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.

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.

• 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

Trauma is trauma, whether you use the ATLS, PALS, or MARCH algorithms, using a systematic approach will guide your through assessment.

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

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.

• 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.
  

Children compensate until they don't. The mechanism of livestock injury with these large animals is significant. The mechanism alone should expedite transport.

For additional guideline direction check out the UPTN website or the new app, "Utah PTN" on android and apple devices.

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.

For this issue, perform a pediatric trauma simulation using Simbox

https://youtu.be/jErbMmsZB0Q?si=wtE08EmIPJIKdq_S

National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!

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.

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

Happy New Year! This year we will develop the Utah pediatric pre-hospital recognition program. With that goal in mind, we have assembled a workgroup that will begin January 30, 2024. We will keep you updated on our progress. Anyone who has ideas to share on the topic, contact our program manager Jared.Wright@utah.gov.

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.

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.

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