Tia Dickson, RN, BSN

Primary Children's Hospital

You respond to a motor vehicle crash, multiple cars, multiple victims. Several crews are working the scene. A 6 year-old is handed off to you. The report, including "One dead, mom is critical," is overheard by the child. What do you think that child is thinking?

"Is my dad dead?"

"What does critical mean?"

"That was a lot blood."

"Was that crash my fault?"

"Where's mom and dad?"

One in four children experience a traumatic event by the time they are 18 years old. EMS is often on the scene after these events occur. While ABCs are your priority, your words will impact the child's experience in the moment and what they go through could impact their lives long term. Do you know what to say and do to ease their experience?

Children will process traumatic experiences in many ways and it will be influenced by their age. Understanding child development will guide the ways you can help.

Provide information about others in the accident.

• Some families want to have these conversations together especially those involving a death.
• Even if you assume the child knows about a death, confirming the hard-to-hear information is best done by someone they know and who will help them feel safe.

Use big or ambiguous words.

• A child may mentally create a definition of the word that isn't correct.
• They may assume a big word means something bad or scary.

Be mindful of your report.

• Who is within earshot?
• When possible step outside of earshot when reporting new or sensitive information ("Mom died en route" or "sister's leg was amputated").
• Even unconscious patients will report memories of conversations held in the trauma bay.

It is typically appropriate to discuss the child's condition in from of them.
Assure the child of their physical safety.

• Remind the child that EMS and those at the hospital are there to help them and keep them safe.

Use Child Life when available to explain information to the child.
Be aware that various cultures may handle traumatic situations and/or death differently.

Know the Signs of Post-traumatic Stress Disorder (PTSD)

One half of the children who survive traumatic events will show signs of PTSD. Every child's symptoms are different. In general, your child may have:

• Intense fear
• Feelings of helplessness
• Feelings of being agitated and disorganized
• Trouble sleeping
• Trouble focusing
• Loss of appetite
• Changes in their interactions with others, including more aggressive or more withdrawn

Your child may also go back to behaviors they had outgrown:

• Bedwetting
• Clinging
• Sucking their thumb
• Emotionally-numb, anxious, or depressed
• Separation anxiety

Your Child Needs Your Support

Let your child know they are safe and you are in control.

• Recognize your child is taking cues from you on how to react to the traumatic event. It is OK for you to be sad or hurt.
• Your child needs to know that you are in control and are protecting them.

Let your child know you are there for them.

• Return to a daily routine as soon as you can. Create a schedule for when to eat, sleep, school, and play. Daily routines help kids know what to expect and make them feel safe.
• Talk to your child. Let them know what you are doing to keep them safe. Answer their questions in a way they can understand.
• Stay close to your child. Let them sit near you or hold your hand.
• Accept and work with your child on regressed behavior.

Monitor information your child is getting about an event. Turn off the TV news and limit your conversations about events in front of young children.

Let teachers know about traumatic events in your child's life. Keep open communication about changes in your child's behavior.

Get Your Child Help

Expect your child will return to their normal routine over time. If your child still has trouble recovering after one month, get professional help. Your child will learn how to:

• Talk about what happened. They will tell their stories with words, pictures, or play. This helps them see the reaction to the trauma is normal.
• Develop coping strategies to help with fear and anxiety.

The 2022 EMS For Children Survey will go live January–March 2022. It will only take six minutes to complete. Among other questions they will ask . . . Does your agency have a PECC?

The answer is YES!

PECCs, you will receive an email this month with a link to the EMS for Children's Survey. It's a short assessment of your agency's peds capabilities. Below is a link to help you and your agency better understand the things the survey will assess.

https://www.nedarc.org/performanceMeasures/pmHelpAndTools.html

Despite the added pressures and obstacles, the pediatric emergency community rallied to make tremendous strides in improvements to care in 2021. A quick highlight of some of EMSC’s work in 2021 includes:

• Provided $655,297 in supplemental funding to support pediatric readiness in rural communities,
• Achieved a 71% response rate for emergency departments participating in the National Pediatric Readiness Project assessment,
• Finalized two pivotal resources in the National Prehospital Pediatric Readiness Project: an EMS agency checklist and toolkit,
• Announced the incorporation of the National Pediatric Readiness Project into the American College of Surgeons’ (ACS) trauma center verification process,
• Supported the participation of 6,910 EMS agencies in the EMS for Children Survey and the release of a corresponding national report to all EMS agencies nationwide,
• More than 40 published papers featured or cited the work of the Pediatric Emergency Care Applied Research Network,
• Registered more than 1,500 individuals in the Pediatric Emergency Care Coordinator Workforce Development Collaborative,
• United across organizations to highlight pediatric readiness during EMS Week, with two webinars hosted by the American College of Emergency Physicians in collaboration with the American Academy of Pediatrics, Emergency Nurses Association, National Association of State EMS Officials, and ACS Committee on Trauma,
• Hosted the 2021 All-Grantee Meeting, which highlighted 60 speakers from across the EMSC and pediatric emergency care space and 20 poster presentations, and
• Launched the Pediatric Pandemic Network, which brought together five hub children’s hospitals and several national organizations to improve pediatric everyday readiness and disaster preparedness.

And so much more.

EMSC Newsletter

COVID-19 hospitalization surge among U.S. children spurs new Omicron concerns
Within weeks, the Omicron variant fueled thousands of new COVID-19 hospitalizations among U.S. children, which raises new concerns about how the many unvaccinated Americans younger than age 18 will fare in the new surge.

Read in Reuters: https://apple.news/AXlZQxhYQQmea5Y1sqBtPZA

Caseloads and vaccination rates among Utah's school-aged children

coronavirus.utah.gov/case-counts/

Covid-19 Trackers

Johns Hopkins Global tracker (desktop)

Johns Hopkins Global tracker (mobile)

Utah Department of Health

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 ($18.95). 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.

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.

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