Tia Dickson, RN, BSN

Primary Children's Hospital

Low cost, convenient, eco-friendly e-bikes/scooters and other micro-mobility devices are popping up everywhere. It's no surprise that along with increased availability, we see increases in injuries. The Consumer Product Safety Commission report identified a steady 70% increase in ED visits due to injuries involving micro-mobility products over the past 6 years. While the research is still early, we are seeing some injury patterns you are likely to encounter this summer. Let's explore this topic.

New ways kids are injured on Utah roads—a trauma case review

Sarah Becker, MD

EMSC medical director

Division of Pediatric Emergency Medicine, Primary Children's Hospital

Excerpts from May 8th PETOS

Any small, low-speed, human or electric powered transportation device.

For electric powered vehicles this means . . .

• Less than 30 mph
• Lightweight (less than 500 lbs)
• Small size (less than 3 feet wide)
• Includes bikes, scooters, and skateboards

Not only are these devices more prominent in private ownership but shared micro-mobility is now common place. As of August 2020 there are more than 260 shared micro-mobility systems in the US. These are most commonly docked e-bikes and e-scooters.

Mechanical

• Falls, collisions
• Structural failures

Electrical

• Battery charging
• Short circuiting and fires

Human factor

• User positioning
• User proficiency/lack of training
• Lack of protective equipment

Current safety standards vary from state to state. Some states have completely banned shared micro-mobility. Others welcome it with minimal oversight. As it becomes more popular, protective/safety policy evolves.

Low cost, convenient, and eco-friendly, they provide an attractive alternative to expensive-to-own and operate, gas-guzzling, pollution-emitting cars and trucks.

Dispatch: A 16-year-old male in central Utah is lying in the dirt behind his home, confused. He was riding an electric scooter down a hill when he fell off. He was not wearing a helmet. There was a 2-minute loss of consciousness (LOC). His face is bruised and scratched up. He has a large "goose egg" on his forehead and he has been vomiting since the fall. GCS 14 for confusion.

On scene: Vital signs are stable; GCS is 10 (E2V3M5). You note a boggy hematoma, along with multiple facial bruises and abrasions. His right eye is swollen shut, and the right side of his nose is bleeding. He reports no neck or back pain. His belly is soft. No other injuries identified. The patient is actively vomiting and smells of alcohol.

Glasgow Coma Scores are very helpful for receiving facilities because they use your scoring to determine the level of trauma activation for the patient. Note that in this case the assumed GCS (14) was very different from how the patient presented on scene (10).

• The GCS is only validated for trauma patients even though it is often used for any patient with mental status changes.
• Your score gives the receiving facility some indication of what's coming and can provide some predictions about outcome.
• The GCS provides loose guidelines on interventions; most often airway management.
• Pediatric GCS scales are helpful if the patient is non-verbal or can't communicate.
• The motor response is the most important indicator of outcome according to the research. Motor response is often the most misunderstood score. Check out these tips at EMS 1

The patient was transported to the nearest trauma center and then transferred to Primary Children's.

• Trauma 2 activation, pan-scanned with labs
• Injuries: large subdural hematoma requiring evacuation in the OR, parietal skull fracture needing repair, multiple facial fractures, orbital fracture with evidence of muscle entrapment around the eye

Outcome: OR repairs, PICU admission, hospitalized for 1 week, discharged with chronic headaches.

Dispatch: A 17-year-old male and a 22-month-old female were found injured on the side of the road, in a grassy field in Provo. The 17- year-old was driving an e-scooter and the 22-month-old was being pulled in a "chariot" behind the e-scooter when they collided with a tree. Neither was wearing a helmet. The 17-year-old lost consciousness for 1 minute and has a nosebleed. The 22-month-old is reported to have facial scratches and a swollen left ankle.

On scene:

What is the 17-year-old's GCS?

• Eyes open to voice
• Words are intelligible but inappropriate
• Moving all 4 extremities, follows commands

12 (E3V3M6)

What is the 22-month-old''s GCS?

• Eyes open spontaneously
• Cries continuously, irritable
• Moving all 4 extremities spontaneously

14 (E4V4M6)

Outcome: The 17-year-old was transported to the nearest trauma center. He had a concussion (TBI), nasal fracture, and septal hematoma. The 22-month-old had a concussion, left ankle sprain, and facial and scalp lacerations that needed repair.

The research on micro-mobility devices doesn't really agree on anything at this point. There is conflicting data from countries all over the world but that isn't surprising since the method of transportation is new. But, they have identified some common injury patterns associated with these devices.

• Most serious injuries are the result of not wearing helmets
• Alcohol is associated with a large number of injuries in both adults and children
• In slow speed devices, extremity and abdominal injuries are common. In higher speed devices, facial and head injury is the most common site of injury.

In severe traumatic brain injury (TBI), even a single oxygen saturation of <90 or a single episode of hypotension is associated with at least 2x mortality.

Recent studies show 4 interventions benefit patients significantly:

1. Prevention and/or treatment of hypoxia through early O2 administration
2. Avoid and treat hypotension by infusing hypotonic fluids
3. Airway intervention to optimize oxygenation and ventilation
4. Prevention of hyperventilation by using age-appropriate ventilation rates and adjuncts

Click the pic below for a link to the Utah Pediatric Trauma Network (UPTN) TBI Clinical Guideline

Pass a policy to protect our most vulnerable riders (suggestions)

• Age restrictions
• Require a driver license for shared micro-mobility devices
• Provide driver education for all ages
• Helmet laws should be similar to motorcycles
• Improve pathways and roads
• Require breathalyzers for scooter rentals
• Enforce safe ridership

Micro-mobility safety—flyer

Understanding and Tackling Micro-mobility: Transportation's New Disruptor

Micro-mobility: E-Bikes, E-Scooters and Hoverboards

Do you have a question for our EMSC medical director, Sarah Becker, MD, PCH, ER attending physician about this newsletter topic or anything related to pediatrics? Email tdickson@utah.gov.

General

Prehospital and ED Pediatric Readiness for Injured Children: A Statement from the American College of Surgeons Committee on Trauma EMS Committee—The Journal of Trauma and Acute Care Surgery

Social media and youth mental health: The U.S. Surgeon General's advisory

U.S. Surgeon General Dr. Vivek Murthy released this advisory. It describes the current evidence on the impacts of social media on the mental health of children and adolescents. It states that we cannot conclude social media is sufficiently safe for children and adolescents and outlines immediate steps we can take to mitigate the risk of harm to children and adolescents.

EMSC Pulse

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

We are excited to introduce the John Wilson Autism Kits that will be made available during our autism trainings. The training and kits are free to you. These kits can be stocked in the ambulance to enhance your care of neuro-divergent children.

Contact Jeff Wilson jeffwilson122615@gmail.com to set up a training

Your Utah EMSC staff are headed to Nevada for the annual National Association of State EMS Officials meetings. At this meeting we work with other state EMSC program managers to share ideas and bring resources created in other states back to Utah.

Summer safety awareness campaign

Link to these resources for your upcoming safety fairs for June, July, August

High temperature injury prevention

Children, especially infants and young children, are more susceptible to high temperatures than adults. How can adults help children stay safe during heat waves?

• Stay alert: Watch for signs of heat-related illnesses, such as headaches, dizziness, clammy skin, or high body temperature.
• Triple-check the car: Never leave kids in parked cars on hot days, for any amount of time, even if the windows are open.
• Make a plan: Prepare for a heat wave in advance by picking a safe place to go if needed, like a library or designated cooling center.
• Hydrate: Encourage children to drink plenty of water and other non-sugary drinks (and eat salty snacks to replace electrolytes lost in sweat).

The resources below offer additional guidance for families, first responders, and medical providers on how to keep children safe before, during, and after heat waves.

There are stabilization and mobile response programs now active in the following counties; Utah, Wasatch, Sevier, Sanpete, Piute, Juab, Wayne, and Millard. Spread the word and use the attached PDFs as handouts for your summer community events.

Did you miss the PECC quarterly meeting last month?

You can watch the recording here. Be sure to sign up for an annual PECC workshop, see the event details below.

Pediatric readiness

For EMS agencies: Three Ways to Improve your EMS Agency’s Pediatric Readiness

For hospitals: The National Pediatric Readiness Quality Initiative (NPRQI)—a new, free platform designed to support EDs including small community and rural hospitals in assessing and improving pediatric emergency care.

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, please 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