Pediatric Trauma

Basic Life Support

• Stabilize spine
• Use modified jaw thrust if airway obstructed
• Supplemental 100% oxygen
  • Including ETCO2 level (35-45 normal)
• Control active bleeding with direct pressure, hemostatic gauze packing and/or tourniquet, as indicated
• Perform head-to-toe survey to identify injuries
• Splint obvious fractures of long bones
• Prevent loss of body heat

Advanced Life Support

• If moderate or severe injuries present, perform Full Pediatric ALS Assessment and Treatment
• Assess for Pediatric Trauma Triage Criteria and initiate transport to State Approved Pediatric Trauma Center (SAPTC) if criteria are met.
• Assess for Tension Pneumothorax:
  • Severe respiratory distress with hypoxia
  • Unilateral decreased or absent lung sounds (may see tracheal deviation away from collapsed lung field)
  • Evidence of hemodynamic compromise (shock, hypotension, tachycardia, altered mental status)
• Pleural decompression for tension pneumothorax should be performed when any of the above criteria are present and likelihood of tension pneumothorax exists; decompress at 2nd intercostal space, mid-clavicular line on affected side
• In the setting of blunt traumatic cardiac arrest with suspected chest trauma, perform bilateral pleural decompressions as part of the resuscitation efforts
• Initiate transport to an appropriate trauma facility within 10 minutes of patient contact unless extenuating circumstances (extrication)
• Perform procedures, history and detailed physical examination en route to the hospital
• Reassess frequently

Basic Life Support

• Remove clothing; cool heat source if tar or asphalt; otherwise prevent hypothermia
• Cool compress dressings on minor (small area) burns with sterile saline (do not use ice packs)
• Dry, clean burn sheet on:
  • 2° burns greater than 10% of Body Surface Area
  • 3° burns
  • Electrical and Chemical burns (after decontamination if indicated)
• Spinal immobilization if high voltage electrical injuries or lightning injuries
  • Initiate Trauma Alert
• If chemical burn, refer to Basic Approach to Hazardous Material Exposures Protocol and transport to burn center

Advanced Life Support

• If moderate or severe pain and no signs of shock (normal cap refill, normal blood pressure for age):
• Fentanyl 1 mcg/kg (max 50 mcg) slow IV; may repeat once after 5 minutes as needed (maximum 100 mcg total dose) or  1 mcg/kg (max 100 mcg) intranasal via MAD (divide dose equally between each nare); may repeat once (maximum 200 mcg total dose)
  • Preferentially use intranasal delivery via MAD for those where IV access may be difficult to obtain in a timely fashion
  • Use with caution if inhalational injury or respiratory symptoms
• Expedite transport to nearest SAPTC if Trauma Alert
• IV 0.9% NaCl per American Burn Association Guidelines
  • 0-5 years old - 25 ml/hr
  • 6-13 years old - 250 ml/hr
  • ≥ 14 years old - 500 ml/hr
• If the patient meets any of the below criteria, transport to the nearest burn center
  • Partial thickness (2nd degree) burns > 10% TBSA
  • Any burns to face, hands, feet, genitalia, perineum, or major joints
  • Any full thickness (3rd degree) burns to any age group
  • Electrical burns, including lightning injury
  • Chemical burns
  • Inhalation injury
  • Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality
  • Any patients with burns and other traumatic injuries in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be transported to the trauma center for stabilization and then transferred to the burn center.

The presence of any of the 4 listed items below requires Trauma Alert activation:

1. Any one red criterion listed below
2. Any two blue criteria listed below
3. Meets Local Criteria: High Voltage Electrical Injury (>1000 volts), hanging, drowning if diving injury suspected, tourniquet in place
4. Patient does not meet any above criteria but, in the judgment of the paramedic, should be transported as a Trauma Alert. Document rationale in narrative. 

The treatment of trauma patients who do not meet trauma alert criteria

To avoid a delay in definitive management, pediatric patients who meet 1 blue criterion for mechanism of injury who do not meet trauma alert criteria should be transported to a trauma center or dedicated pediatric center with surgical capabilities (APH or Nemours)

Any patients with external signs of blunt head, chest or abdominal trauma who are medically high risk such as anticoagulated, known clotting disorders, or malignancy should be transported to a pediatric capable trauma center. 

These patients do not require emergent transport if stable, however can be upgraded at paramedic discretion.

When in doubt, patients with traumatic injuries should be transported to a trauma center. Medical Control can be contacted for Transport Recommendations if Needed