1. Pediatric Trauma Pediatric Trauma 2014 Emergency Care Trauma Symposium June 24, 2014 Michael Kim, MD

2. objectives Epidemiology Resources Pediatric Assessment Triangle Trauma approach Destination: how and where?

5. Pediatric Trauma Leading cause of death: 1-15 yr 22 million injured / yr 9.2 million ED visits 20K deaths / yr 50K permanent disabilities Economic impact: $10,000,000,000 per year

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8. Injury Prevention You can make a difference !

9. Resources for optimal prehospital care Training Equipment Support and resources

10. EMS pediatric education / exposure BLS training in pediatrics: 8 hrs ALS training in pediatrics: 16 hrs Percentage of pediatric runs: 10% % of all peds runs requiring ALS: 12 % BMV: 1 in every 1.7 years ETT: 1 in 3.3 years IO placement: 1 in 6.7 years

11. Pediatric and trauma training

14. Anatomy Not just smaller Bigger head Airway Musculoskeletal Organ proportions Greater surface to volume 14

16. The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines. EMSC Performance Measure 73 2010 EMSC Program

17. The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines. Wisconsin BLS PCUs: 57/203= 28% (National Average 23%) ALS PCUs: 81/353 = 23% (National Average 34%) EMSC Performance Measure 73 2010 EMSC Program

18. WI EMSC Pediatric Jump Kit

19. Resources

20. 9 y/o missing for 30 min found face down next to rolled over ATV no protective equipment active hemorrhage from scalp PNB at the scene

21. Approach to trauma patient Airway Breathing Circulation Disability Exposure/Environment

23. Initial Assessment Airway Normal speech & crying Talking? Crying? Airway noises Stridor Appearance AVPU A &O Confused Irritable GCS Respiratory effort Retraction Rate Nasal flaring Grunting Gasping Abdominal breathing Wheeze Pulse oximetry Endtidal CO2 Circulation Heart rate Hypotension Mental status Cyanosis Pale Cool to touch Weak pulse Poor capillary refill

24. Disability

25. Pediatric GCS

26. Intervention? No resp effort No pulse Cyanotic No movement

27. Interventions Respiratory effort Supplemental oxygen PEEP + pressure ventilation Circulation Stop hemorrhage Temperature Fluid resuscitation Airway Open airway Jaw thrust (c-spine) Oral airway Maintainable? Appearance Stimulate Interact Support/console

28. Airway and Breathing

29. Circulation assessment intervention

30. Next Disability (Dexi) – Glasgow Coma Scale (age appropriate) – Brief neurologic eval – Splint and immobilize Exposure – Head to toe look see – Temperature control

31. Development and emotional Age dependent abilities and understanding – Stranger anxiety – Crying – Attitude – Reaction to… Intervention – Parental presence – No surprises – Distractions – Toys, bubbles, talking 31

32. Where to and how?

33. Trauma center FAQ What is trauma center? – All resources available for severely injured pt – Levels I - IV Why is trauma center important? – Mortality reduction 25% – Shorter length of stay – 24/7 pediatric specialists

35. Pediatric Trauma Center Criteria Pediatric Trauma LevelCriteria (facility and personnel…) I>200 trauma admissions/yr At least 2 BC peds surgeon 1+ BC peds orthopedic surgeon 1+ peds neurosurgeon PICU and 2+ BC Peds critical care physicians Pediatric ED with 2+ BC PEM physicians Much MORE…

36. How we do it.

37. Resources Regional Trauma Advisory Council – http://www.dhs.wisconsin.gov/Trauma/councils/index.htm http://www.dhs.wisconsin.gov/Trauma/councils/index.htm Emergency Medical Services for Children – http://www.dhs.wisconsin.gov/emsc/ http://www.dhs.wisconsin.gov/emsc/ – http://www.chawisconsin.org http://www.chawisconsin.org – http://www.childrensnational.org/emsc/ http://www.childrensnational.org/emsc/

39. summary What is killing our children? Pediatric assessment triangle Know your resources You can make a difference