Tia Dickson, RN, BSN

Primary Children's Hospital

The CDC reports falls are the leading cause of non-fatal injuries for all children ages 0 to 19. Every day, approximately 8,000 children are treated in U.S. emergency rooms for fall-related injuries. This adds up to almost 2.8 million children each year. The beginning of spring equals the opening of doors and windows. Children begin falling out of screens and doing all sorts of activities outdoors that can lead to falls. Seventy percent of window-related falls happen in the spring and summer months. April 4–10th is officially Safe Window Week.

• Insect screens cannot support a child's weight
• Never leave children unattended around open windows, with or without a screen
• Windows within a child's reach should remain closed
• Don't place furniture under windows; children can climb and potentially fall from an open window

• Keep children's play areas away from windows, balconies, or patio doors

• Purchase window locks or guards to prevent windows from opening more than 4 inches.
  

Falls accounted for 857 of our pediatric calls in 2020. The Utah data also shows windows are not the only culprit when it comes to pediatric falls. Monkey bars, and shopping carts get a lot of media but our state data shows little ones are just as likely to be dropped by a parent or a sibling and older children have a lot of sports-related falls.

A first consideration is spinal motion restriction. It's always hard to immobilize a child. First we have to take them away from parents. This immediately causes anxiety and often, screaming. Then we have to tie them down. However, studies have shown spinal cord injuries and SCIWORA (spinal cord injury without radiological abnormality) occur more frequently in young children than previously thought. A young child cannot accurately pin-point the source of their pain or severity of injury, so all precautions should be taken.

The 2020 Utah EMS Protocol Guidelines has guidance on Spinal Motion Restriction and pediatric considerations.

• Children younger than age 2 should be secured in a car seat or age appropriate papoose device.
• Children who are <5 years old should be secured with an appropriately-sized cervical collar or soft towel rolls and tape, if tolerated. If attempts at SMR result in more distress and fighting to get free, the SMR should be minimized.
• Children younger than age 8 cannot have their cervical spines reliably assessed in the field and should have the cervical spine immobilized if the mechanism warrants it.
• Children do not require full SMR if isolated injury to the cervical spine is suspected as their risk for noncontiguous spinal injuries is much lower than adults.
• Use a pediatric-specific backboard for those <8 years old OR use a towel or pad to raise the child’s body (not their head) to insure appropriate spinal alignment on an adult board.

Kids are SURVIVORS! Even after falling out of third story windows, being dropped on their head, or tossed in the air and not caught . . . they LIVE!

The number of deaths due to accidental falls in the Utah Statewide Trauma Registry for age 0-16, is low (the average is 1.6 per year) but non-fatal injuries can be severe and these incidents account for a large number of pediatric calls every year.

Falls and Pain Control

If it looks like it hurts, it probably does. Pain can be a large source of fear in children. Effective pain control can improve the experience for the child and also make it easier to assess and care for them. One of the best ways to treat pain is non-pharmacological. Never discount the effectiveness of a movie/game on a smartphone/tablet to distract attention away from the injury. Toys are also a great distraction!

If you do decide to use medication a large source of anxiety is the IV poke. The IV poke can be avoided in some cases by using intranasal administration. Fentanyl 2 mcg/kg intranasal x1 (using 50mcg/ml, max 100mcg) is recommended by most EMS protocols.

Pros

• Fantastic pain control
• It starts working (onset of action) within 5-10 minutes
  
• Intranasal routes have fewer respiratory suppression side effects when compared with IV routes

Cons (limitations)

• The intranasal route has a 2 mL (1 mL per nostril) max. If you exceed that volume you have minimal additive effect of the medication and you increase the “drowning sensation” the patient may experience.

Opiates for Pediatric Pain in Prehospital Care

For children, both fentanyl and morphine work well. Since fentanyl is more potent than morphine the intravenous dose is 1 mcg/kg (0.001 mg) compared with 0.1 mg/kg for morphine. The added advantage of fentanyl is it can be given intranasally. Intranasal fentanyl can provide rapid pain relief in an injured child within minutes. Morphine may be the best choice for longer transport times as its effects tend to last longer than fentanyl (30-40 minutes).

From Safe Kids Worldwide

Install Window Guards and Stops

1. Screens are meant to keep bugs out, not children in. Properly install window guards to prevent unintentional falls out of windows. For windows above the first floor, include an emergency release device in case of fire.
2. Install window guards that adults and older children can easily open in case of emergency. Include this in your family’s fire escape plan and practice it regularly.
3. Install window stops so windows open no more than four inches.

Open Windows From the Top and Close After Use

1. If you have windows that can open from both top and bottom, make a habit of opening just the top to prevent accidental falls. Keep in mind that as kids grow, they may have enough strength, dexterity, and curiosity to open the bottom.
2. Keep windows locked and closed when they are not being used.

Keep Kids From Climbing Near Windows

1. For your crawlers and climbers, move chairs, cribs, and other furniture away from windows to help prevent window falls.
2. Never move a child who appears to be seriously injured after a fall—call 911 and let trained medical personnel move the child with proper precautions.

Secure Kids When Seated

1. Keep babies and young kids strapped in when using high chairs, infant carriers, swings, and strollers.
2. If your baby is in a carrier, remember to place it on the floor, not on top of a table or other furniture.

Help Babies Learn to Stand and Walk Safely

1. There are some things to know about baby walkers: They don't come with safety features to prevent the walkers from rolling down the stairs, and it's easy for children to fall or reach higher objects that may be unsafe. Please be extra careful.
2. Because baby walkers can be dangerous, try using a stationary activity center. These items give your baby a chance to practice standing and moving more safely. Look for one on a stable, non-moveable base and place it away from stairs, hot appliances, or window cords.

Play on Soft Surfaces at Playgrounds

1. Take your kids to playgrounds with shock-absorbing surfaces such as rubber, synthetic turf, sand, pea gravel, wood chips, or mulch. If your child falls, the landing will be more cushioned than on asphalt, concrete, grass. or dirt.
2. Click for more tips on playground safety.

Be Smart, Protect Your Head

1. It's important for kids to have the freedom to be creative and push their limits. That means they need to wear a helmet for appropriate activities such as when they bike or snowboard to prevent a head injury that can ruin the fun down the road.

Use Shopping Carts With Wheeled Attachments for Kids

1. Don't leave your child alone in a shopping cart.
2. If possible, use shopping carts with a wheeled child carrier that is permanently attached. Some of these models look like cars or benches attached to the shopping cart, so your kids will love them.
3. If you place your child in a shopping cart seat, use a harness or safety belt. If the belt is missing or broken, select another cart.
4. We know it's fun to let your child ride in the cart basket, under the basket, on the sides or on the front of the cart. It can also be dangerous.

Watch Out for the Stairs

1. Use approved safety gates at the tops and bottoms of stairs and attach them to the wall, if possible. Remember to read the manufacturer's instructions and warning labels to make sure you have the right gate for your needs. Not all gates are safe for use at the top of stairs.
2. Actively supervise toddlers on stairs. Hold their hands when they walk up and down stairs.

Prevent Slips at Home

1. Consider anti-slip rugs for the floors in your home, and mats or decals in the bathtub or shower to help prevent dangerous falls.
2. Keep hallways and stairs well-lit and clear of clutter.
3. Don't let kids play on high porches, decks, stairs, or balconies. If it's unavoidable, make sure they are supervised by an adult.

Show Older Kids How to Be Responsible

1. Talk to your kids about appropriate play behaviors. We know some play can be physical, but it's important to know when and where it's appropriate.

Prevent TV and Furniture Tip-Overs

1. Secure TVs and furniture to the wall using mounts, brackets, braces, anchors, or wall straps to prevent tip-overs. These kind of accidents happen more than you might think. Take a few minutes, secure your TV and furniture, and then never worry about it again.
2. Don't let children climb on furniture or use drawers or shelves as steps.
3. Learn more about TV and furniture tip-overs.

More Babies in Strollers, Cribs Winding up in ER: Study

A new U.S. study finds more babies and toddlers end up in the emergency room for injuries related to strollers, cribs and other nursery products. The researchers found those ER trips rose nearly 24 percent between 2003 and 2011, after more than a decade of decline. However, only 1 percent of those ER trips were blamed on actual product "failures."

Baby Gear Injuries Surging, often due to falls

A study suggests every eight minutes in the U.S., a child younger than age three has an accident related to baby products like strollers, carriers, cribs, and walkers. That adds up to more than 66,000 injuries a year on average, and it only counts infants and toddlers who visit the emergency room. Injuries are on the rise, and roughly four in five are due to falls, researchers report in Pediatrics.

The 2022 EMS For Children Survey is complete!

THANK YOU!

We are excited to announce Utah's EMSC has a NEW PROGRAM MANAGER!

Jared Wright

• jaredwright@utah.gov
  
• Cell: 801-230-4721
  

The majority of my EMS career was spent in Tooele County for Mountain West Ambulance where I worked as a paramedic & training officer. For approximately six years, I've been instructing EMT/AEMT, AHA, and NAEMT courses. I am a Weber State University paramedic graduate. I started at BEMSP as an Educator Specialist last year. I'm excited to have just joined the EMSC team!

March 2022 is the official launch date of phase 2 for the National Pediatric Readiness Project. Hospitals will join EMS agencies and designate a PECC (likely an emergency room doctor or RN). In all trauma centers, the emergency departments must evaluate pediatric readiness and create a plan to address any deficiencies. The EMS survey results will be out soon so EMS agency PECCs can do the same for their organizations.

• Have you been able to define the PECC role within your organization?
• Choose an area of focus from the wheel above.
• Start with one S.M.A.R.T. goal.
• Contact your EMSC team to brainstorm achievable goals for your agency, we'd love to hear how things are going. Email Tia at tdickson@utah.gov
  

Pediatric Disaster Preparedness Toolkit https://emscimprovement.center/education-and-resources/toolkits/pediatric-disaster-preparedness-toolbox/

Pediatric Equipment Toolkit https://emscimprovement.center/education-and-resources/toolkits/pediatric-equipment-toolkit/

• ED Preparedness Checklist

• Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers
• Pediatric Care Recommendations for Freestanding Urgent Care Facilities
• Equipment for Ground Ambulances
• Schools, Home, and Children with Special Healthcare Needs

National Pediatric Readiness Checklist

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 following address tdickson@utah.gov.

Pediatric Education for the Prehospital Provider

Register online at www.peppsite.com. Look up classes in Utah and find the one 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 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