Utah is a "prepper" state. We like to plan for the worst and September is a fantastic month to refresh those plans. In preparing for disaster we don't forget about our kids and Ready.gov has a section just for them. Ready Kids has everything to get your family started. This issue is chock-full of links because there is no need to reinvent the wheel. There are so many fantastic resources available for pediatric and general preparedness. We would like to highlight a few.

EMTs and paramedics should include the pediatric patient in your professional response plan. A great place to start is with the National Pediatric Readiness Toolbox, a national quality improvement initiative co-led by the Health Resources Services Administration’s (HRSA) Emergency Medical Services for Children (EMSC) Program, the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association. This toolkit is available as a free open-access resource intended for use by all providers (e.g., technicians, nurses, physicians, EMS providers, and ancillary staff) across the spectrum of pediatric emergency care to help facilitate delivery of high quality care to all children.

And just for fun, check out this link for the video game "60 Seconds to Survival," a mass casualty scene assessment and triage learning platform. The resource is free to use and may be useful as an adjunct to disaster preparedness activities. http://disastertriagegame.org/index.html. It has also been posted to the EIIC Education Page: https://emscimprovement.center/domains/preparedness/disaster-triage-game/

Free Printables

Family Emergency Plan

A two-page form intended to help families document information necessary after an emergency.

• Family Communication Plan for Parents and Kids (PDF)

Emergency Supply List

A comprehensive list of suggested materials to help prepare for emergencies in the home and for the family.

• Emergency Supply List (PDF)
  This download is a full-color, two-sided, tri-fold brochure.

General Brochure

A comprehensive brochure explaining the key steps to emergency preparedness, including: being informed, making a plan, building a kit, and getting involved.

• Prepare for Emergencies Now: Information to Get Ready (PDF)
  This is a full-color, two-sided, tri-fold brochure.
• Printer Friendly version

Ready Kids Publications

Emergency supply kit checklists for parents and kids

• Two checklists designed to help kids and parents prepare for emergencies (PDF)

Family Communication Plan for Parents and Kids

Two family communication plan templates designed for kids and for parents to organize emergency contact phone numbers and identify an emergency meeting place.

• Family Communication Templates (PDF)
• Family Emergency Communication Plan and Fillable Card (PDF)

Spanish Language Resources for Preparedness

Hispanic Heritage Month spans September 15--October 15. It’s an opportunity for the nation to celebrate our Hispanic and Latino communities. In honor of this month, take a look at Spanish-language preparedness resources to share in your community:

• Listo.gov is FEMA’s Spanish-language preparedness website. It has hazard-specific guides, posters, toolkits, and more.
• The Red Cross mobile apps are also available in Spanish. They include apps about first aid as well as specific disasters such as hurricanes and tornadoes.
  
• In the Prepare with Pedro (Prepárate con Pedro) Disaster Activity Book, kids can follow Pedro the Penguin around the United Sates to visit his friends and learn how they prepare.
  

Blast Injuries

Although uncommon in the U.S., there is a large amount of data worldwide regarding blast injuries. Children are more susceptible to these injuries given proximity to the ground, increased ventilatory rate, increased head to body ratio, and their curious nature. Without delving too deeply into physics, explosive charges can be divided into two types: high order explosives (HE) – which cause a supersonic overpressure wave, and low order explosives which do not cause the overpressure wave. Injuries can be categorized by timing.

• Primary - caused by a direct effect of overpressure by the blast wave passing through the body’s tissues
• Secondary - injury caused by fragments of the of explosion (penetrating injury)
• Tertiary - generally the result of displacement of the body and impact on a surface (fractures, TBI, abrasions/lacerations)
• Quaternary - injuries are usually burns and inhalation caused by the blast

Primary blast injuries affect the body by causing stress and shear mechanisms through the tissues with the transmission of kinetic energy traveling from tissue to air-filled organs. The area in which the explosive is detonated is significant as closed spaces had a 49% vs 7.8% mortality rate (along with more than two times more primary blast injures) in a study performed in Israel.

Systems affected:

The most commonly affected region of the body is the tympanic membrane in the ear. Studies have noted the ears provide a sensitive measure as to other injuries in the body. Lungs are also commonly affected as overpressure passes from tissue to the air-filled alveoli causing pulmonary hemorrhage, pulmonary edema, pneumothorax, pulmonary fat embolus, or air embolus from AV fistulas. Signs to look for include respiratory distress, tachypnea, cyanosis, and hemoptysis. Cardiac injury can be in the form of contusion or tamponade. There is also a unique blast injury phenomenon of bradycardia, apnea, and hypotension directly following a blast. Animal studies suggest a vagal component to this. GI injuries are generally more late presenting and deal with perforation or bleeding. Ocular injuries include foreign bodies, hyphemas, globe rupture, and facial fractures. Traumatic brain injuries (TBI), crush syndrome, and compartment syndrome can also occur depending on the nature of the blast.

Treatment in the field should concentrate on specific primary survey concerns (ABCs) with emphasis on maintaining the airway, oxygenation, and ventilatory support as needed. These scenes are generally chaotic but a careful scene survey should be documented—not only for the rescuer’s safety but also for the report to the trauma center as specific types of injuries increase or decrease with distance from the blast, and tertiary/quaternary injuries may become more apparent (crush, fracture, TBI, burns, toxic inhalants, CO and cyanide exposure). Decontamination of the patients may need to be done outside the accepting facility. If the TM’s are ruptured, these patients will require greater workup and observation (especially O2 monitoring), even in the absence of other injuries, for 6-8 hours. If this is a mass casualty, there may be limited resources but children have historically required more intensive care, surgical interventions, and have higher injury severity scores than their adult counterparts.

References:

Available upon request

Some exciting news! The 2020 update of the Utah EMS Protocol Guidelines has been released!

Effective September 1st, a new collaboration between Primary Children's Hospital (PCH) and the U of U burn center started. PCH will now take any pediatric patient FROM THE SCENE with burn +/- trauma. Burn injury in itself is a trauma. These patients will be coming to PCH first for a trauma evaluation. This will include children for whom EMS has concerns of significant inhalational injury. The trauma team will work with burn to run the initial resuscitation at PCH and, depending on other trauma related injuries and potential need for ECMO, the child will either be kept at PCH or transferred to the Burn Unit after stabilization.

The Emergency Medical Services for Children (EMSC) program is looking into purchasing Handtevy statewide with some carryover funds. Handtevy is a customized application for pediatric medication dosing, but also works for adults. The EMSC program worked with the county coordinator to get feedback from agencies concerning the need in pediatrics and Handtevy stood out. The demos will be led by the Handtevy team and will focus on how the application works and data about it’s successes. We are working through the logistics of the purchase now, but wanted to get it on your radar. Many Utah agencies in have purchased it and we hope to help you out as well! There are 2 sessions, but you only need to attend one of them.

Advanced registration is preferred:

September 24th 2020 @ 10 AM

https://attendee.gotowebinar.com/rt/90603465712081422

September 24th 2020 @ 2 PM

https://attendee.gotowebinar.com/rt/2386115463671245582

For questions or more information contact our EMSC program manager Brianne Glenn at brianneglenn@utah.gov.

Coronavirus Avoidance, a few things teachers can learn from healthcare workers

Last month Utah EMSC put together a training toolbox for teachers entitled Coronavirus Avoidance, a few things teachers can learn from healthcare workers. The toolbox includes posters and signage from PCH/Intermountain on the following topics:

• Six steps to stop the spread of germs
• Cleaning your workspace
• Keeping safe in the break room
• The right way to wear a mask
• Keeping your family safe
• Transitioning from work to home.

There is also a 40 minute recorded zoom training from our Nurse Clinical Consultant Tia Dickson on the topic. Feel free to share the training with your teachers. Access through the link below or contact Tia Dickson at tdickson@utah.gov

https://drive.google.com/drive/folders/1cJbzPOc-D0B-PI1fK-HTJUvaxG_lCAns?usp=sharing

Resources

From the CDC

The CDC has updated its mask-wearing guidance. CDC recommends you wear masks in public settings around people who don’t live in your household and when you can’t stay 6 feet away from others. Masks help stop the spread of COVID-19.

Overview

• Wear masks with two or more layers to stop the spread of COVID-19
• Wear the mask over your nose and mouth and secure it under your chin
• Masks should be worn by people two years and older
• Masks should NOT be worn by children younger than two, people who have trouble breathing, or people who cannot remove the mask without assistance
• Do NOT wear masks intended for healthcare workers, for example, N95 respirators

For more information on this topic, including gaiters, face shields, masks and children, wearing masks with glasses, mask wearing mistakes, and how to take off a mask, click the Learn More button below.

From Primary Children's Hospital (PCH)

How to help kids adjust to wearing a mask

Wearing a mask is critical to slowing the spread of COVID-19 but getting a child to wear a face mask may be tricky. They may be afraid, feel self-conscious, or feel a mask is too uncomfortable. Here are some ways to help your child adjust to wearing a mask.

What kind of masks do children need?

You’d never send your first-grader to school wearing your high-schooler’s pants and the same is true for your child’s face-covering. For a mask to be effective, fit is key. Look for face coverings specifically sized for children. Your child’s mask should cover their nose, mouth, and chin and fit snugly but not tight. Ear loops can be easier than ties for young children. Kids are unlikely to keep their mask on if it’s uncomfortable. If it’s too big (or too small), they’re more likely to touch their mask to make adjustments and reposition it, which could also increase their risk of infection.

How can I help my child wear a mask?

Help your child feel more comfortable with wearing a mask by:

• Using simple words to explain why people are wearing masks. For example, try saying, “We need to wear a mask to help keep people from getting sick.”
• Making mask-wearing fun. Let your child participate in choosing, making, or decorating his or her mask.
• Letting your child see you wear your own mask.
• Maintaining a positive attitude around mask-wearing.
• Answering your child’s questions in age-appropriate terms.

Here are a few ideas from the American Academy of Pediatrics that may also help.

• Practice wearing a mask at home for longer periods every day until school starts to help with the adjustment. Wearing a mask all day is much different than a quick trip to the store.
• Look in the mirror with the mask on and talk about it.
• Find pictures of other kids in masks.
• Put a mask on a loved stuffed animal or draw one on a favorite book character.
• Let your kids decorate masks to be personalized and fun. If homemade, let kids choose the fabrics.
• Be sure to send an extra mask in their backpack.
• Label masks with names.
• Clip a lanyard to their mask so it doesn’t get lost.
• Soft, pleated face coverings with elastic are likely to work best for kids.
• Find the right size for your child's face and show them how to adjust it for a secure fit.

RELATED: How to wear, clean, and store your face mask.

What if my child has special needs

If you have a child with special needs, talk to your child’s school and your pediatrician about your child’s situation and your concerns. For deaf and hard of hearing children who lip read, a custom mask worn by the teacher or aides may help.

Going back to school raises a lot of concerns and district plans will most likely evolve as time passes. In the meantime, teach your kids to wear a mask, wash their hands correctly, avoid touching their cute face, and choose elbow bumps instead of hugs when they see their friends.

Additional Resources

• Let's Talk About It...Tips for Wearing a Mask or Face Covering (printer friendly PDF)
• American Academy of Pediatrics - COVID-19: Helping kids get used to masks
• Debunking common face mask misconceptions
• Mask up Utah

Covid-19 Trackers

Johns Hopkins Global tracker (desktop)

Johns Hopkins Global tracker (mobile)

Utah Department of Health

Do you have a question for our EMSC Medical Director, Hilary Hewes, MD, PCH, ER Attending Physician about this newsletter topic or anything related to pediatrics? Shoot an email to the address below.

tdickson@utah.gov

Contact PCH EMS Liasion Lynsey Cooper at Lynsey.Cooper@imail.org

OR use the dedicated EMS follow up email

PCH-EDRTU-EMS@imail.org

If you are a pediatric advocate within your agency, we need you. Please contact our program manager, Brianne Glenn (brianneglenn@utah.gov) to find out how you can help.

The Emergency Medical Services for Children (EMSC) Program aims to ensure that emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure that 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, no matter 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