Tia Dickson, RN, BSN

Primary Children's Hospital

Utah ranked #1 in the United States for ATV child injuries in 2021. According to Primary Children's Hospital traumatic injuries between 2019 and 2020 increased by 34%. this year, current trends are on track to pass that number. The Utah Department of Health says children are 1,000 times more likely to be injured riding on an ATV than in a car.

We know people won't to stop riding ATVs, so let's work toward safe ridership. Simple safety steps such as keeping children off of adult-sized vehicles, increasing helmet use, and making sure there is only 1 rider on a single-rider ATV could greatly reduce serious injury and death in children.

Hilary Hewes, MD, Pediatric Emergency Medicine

University of Utah and Primary Children's Hospital

Excerpts from EMSC Connects May 2014 and PETOS: Hurt in the Dirt, ATV Injuries https://mediaspace.utah.edu/media/t/0_629hp98r

In the state of Utah, pediatric ATV use is a controversial, often emotionally charged, issue. As someone who treats seriously injured children from ATV use throughout the state of Utah, I have spent time researching this subject.

Definitions

• 
  

  
  

  ATV (all-terrain vehicle)—OHV (off-highway vehicle)
• Utah law defines OHVs as “any snowmobile, all-terrain type I vehicle, all-terrain type II vehicle, or motorcycle”

Statistics show OHVs are in and of themselves dangerous. Children are not physically or mentally prepared to handle the complexities of operating complicated machinery while navigating unfamiliar terrain.

A 14-year old male riding on an ATV, rolled into a ditch. By report, he flew off the ATV and landed headfirst. He was not wearing a helmet, +LOC. Friends reported recent seizure activity po arrival. The patient is now alert but combative.

What would you do first?

What are your management priorities?

Hospital summary:

CT head/face showed no intracranial injury, but complex left maxillary fractures and inferior orbital blowout fracture, right condylar fracture, possible aspiration pneumonia on CXR, and L3 spinous process fracture.

Was your care appropriate for these injuries?

• As with everything, start with ABC’s
• Quickly add “D” (disability)
• Stabilize the spine
• Get a full set of vitals including blood pressure
• Consider securing the airway for any depressed level of consciousness, severe facial or neck injury, or severe respiratory distress; especially if there is a long transport time

• Look for any obvious deformity or localized tenderness
• Immobilize the limbs as needed
• Note if there are any lacerations over obvious fracture sites before wrapping the area
• Check for distal perfusion and neurologic function
• Apply pressure dressings to any lacerations
• Tourniquets for significant bleeding

• Assume internal thoracic and abdominal injuries, possible back injuries
  
• Get IV access
• If unstable, assess for tension pneumothorax
• Keep entire spine immobilized
• Maintain blood pressure with fluid boluses

• Intubate for GCS < 8
• Assess pupils before giving any medications and report this to accepting hospital
• Maximize blood pressure to maintain cerebral perfusion pressure
• Sedation: balance sedation with ability to assess neurologic exam
• Elevate head slightly if no concern for upper thoracic trauma
• Mild hyperventilation (goal pCO2 35)
• Hypertonic saline/mannitol (if have the capability)

Riding ATVs is a popular form of recreation and use is increasing over time. OHVs are powerful, heavy machines with inherent stability issues. Most injuries are not life-threatening. However, thousands of children have died from ATV-related injuries since data collection began in the 1980s. Most pediatric fatalities are related to unsafe riding practices.

Approach the injured pediatric ATV rider like any trauma, with particular attention to potential head, chest, abdominal, and spine injuries.

Get involved in your community and help promote ATV safety and responsible ridership.

They started out as handy farm vehicles but with seating for up to 6, roll bars, seat belts, and cushy bucket seats, side-by-sides have become the luxury level of off-roading. They are so popular that they outsell traditional ATVs. It is assumed they are safer than other types of ATVs but Primary Children's Hospital sees rollover injuries from side-by-sides each year. The most common injury is a hand degloving, crush, or amputation that occurs when the vehicle rolls and the passenger grabs onto the roll bar to brace themselves.

Get certified: Educate yourself and your kids about ATVs and ATV safety in person or online using the Utah OHV Safety Education Course

Other safety tips and training go to https://atvsafety.org/

Is my child ready to ride? follow the checklist below

The Utah Pediatric Trauma Network (UPTN) is the pediatric trauma quality improvement program for Utah. The goal is to establish a statewide network that includes all trauma regions and hospitals. UPTN has a strong commitment to utilizing evidence-based best practices to improve outcomes while decreasing the financial cost to injured children and their families. Since 2019, this has been accomplished by extending pediatric expertise to clinicians who provide emergency care in various roles and settings.

Currently, 98% hospitals participate with the network. However, as we continue to expand, there’s still much work to be accomplished with EMS providers. In coming months more information will become available but for now please take time to visit the UPTN website @ https://www.utahptn.org/. This will remain our main platform for sharing updated guidelines with emergency care providers.

UPTN holds an annual conference to discuss hot topics and provide pediatric trauma updates. This year's conference is scheduled for Oct 28 at the Blair Education Center in Park City. The conference is free of charge and registration can be found on the UPTN website under the conference tab. Please feel free to reach out to the program manager Matthew.Eyre@imail.org for additional information about the conference or this effort as a whole. Thanks for your efforts to improve pediatric care. We look forward to building new relationships as we continue to grow the Utah Pediatric Trauma Network.

On Topic:

‘I Think This Is Going to Be a Very Bad Year’: Recent Teen Driving Deaths Alarm Experts in Mass. | Boston Globe

Seasonal Prevention:

Fireworks Safety Tips | National Safety Council

Distribution of Injury in Inflatable Jumping Amusements in the U.S. Over the Last 20 Years | Journal of Pediatric Surgery

Join the Western Pediatric Trauma Conference and earn CME, FREE!

Please join us in our Virtual Live Webinar for the Western Pediatric Trauma Conference July 13th-15 , 2022. We are just now able to confirm that we can offer this exciting event to our EMS Community for FREE.

EMS professionals are eligible for a maximum of 15.75 continuing education credits – actual awarded credit will be commensurate on their participation at the conference.

To register, Click Here and complete the registration form. When prompted for payment, a coupon code field will appear. Enter the code EMSDISCOUNT to receive a complimentary registration to attend this conference.

Once registered and before the conference date, you will receive a Virtual Zoom Conference Link to join the conference.

EMS:
Children’s Hospital Colorado is a State of Colorado recognized EMS Training Group (CO-049) and will provide 15.75 continuing education credit(s) for all pre-hospital providers.

We look forward to you joining us for this educational pediatric trauma event.

Thank you all for your service in our community!

Melanie Stroud, MBA, RN

Director of Pediatric Trauma & the Hospital Outreach Program (HOP)

Save the Date!

Our 2nd annual PECC Conference is planned for September 16, 2022.

The Centers for Disease Control and Prevention (CDC) issued recommendations for vaccinating children 5 years old and younger against COVID-19. The recommendation clears the way for the nearly 241,000 Utah children in this age group who are now eligible to get vaccinated.

Additionally, the U.S. Food and Drug Administration (FDA) has authorized both the Pfizer and Moderna mRNA vaccines for use with all ages (6 months and older) eligible for COVID-19 vaccinations. Previously, only the Pfizer vaccine was available for children younger than 18.

“We encourage parents to reach out to their child’s healthcare provider if they have questions about the COVID-19 vaccines and to find out when they can get their children vaccinated. Please be patient with vaccine providers over the next couple of weeks as they receive vaccines and prepare to administer them to our youngest children,” said Dr. Leisha Nolen, a pediatrician and the state epidemiologist at the DHHS.

A list of vaccine providers is available on https://coronavirus.utah.gov/vaccine-distribution. Parents can visit vaccines.gov to verify which providers have pediatric vaccines available for younger children or call their child’s doctor’s office or local health department for information on scheduling a vaccination.

Vaccine dosage is based on the brand of the vaccine and a person’s age the day they receive the vaccine, not weight. Depending on the type of vaccine given, children younger than 5 may need 2 or 3 doses.

• Pfizer vaccine: Children ages 6 months through 4 years of age will need 3 doses to complete their primary vaccine series. The 2nd dose should be given 21 days after the 1st dose and then a 3rd dose 2 months after the 2nd dose.
• Moderna vaccine: Children ages 6 months through 5 years of age will need 2 doses to complete their primary vaccine series. The 2nd dose should be given at least 28 days after the 1st dose.

“We strongly encourage healthcare providers to familiarize themselves with the CDC recommendations and begin immunizing these children immediately,” said Nolen. “Doctors, and especially pediatricians, will play a critical role in vaccinating this population. We hope doctors will proactively reach out to their patients with the information they need to make the decision to vaccinate their children.”

“The clinical trials showed these vaccines are safe for young children and can prevent them from getting sick or suffering from long-term impacts of COVID-19,” said Nolen. “Children have not been exempt from this pandemic. The Omicron wave this winter sent a number of our very youngest kids to the hospital; one-quarter of whom ended up in intensive care. Most tragically, COVID-19 has killed more children younger than 5 than flu would during 2 normal flu seasons. I think we can all agree, this is tragic. We need to help keep kids out of the hospital and now we can through vaccination. ”

For more information visit https://coronavirus.utah.gov/vaccine/ or call the COVID-19 hotline at 1-800-456-7707.

Yes. There is a tremendous burden of disease in this age group. Thankfully the rate of severe disease is lower compared to adults, but this is an inherently flawed comparison because kids don’t die as often as adults. Since the beginning of the pandemic, 442 children aged 0-4 years old have died from COVID-19. If we compare this to other vaccine preventable diseases among children, deaths due to COVID19 are highest. We cannot become numb to these deaths.

In terms of hospitalization, children, and specifically those younger than age 5, did not fare well during our first Omicron wave. According to the CDC, children younger than 5 had the highest rate of hospitalizations compared to other pediatric groups. Among children hospitalized, 1 in 4 ended up in the ICU.

The rate of COVID-19 hospitalization was particularly high in October 2021-April 2022 compared to previous flu years and compared to COVID-19 hospitalizations the prior year (October 2020-September 2021).

Severe disease is not the only outcome of SARS-CoV-2:

• Long COVID-19 does occur among kids, and vaccines reduce the burden of long COVID by 15-50%.

• Parents know wearing masks and social distancing very young kids can be nearly impossible. The layers of protection we can use for them are less than optimal.

• We have frequent, unexpected disruptions in care and schooling of children that contribute to the daily burden of COVID-19. While not perfect, vaccines will help reduce infections and transmission, inching us closer to fewer family disruptions.

Have you attended a home birth transfer of an infant or a mother to a hospital and noticed ways the process could be improved? Have you seen midwives who have really great systems and communication and wish they all did? Help us learn how to improve the collaboration and communication about birth transfers by giving feedback to the Utah Women's and Newborns Quality Collaborative!

Find out more about our work and the improvement tools we have created here: https://mihp.utah.gov/uwnqc/out-of-hospital-births

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