safe transport of the pediatric patient in an ambulance is:
- No car seats on the bench seats (or other side facing seats)
- No rear-facing infant (rocker bottom) seats on a gurney
- No parents holding children on the gurney
- No loose objects in the ambulance
Let's learn more!
Expert input
Guardians of safety: navigating the importance of car seat protocols
Kerilee Burton, BS, CPS/Teen Driving program manager at the Department of Public Safety and Michelle Jamison, Community Health program manager at Primary Children's Hospital
Excerpts from February 12, 2024 PETOS
There are some excellent resources in Utah for child passenger safety.
The most important people in your lives should be safe in a car. The most vulnerable should be safely transported in your ambulances. Nearly 6 out of 10 car seats are installed wrong. Do you know how to properly install a car seat? You can tell local parents to get a car seat check or help with installation by visiting Clickit.Utah.gov.
What's the law?
The seat belt law became a primary enforcement law on May 12, 2015 in Utah. What does that mean? It means that any person riding or driving in a vehicle can be pulled over just for not wearing his or her seat belt. Previously, a person could only be issued a seat belt citation if they had been pulled over for another violation.
The law: All vehicle occupants must wear seat belts and children ages 8 and younger must be properly restrained in a car seat or booster seat.
Remember, seat belts save lives. If you or anyone in your vehicle isn’t properly restrained, you can be issued a $45 citation.
This law is the most basic requirement, the least amount of restraint. Over and above is best practice.
Critical facts
- Crashes are a leading cause of death for children.
- Car seats reduce the risk of injury by 71% and death by 28% in comparison to children buckled in seat belts alone.
- Car seat and booster seat misuse ranges from 60-70%.
Which car seat is the safest?
The best car seat is the one that fits the child, fits the vehicle, and that the caregiver can use correctly every time.
Check your labels. Follow height and weight recommendations and pay attention to expiration dates. How can a car seat expire? They are plastic which warps over time.
Seat belt install vs. anchor?
Both are safe when used correctly. Never use the seat belt and lower anchors unless allowed by the car seat manufacturer. When used forward-facing, always use a top tether when available to protect the spine.
How tight should my car seat be?
Once installed, the seat should not move at the belt path more than 1 inch from side to side or back to front.
How tight should the harness straps be?
The harness straps should be tight enough so you can't pinch the webbing together vertically.
Be sure to use the correct harness slots.
Where should the chest clip be located?
At armpit level. Usually, the chest clip is positioned too low.
Additional tips
- Never put blankets or thick clothing/coats between the child and the seat. This includes those cute aftermarket paddings and toys that can become projectiles in a crash.
When can a child be moved from a forward-facing seat to a booster?
When the child has outgrown either the height or weight limit of the forward-facing car seat. There should be no rush, the 5 point harness is the safest seating for your child.
Why are booster seat so important (despite the law)?
How can a seat belt hurt a child?
When can a child safely use a regular seat belt?
When is a child safe to sit in the front seat?
Though not a popular answer, children 12 years and younger should be in the back seat. All passengers are safer in the back seat. If circumstances require they ride in the front, it is recommended that you turn off the airbag and push the seat back as far as possible.
Ambulance crash data
- There are an estimated 4,500 crashes a year involving ambulances resulting in 33 fatalities and 2,600 injuries
- 58% of fatal crashes and 59% of injury crashes happened during emergency use
Which car seats are safe to use on a gurney?
Convertible care seats
- Install them facing the rear of the ambulance
- Elevate the head of the cot
- Run the cot straps through the rear-facing and forward-facing belt paths and check for tightness
- These recommendations are based on crash tests by the Automotive Safety Program
Dream ride car bed
- For infants 5-20 lbs. who cannot tolerate semi-upright seated position or who, for other reasons, must lie flat.
- Requires extra set of belt loops from Dorel Juvenile Group
- Install perpendicular on the cot
- Cot straps go through loops on both sides of the car bed
- They vary greatly in cost and effectiveness
- These are nice for storing on the ambulance
Unsafe gurney transport
- Rear-facing only seats
- Any seat where only one belt path can be used (this does not secure adequately to the cot)
- Combination seats
- Boosters because they require lap and shoulder belt to work properly
Can we use a car seat that was in an accident to transport?
Good answer: if it was a minor crash, the car is still drivable, and there is no visible damage to the seat, maybe. Sometimes the car seat is helpful to maintain spinal immobilization. Use your clinical judgement.
Best answer : NO. Use one you brought with you.
Children in ambulances—just the facts
- Currently there are no Federal Motor Vehicle Safety Standards (FMVSS) to define performance criterion for child restraint use in ambulance patient compartment.
- Research is underway but until then we use best practice to securely transport children in EMS vehicles.
Strive for best practice when you secure a child in your ambulance!
- Injured—splinted and immobilized; sick—restrained in the right seat; critical—secured to a stretcher with the most appropriate device available using all available straps.(See the National Highway Traffic Safety Administration (NHTSA) recommendations below).
- Be sure the manufacturer has certified it for the estimated height and weight of the child
- Child safety devices should be used and installed according to the directions—train ahead of time
- Vehicle seat and stretcher straps and harness are used properly
NHTSA working group recommendations
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cpsboard.org/wp-content/uploads/2016/03/Safe-Transportation-of-Children-in-Ambulances.pdf
Protocols in practice—spinal motion restriction
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
- This webinar is dated but there are several excellent demonstration videos on how to secure CRS to the gurney. Use these videos to guide a hands-on practice to secure your agency pediatric devices and car seats to the stretcher.
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
Congratulations
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.
From East Carbon's local newspaper . . .
AUTISM TRAINING
The Power of Acceptance
It is very important, because it creates a world that's more understanding and inclusive. It helps us celebrate the unique strengths of those with autism and gives them a chance to shine. East Carbon Fire, Ambulance and Police Department took part in a training dealing with how to understand taking care of someone with autism.
Jeff Wilson EMSC-FAN NREMT-P came here to help us how to understand others who may need our help.
The range and severity of symptoms when helping someone with autism can vary widely. Common symptoms include difficulty with communication, difficulty with social interactions, obsessive interests, and repetitive behaviors.
Thank you to Fire Chief Cody Valdez for setting this up for us.
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 ranging 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
Southern 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. 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
3/11/2024—Prehospital Pediatric Trauma with Dave Weber
4/8/2024—Child Life
6/10/2024 - Pediatric Shock
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, Mar 11, 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
Current concepts in neonatal and pediatric transport
The Western Pediatric Trauma Conference
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, Mar 19, 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.
March 13, 2024 Pediatric Sepsis Roni Lane, MD
March 20, 2024 Pediatric Weight Loss Recommendations Jessica Morales, MD
April 3, 2024 Pyscho-social Considerations in Working with Youth with POTS, Long COVID, and other Autonomic Dysfunctions Corinne Espinoza, PhD
April 10, 2024 Medical Home Eric Christensen, UDHHS
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, Mar 13, 2024, 11:30 AM
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, Mar 14, 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