4-13 PEDIATRIC TRAUMA

Pediatric patients under age 5 with major trauma should be transported to St. Vincent Hospital

EMR - Emergency Medical Responder

1. Establish patient responsiveness.
2. If cervical spine trauma suspected, and trained to do so, manually stabilize the spine.
3. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
4. Open the airway via chin lift or modified jaw thrust.
5. Suction as necessary
6. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
7. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
8. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
9. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
10. Assess circulation and perfusion.
11. Control obvious sites of hemorrhage with direct pressure or a pressure dressing.
12. Splint any obvious sites of extremity deformity.
13. Call for ALS intercept  

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading, if indicated.
2. Continue manual stabilization while placing a rigid cervical collar. Immobilize the patient on a long backboard or similar device.
3. Initiate rapid transport and Contact MEDICAL CONTROL to request ALS intercept. Target scene time in major trauma is less than 20 minutes unless extenuating circumstances exist.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Establish vascular access and administer NS at a TKO rate. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6, and signs of poor perfusion are present, request ALS intercept and initiate transport.
3. If access is obtained and signs of poor perfusion are present, administer 20 mL/kg NS bolus.
4. If evidence of poor perfusion persists, administer additional 20 mL/kg NS bolus.
5. Initiate rapid transport and Contact MEDICAL CONTROL to request ALS intercept and for further fluid orders, if indicated. Target scene time in major trauma is less than 20 minutes unless extenuating circumstances exist. Time should not be spent on scene solely to establish IV access.

Intermediate - Perform/Confirm All Above Interventions

1. Evaluate for need for endotracheal intubation if trained to do so.
2. If absent breath sounds and signs of respiratory distress are noted together with a mechanism of injury consistent with tension pneumothorax, consider needle decompression, utilizing a large bore IV catheter in the mid-clavicular line at the second intercostal space on the injured side.
3. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement. Note that 2 IV lines are preferable if possible. Scene time should not be delayed for IV placement.
4. Evaluate any obvious sites of extremity deformity and check for adequate perfusion. If perfusion adequate, splint in position of comfort. If perfusion is absent, attempt manipulation once to re-establish perfusion and splint. Check CMS after manipulation.
5. Initiate rapid transport and Contact MEDICAL CONTROL for further orders. Target scene time in major trauma is less than 20 minutes unless extenuating circumstances exist.

Paramedic - Perform/Confirm All Above Interventions