Pediatric Trauma:Pediatric Trauma:

- - An OverviewAn Overviewof the Problemof the Problem --

Presented by:Presented by:

Oklahoma EMSC Resource CenterOklahoma EMSC Resource Center

Objectives:Objectives:

Upon completion of this presentation the Upon completion of this presentation the participant will have:participant will have:

Increased awareness of issues specific to children Increased awareness of issues specific to children and trauma.and trauma.

Improved skills inImproved skills in assessing assessing pediatric trauma:pediatric trauma:• Mechanisms of injuryMechanisms of injury

Objectives: Objectives: (Continued)(Continued)

• Identify key components of the assessment processIdentify key components of the assessment process• Recognize differences between adult and child Recognize differences between adult and child

priorities priorities • Identify and avoid common errors in the care of the Identify and avoid common errors in the care of the

traumatized pediatric patienttraumatized pediatric patient• Implement appropriate treatment plansImplement appropriate treatment plans

Nature of theNature of the “Beast”“Beast”

Pediatrics account forPediatrics account for 5-15% 5-15% of of total EMS calls.total EMS calls.• but up to but up to 33%33% of these calls require ALS. of these calls require ALS.

Trauma isTrauma is 50% 50% of pediatric EMS callsof pediatric EMS calls• usually over 2 years oldusually over 2 years old• (more medical calls under 2.)(more medical calls under 2.)

InjuryInjury is the is the leading cause of deathleading cause of death in children in children• MVC = MVC = 50% 50%

Nature of theNature of the “Beast” “Beast” cont’dcont’d

Up to Up to 70%70% of major Pediatric trauma cases of major Pediatric trauma cases die die because of the severity of injurybecause of the severity of injury..• NOTNOT because of because of deficit in pre-hospital caredeficit in pre-hospital care

When a child is injured, the whole family is When a child is injured, the whole family is injured too!injured too!• >40% >40% divorce ratedivorce rate within 1 year after a major within 1 year after a major

trauma. trauma.

General Principles:General Principles:Pediatric TraumaPediatric Trauma

Priorities are similar to adultsPriorities are similar to adults• All roads lead to the ABC (DE)’sAll roads lead to the ABC (DE)’s

• Start with “A”, not the most obviousStart with “A”, not the most obvious

General PrinciplesGeneral Principles (Continued)(Continued)

Children have certain key differencesChildren have certain key differences• size = size = different types of energy transfer different types of energy transfer

• metabolismmetabolism

• ability to respond to words and give historyability to respond to words and give history History of accident may be critical in History of accident may be critical in

determining treatment plandetermining treatment plan

Physical Differences: ChildrenPhysical Differences: Children Larger HeadLarger Head

• More leverage on neck and to brain during impactsMore leverage on neck and to brain during impacts• Forces neck into flexion while lying flatForces neck into flexion while lying flat

– airway tends to buckle and close on adult spine board airway tends to buckle and close on adult spine board without shoulder supportwithout shoulder support

Shorter neckShorter neck • causes different injury patterns causes different injury patterns • (C2-C4 more common injuries)(C2-C4 more common injuries)

Physical Differences in ChildrenPhysical Differences in Childrencont’dcont’d

Chest more pliableChest more pliable• Pulmonary contusion more likelyPulmonary contusion more likely• Diaphragm motion essential for ventilationDiaphragm motion essential for ventilation• Energy transmitted to chest organsEnergy transmitted to chest organs

Abdominal organs less well protected.Abdominal organs less well protected.• Liver is not covered by the rib cage.Liver is not covered by the rib cage.• Less muscle mass to abdominal wall.Less muscle mass to abdominal wall.• Less Sub-Q tissue to absorb the injury. Less Sub-Q tissue to absorb the injury.

Effects w/Size: Energy TransferEffects w/Size: Energy Transfer Children are smallerChildren are smaller

• more force per square inch of body.more force per square inch of body.• organs are closer together = multi-system injury is organs are closer together = multi-system injury is

the rule.the rule. Children are softerChildren are softer (= more flexible, bouncy) (= more flexible, bouncy)

• Bones don’t break but instead pass on energy Bones don’t break but instead pass on energy • Internal organ damage without fractures is more Internal organ damage without fractures is more

common.common. Larger surface area to size ratioLarger surface area to size ratio

• Lose heat more rapidlyLose heat more rapidly

Metabolic Differences in KidsMetabolic Differences in Kids Children have a higher metabolic rateChildren have a higher metabolic rate

• Nearly twice as rapid O2 consumptionNearly twice as rapid O2 consumption• Need more blood flowNeed more blood flow• More frequent feedings More frequent feedings • More fluid intake per size ratioMore fluid intake per size ratio

Metabolic DifferencesMetabolic Differences cont’dcont’d

Children “shock out” differentlyChildren “shock out” differently• Children compensate better Children compensate better initiallyinitially

– May show minimal signs and symptoms.May show minimal signs and symptoms.

• Children have less reserves than adultsChildren have less reserves than adults– Platinum half-hourPlatinum half-hour in trauma resuscitation in trauma resuscitation

– Rapid intervention critical Rapid intervention critical

– Once reserves are exhausted, Once reserves are exhausted,

Bad Things HappenBad Things Happen

The Bad ThingsThe Bad Things Decompensation can be rapidDecompensation can be rapid

• A conscious, crying child can become pulseless and A conscious, crying child can become pulseless and apneic in less than 2 minutes.apneic in less than 2 minutes.

Once decompensated, it may be too lateOnce decompensated, it may be too late• Limited Reserves are gone; whole system collapsesLimited Reserves are gone; whole system collapses

Early recognition and intervention are criticalEarly recognition and intervention are critical

ASSESSMENT is the ASSESSMENT is the

for SURVIVAL!!!for SURVIVAL!!!

Approaching the SceneApproaching the Scene

The first step in a cardiac arrest The first step in a cardiac arrest or other critical situation is to:or other critical situation is to:

Take your own pulse!!!Take your own pulse!!!

Prepare YourselvesPrepare Yourselves

Assign roles ahead of timeAssign roles ahead of time• History takerHistory taker• Spine ManagementSpine Management• Airway managementAirway management• EquipmentEquipment

On the SceneOn the Scene

SAFETY FIRST!!!!SAFETY FIRST!!!!

BSIBSI

Scene HazardsScene Hazards

ResourcesResources

On the SceneOn the Scene Careful Attention to the Careful Attention to the

Initial assessmentInitial assessment is is CRUCIALCRUCIAL• Don’t be distracted by the Don’t be distracted by the

blood and screamsblood and screamsA quiet Kid should scare the `*^@* A quiet Kid should scare the `*^@*

out of you !!!!out of you !!!! If practical, keep the parents If practical, keep the parents

with the child to help reduce with the child to help reduce the child's fear.the child's fear.

Lots of bloodLots of blood

Can’t Can’t breathebreathe

Uncon.Uncon.Everyone scaredEveryone scared

Fx’Fx’ss

cryingcrying

QuietQuiet

Brilliance vs. BasicsBrilliance vs. Basics

For every For every ““brilliant”brilliant” maneuver or diagnosis you maneuver or diagnosis you make which saves a life, make which saves a life, you’ll save 10 by just doing you’ll save 10 by just doing a good, solid job; a good, solid job; stay stay focused on the basics in the focused on the basics in the heat of the moment.heat of the moment.

On the SceneOn the Scene cont’dcont’d

Consider the mechanism of injury

Consider the mechanism of injury

Initial AssessmentInitial Assessment“Quickie ABC’s”“Quickie ABC’s”

Pediatric Pediatric Assessment Assessment

TriangleTriangleAPP

EA

RA

NC

E

APP

EA

RA

NC

E BR

EA

THIN

G

BR

EA

THIN

G

CIRCULATIONCIRCULATION

AppearanceAppearance

STOPSTOP

Remember theRemember the

““...the...the biggest failurebiggest failure among the basic services is to call among the basic services is to call

for an ALS ground or air unit and for an ALS ground or air unit and ignore the basicsignore the basics while while they are waiting.”they are waiting.”

““Proper basic airway managementProper basic airway management is often is often performed performed inadequatelyinadequately if at all, apparently due to fear and panic.”if at all, apparently due to fear and panic.”

Theodore M. Barnett, M.D. Children's Mercy Hospital, Kansas City, MO

‘‘ss

Airway Assessment - LOOKAirway Assessment - LOOK

Is the patient breathing? How well?Is the patient breathing? How well? Respiratory RateRespiratory Rate

• A slow or irregular respiratory rate in a child is an A slow or irregular respiratory rate in a child is an OMINOUS SIGNOMINOUS SIGN

LOOK LOOK cont’dcont’d

Watch for the Watch for the effort needed to breatheeffort needed to breathe • chest, neck, or abdominal muscle retractionschest, neck, or abdominal muscle retractions• flaring of the nostrils flaring of the nostrils

Level of AwarenessLevel of Awareness• Agitated child could lack oxygenAgitated child could lack oxygen• Obtunded/ gorked could be excessive CO2Obtunded/ gorked could be excessive CO2• How does the child respond to its parents??How does the child respond to its parents??

Assessment #2 - ListenAssessment #2 - Listen

Observe the skinObserve the skin– pale and clammy - ??shockypale and clammy - ??shocky– cyanosis - inadequate oxygencyanosis - inadequate oxygen

Listen -Listen -• anything loud is a anything loud is a goodgood sign, airway-wise,but a sign, airway-wise,but a

noisy airway may be partly obstructednoisy airway may be partly obstructed – Snoring, gurgling, crowing = upper airwaySnoring, gurgling, crowing = upper airway– Grunting Grunting – Wheezing - lower airwaysWheezing - lower airways– Hoarseness - voicebox affectedHoarseness - voicebox affected

RAPID ASSESSMENTRAPID ASSESSMENT and and SUPPORTSUPPORT[SIGNS OF [SIGNS OF DEEP DOO-DOO DEEP DOO-DOO ]]

Respiratory rate > 60Respiratory rate > 60 Heart RateHeart Rate

– Less than 5 years <80 or >180 per minuteLess than 5 years <80 or >180 per minute– Over 5 years <60 or >160 per minuteOver 5 years <60 or >160 per minute

Increased work of breathingIncreased work of breathing• retractions nasal flaring gruntingretractions nasal flaring grunting

CyanosisCyanosis Altered level of consciousness Altered level of consciousness

• Failure to recognize parentsFailure to recognize parents Lethargy Irritable Lethargy Irritable

Airway Airway w/w/C-Spine ProtectionC-Spine Protection

Failure to secure airway is major preventable Failure to secure airway is major preventable cause of death in Peds traumacause of death in Peds trauma

Must protect spineMust protect spine• Avoid flexing or extending neckAvoid flexing or extending neck• Use Use jaw thrustjaw thrust to open airway to open airway

Suspect possible neck injury if:Suspect possible neck injury if:• Any injury to head or above claviclesAny injury to head or above clavicles• Ejected, thrown, rolloverEjected, thrown, rollover• Unconscious trauma caseUnconscious trauma case

A=AirwayA=Airway w/w/C-spine ControlC-spine ControlClipArt Unconscious patients often can’t protect their Unconscious patients often can’t protect their

airwayairway• Tongue most common obstructionTongue most common obstruction• Little airways are easily blocked by blood, teeth - have Little airways are easily blocked by blood, teeth - have

rigid suction availablerigid suction available• Jaw thrust to open airway Jaw thrust to open airway • May need oral/nasal airwayMay need oral/nasal airway

– Do not rotate in childrenDo not rotate in children

Infants need to breathe through their noses-Infants need to breathe through their noses- • may need to suction out blood/mucusmay need to suction out blood/mucus

Airway AdjunctsAirway Adjuncts

Use of oral and nasal-pharyngeal airways. How to insert (e.g do not invert OPA in younger child to insert, and directing NPA directly posterior, not up into nasal turbinates).~ Also contraindications to OPA/NPA use.If neck is OK, allow the child to be in position of comfort - they open their own airway.

–Sniffing position is an option

ImmobilizationImmobilizationI am a pediatric ICU fellow at Mass. General Hospital. I have been teaching a one hour segment on pediatric trauma, and have found these to be some of the more common questions or misconceptions:1. Practical aspects of stabilizing a c-spine. Particularly in infants and toddlers for whom there are no C-collars (because at this age they don't have necks yet!). We have also emphasized the fact that two points are necessary to stabilize a c-spine when doing in line stabilization. When doing case scenarios with mannequins, I was surprised to see that in-line stabilization was consistently provided by holding the patient at the ears, allowing the body to continue to move relative to the position of the head. I imagine this problem is greater with children who tend to kick and scream and resist immobilization more. I have tried to emphasize that the head/C-spine need to be immobilized relative to the body in order to be effective. Most BLS providers have felt more comfortable doing this from above the head and stabilizing against the shoulders, much as a c-collar does. I have also demonstrated stabilizing with forearms against the chest, hands around the head and occiput as a second option, particularly if they are assisting a paramedic who can provide intubation or advanced airway maneuvers.

Proper ImmobilizationProper Immobilization

3. commercial cervical collars often do not fit, stabilization best provided by smaller collar (if you have to choose one evil over another)

NO SOFT COLLARS !!!!!

4. when placed on an extrication board, most children under 5 years will be in cervical flexion, unless you elevate their upper thoracic region by 1 inch (say with a few towels) [or use a peds board with head well.]

Infant immobilizationInfant immobilization

ImmobilizationImmobilization1) Keep infants in car seats unless treatment of injuries 1) Keep infants in car seats unless treatment of injuries

requires removal (IV, ETT, BVM, control of hemorrhage). requires removal (IV, ETT, BVM, control of hemorrhage). If they survived the crash in an intact car seat, they are If they survived the crash in an intact car seat, they are usually better off to stay in it for the ride to the hospital.usually better off to stay in it for the ride to the hospital.

William E. Hauda, II, MDWilliam E. Hauda, II, MDPediatric Emergency Medicine FellowPediatric Emergency Medicine FellowAttending Emergency Medicine PhysicianAttending Emergency Medicine PhysicianFairfax Hospital, Falls Church, VAFairfax Hospital, Falls Church, VA

B = BreathingB = Breathing

All children get OxygenAll children get Oxygen May need to assist with bag-valve-maskMay need to assist with bag-valve-mask

• Good mask seal is the Good mask seal is the KEY KEY to baggingto bagging– Proper fit of mask. Proper fit of mask. – Watch your fingers and your jaw thrustWatch your fingers and your jaw thrust

• Two people should bag whenever possibleTwo people should bag whenever possible If the chest doesn’t rise, you ain’t doing it rightIf the chest doesn’t rise, you ain’t doing it right Avoid distending the stomachAvoid distending the stomach

• Cricoid pressureCricoid pressure• Easy does itEasy does it• Distended stomach = less room for air in lungsDistended stomach = less room for air in lungs

Breathing adviceBreathing adviceHaving given this talk many times to EMS providers at George WashingtonUniversity and through the Maryland PALS courses I can offer a few hints.

Airway1) Remember to mention all those anatomic differences, but stress the large tongue. Good airway positioning is crucial.2) All children can be ventilated with a bag valve mask. This most common reasons that providers have difficulty is a) partially obstructed airway because of poor positioning, b) poor technique in getting the mask to seal,.. c) gastric distension from crying or vigorous bagging4) All injured children get oxygen. Always. Everytime. No exceptions.

Recognizing early signs of shock, and suspecting it sooner if significant mechanism of injury

A few pediatric trauma messages for EMT's:1. a little bleeding is a lot the smaller you are (I use e.g. of a 10 kg child with a 30% hemorrhage = only 210 ml of blood, all too easily obtained with a scalp lac & extremity fracture)

2. BP often maintained until very late in hemorrhage by young patients because of their overactive vasoconstrictive responses Good luck.

Tom Terndrup, MD Director of Pediatric Emergency MedicineUniversity Hospital Syracuse, N.Y.

What is shock??What is shock??

Any abnormality of the circulation Any abnormality of the circulation which causes inadequate blood flow which causes inadequate blood flow or oxygen to the tissues of the body.or oxygen to the tissues of the body.

BLOOD LOSS most common type BLOOD LOSS most common type of shock in traumaof shock in trauma

Can occur from open bleeding, Can occur from open bleeding, internal bleeding, into fracturesinternal bleeding, into fractures

Recognizing Possible ShockRecognizing Possible Shock

Early signs can be subtleEarly signs can be subtle

• May be minimal signs with under 20% lossMay be minimal signs with under 20% loss 50% and over blood loss usually pulseless and 50% and over blood loss usually pulseless and

unconsciousunconscious Any injured patient who is cool and tachycardic is Any injured patient who is cool and tachycardic is

in shock until proven otherwise!!!in shock until proven otherwise!!!

Shock recognition #2Shock recognition #2

Anxiety, fear, and cold weather can all mimic Anxiety, fear, and cold weather can all mimic early shock.early shock.• Increased heart rateIncreased heart rate• Decreased capillary refillDecreased capillary refill• Pale, cool extremitiesPale, cool extremities

Since the consequences of preventing Since the consequences of preventing decompensated shock are so high, sometimes all decompensated shock are so high, sometimes all you have is the history.you have is the history.

Shock #3Shock #3 First sign is First sign is loss of capillary refillloss of capillary refill

• Hold for 5; release for 3Hold for 5; release for 3• > 4 critical; > 2 but < 4 transition to critical> 4 critical; > 2 but < 4 transition to critical

Next comes a decrease in Next comes a decrease in pulse pressurepulse pressure• (Systolic - diastolic)(Systolic - diastolic)• May feel this as a May feel this as a rapid, thready pulserapid, thready pulse

Drop in Blood Pressure is a Drop in Blood Pressure is a late signlate sign• Systolic should be >[ 70 + 2(age in years)] but it rarely falls Systolic should be >[ 70 + 2(age in years)] but it rarely falls

below this until 25-30% blood lossbelow this until 25-30% blood loss Altered mental status may be from shockAltered mental status may be from shock

• Should recognize parents!!!!Should recognize parents!!!!• Shock may cause irritability or lethargyShock may cause irritability or lethargy

C = Circulation and Shock ControlC = Circulation and Shock Control

If cool, clammy, thready pulse, If cool, clammy, thready pulse, then then already over 25% of blood volume lostalready over 25% of blood volume lost

External Bleeding - usually obviousExternal Bleeding - usually obvious• Use a Use a little gauzelittle gauze and a and a big fingerbig finger

Internal BleedingInternal Bleeding• Mechanism of injury very important Mechanism of injury very important

• Physical findings not clearPhysical findings not clear

• Need Need definitive treatmentdefinitive treatment (IV’s Surgery…) (IV’s Surgery…)

Stopping BleedingStopping Bleeding Failure to control external hemorrhage using direct Failure to control external hemorrhage using direct

pressurepressure. I have seen any number of cases, particularly . I have seen any number of cases, particularly with scalp lacerations (but also extremity arterial with scalp lacerations (but also extremity arterial hemorrhages) where prehospital personnel apply hemorrhages) where prehospital personnel apply

"mounds and mounds" of gauze. I have"mounds and mounds" of gauze. I have seen many seen many patients lose excessive amounts of blood into these patients lose excessive amounts of blood into these dressingsdressings,, sometimes to the point of developing sometimes to the point of developing

hypotension. I like to emphasize the importance hypotension. I like to emphasize the importance of of

using a smallusing a small amount of gauze, and firm continuous direct amount of gauze, and firm continuous direct pressure.pressure. I tell them to assign one I tell them to assign one

person to this job .person to this job . Michael A. Shapiro MD Vice ChairmanMichael A. Shapiro MD Vice Chairman Dept of Emergency MedicineDept of Emergency Medicine Women's Christian Association HospitalWomen's Christian Association Hospital Jamestown, NY 14701Jamestown, NY 14701

Treating ShockTreating Shock1) Hypotension means the child is in shock, but children are often in 1) Hypotension means the child is in shock, but children are often in

shock without hypotension. An agitated child with cool skin is in shock without hypotension. An agitated child with cool skin is in shock until proven otherwise at the hospital. shock until proven otherwise at the hospital.

2) Any signs of shock require fluid administration. 2) Any signs of shock require fluid administration. For Basic EMTs For Basic EMTs this means rapid transport or meeting an ALS crew en route.this means rapid transport or meeting an ALS crew en route.

3) PASG or MAST are out, no good, dangerous in children, 3) PASG or MAST are out, no good, dangerous in children, especially if the abdominal compartment is inflated because of especially if the abdominal compartment is inflated because of impingement upon the diaphragm. The leg compartments can be impingement upon the diaphragm. The leg compartments can be used for stabilizing femur fractures or air splints.used for stabilizing femur fractures or air splints.

WORK QUICKLY

Let me say that I have been in EMS for three years, and have been aparamedic since March. One of the strongest points people forget to about trauma is time. (Platinum 10 Minutes, and the Golden Hour are the phrases used to describe the `time criteria'.) In any trauma, pediatric or adult, the ideal setting is for the patient to be in surgery within one hour (The Golden Hour) of their injuries. It is stressed in our training that scene time be less than 10 minutes to remain under the curtain of that hour.

I think that you need to stress that. In many medical settings, theambulance can do almost as much as an ED, but in trauma, the patient needs more than what we can provide - namely surgery. Time is the most critical factor in patient survival.

D = DisabilityD = Disability

Down’s syndrome and large headed children may have Down’s syndrome and large headed children may have cervical spine injury from apparently minimal trauma.cervical spine injury from apparently minimal trauma.

Ideal immobilization is hard collar, full spine board with Ideal immobilization is hard collar, full spine board with soft spacers and head straps.soft spacers and head straps.• Secure child across forehead, collar, shoulders and pelvisSecure child across forehead, collar, shoulders and pelvis

• Make sure chest can rise!!Make sure chest can rise!!

• May need blunt under torso under age 8 to prevent neck flexion May need blunt under torso under age 8 to prevent neck flexion on the spine board.on the spine board.

Injured brains need adequate oxygen !Injured brains need adequate oxygen !

Quickie neuro eval - “D”Quickie neuro eval - “D”

Assessment:Assessment:1) Reassess, reassess, reassess. The only way to know if your patient 1) Reassess, reassess, reassess. The only way to know if your patient

is getting better or worse is to be diligent in evaluation. is getting better or worse is to be diligent in evaluation. 2) Use the AVPU system (alert, responds to verbal, responds to pain, 2) Use the AVPU system (alert, responds to verbal, responds to pain,

unresponsive) in children. The GCS score is time consuming if unresponsive) in children. The GCS score is time consuming if you're using your memory and doesn't "paint a picture" of the you're using your memory and doesn't "paint a picture" of the patient. Avoid "lethargic" "semi-conscious" etc.. because patient. Avoid "lethargic" "semi-conscious" etc.. because everyone has different meanings with these terms.everyone has different meanings with these terms.

3) Remember what children of various stages are capable of doing (a 3) Remember what children of various stages are capable of doing (a two year old may not talk yet, especially if frightened).two year old may not talk yet, especially if frightened).

E = ExposureE = Exposure

Children lose heat quicklyChildren lose heat quickly Keep them coveredKeep them covered If you are comfortable, it’s probably If you are comfortable, it’s probably

too cold for themtoo cold for them

Exposure- Staying WarmExposure- Staying Warm

5. Keeping the patient warm. (especially if this winter is at all like last winter)6. To emphasize the above point in burn victims. Cool wet dressings may feel good on a small isolated burn, but with involvement of greater body surface area, priorities become maintaining temperature and preventing fluid loss which can be best accomplished with a dry sterile dressing. Many of our local EMTs have asked about the new "gel-packs" that are available. To be honest, they sound great, but I have little information about them specifically and am in the process of reading up on them.

SAMPLE History for TraumaSAMPLE History for Trauma

S= Signs and SymptomsS= Signs and Symptoms A= AllergiesA= Allergies M = Medications currently takenM = Medications currently taken

– Grab pill bottlesGrab pill bottles

P = Pertinent Past/ Present IllnessesP = Pertinent Past/ Present Illnesses L = Last MealL = Last Meal E = Events/ environment related to the E = Events/ environment related to the

injuryinjury

Always think about Always think about child abusechild abuse when you see an injured child. when you see an injured child.

. Many EMTs have asked about child abuse. They feel that those of us in the hospital and ED are leaving them out in the cold, particularly at smaller hospitals where they do not have a "Child protective services team" who become involved. Many tell me they have heard comments such as "Oh, good. You are filing the DSS report, so I don't have to". This is something that needs to be addressed at individual hospitals and ED's. Hopefully we can assure our EMS providers that they will not be alone in filing and following up with these cases.

Common cause of injuries in children.50% of second hospital visits for these children result in death EMT awareness of signs and symptoms of abuse would help identify cases.

SummarySummary

The more critical the patient, the more important it is to focus on The more critical the patient, the more important it is to focus on the basics IN ORDERthe basics IN ORDER

• AirwayAirway

• OxygenOxygen

• Good mask and baggingGood mask and bagging

• Proper immobilizationProper immobilization

• Keep them warmKeep them warm

• Speed of transport is a key issue.Speed of transport is a key issue. Assign roles ahead of time to keep responsibilities clear.Assign roles ahead of time to keep responsibilities clear.

Rewards from the jobRewards from the job

Thank you for your Thank you for your time and attentiontime and attention

External rewards are scarce in this field.

Knowing you did right by your patients

Where to get more informationWhere to get more information

Other training sessionsOther training sessions * Andrew W. Stern* Andrew W. Stern * NYS*DOH Emergency Medical Services* NYS*DOH Emergency Medical Services * 1 Commerce Plaza, Room #1126 # (518) 474-2219* 1 Commerce Plaza, Room #1126 # (518) 474-2219

Dr. Jane Ball 301-650-8066 peds EMSDr. Jane Ball 301-650-8066 peds EMS• NERA 310-328-0720NERA 310-328-0720• SafeKids 202-884-4993SafeKids 202-884-4993

Web sitesWeb sites• Global Emergency Medicine ArchivesGlobal Emergency Medicine Archives• Website of TraumaWebsite of Trauma

ResourcesResources

For anyone interested, the Pediatric Airway Management Project headed by Dr. For anyone interested, the Pediatric Airway Management Project headed by Dr. Marianne Gausche just completed a curriculum for a 2-day pediatric airway Marianne Gausche just completed a curriculum for a 2-day pediatric airway management course for paramedics (ALS), and another course for EMT's management course for paramedics (ALS), and another course for EMT's (BLS), complete with slides for lectures and videos. This is the curriculum used (BLS), complete with slides for lectures and videos. This is the curriculum used to train all of LA and Orange county's paramedics airway management in to train all of LA and Orange county's paramedics airway management in children by the project. The curriculum emphasizes many facets of ALS, not children by the project. The curriculum emphasizes many facets of ALS, not just intubating. just intubating.

The curriculum is available through the National EMSC Resource Alliance The curriculum is available through the National EMSC Resource Alliance (NERA) at 310-328-0720(NERA) at 310-328-0720

Kelly D. Young, MD Dept of Emergency MedicineKelly D. Young, MD Dept of Emergency Medicine Harbor-UCLA Medical Center, Box 21 Harbor-UCLA Medical Center, Box 21 Fax: (310) 782-1763 1000 West Carson StreetFax: (310) 782-1763 1000 West Carson Street Torrance, CA 90509 mail: ekyoung@harbor4.humc.eduTorrance, CA 90509 mail: ekyoung@harbor4.humc.edu

AcknowledgementsAcknowledgements

This presentation has been adapted from a This presentation has been adapted from a powerpoint presentation developed by: powerpoint presentation developed by:

Bruce Nayowith MDBruce Nayowith MD

Ellenville Community Hospital EREllenville Community Hospital ER

We gratefully acknowledge his willingness to share We gratefully acknowledge his willingness to share this information with others.this information with others.