Brought to you by The National Association of EMS Physicians (NAEMSP) and Missouri Emergency Medical Services for Children (MO-EMSC).

Hosts: Dr. Joelle Donofrio-Odmann and Dr. Joseph Finney

Website: https://sites.libsyn.com/414020

Guest Experts:

Mark Cicero, MD

John Lyng, MD

Episode Summary:
In this episode, we explore the latest NAEMSP Prehospital Trauma Compendium on Pediatric Severe and Inflicted Trauma, published in Prehospital Emergency Care (2025). Joined by pediatric EMS and trauma experts, we discuss how Emergency Medical Services (EMS) clinicians can improve outcomes for children through evidence-based assessment, early recognition of inflicted injuries, and thoughtful implementation of trauma care protocols.

Listeners will learn how unique pediatric physiology—from airway structure and head-to-body ratio to compensatory shock mechanisms—shapes both injury patterns and treatment priorities in the field. We highlight the use of tools such as the Shock Index Pediatric Age-Adjusted (SIPA) and simplified neurologic assessments (GCS-M, AVPU) to identify high-risk patients early.

The discussion emphasizes critical prehospital priorities: preventing hypoxia and hypotension in children with traumatic brain injury, using crystalloids judiciously, expanding access to prehospital blood transfusion, and ensuring rapid transport to pediatric trauma centers when indicated.

We also address inflicted trauma recognition, including sentinel bruising patterns, mechanisms inconsistent with developmental ability, and the challenges of detection in children with chronic or developmental comorbidities. The conversation underscores the importance of ongoing EMS training, simulation, and the role of Pediatric Emergency Care Coordinators (PECCs) in sustaining readiness across systems.

Through case discussion and review of the Compendium's recommendations, this episode reinforces a central message: prehospital providers are a critical first link in the chain of survival for injured children. From field assessment to destination decisions, every action can profoundly shape outcomes.

Key Takeaways:

• Recognize the physiologic and anatomic nuances that make pediatric trauma unique.

• Use SIPA and simplified GCS assessments to identify severe injury early.

• Prioritize oxygenation, blood pressure, and temperature control to prevent secondary injury.

• Identify and report patterns concerning for inflicted injury.

• Partner with regional systems to ensure appropriate pediatric trauma triage and interfacility transfer.

• Integrate simulation, case review, and continuous pediatric-specific education into EMS training programs.

Reference:
Cicero MX, Adelgais K, Funaro MC, et al. Prehospital Trauma Compendium: Pediatric Severe and Inflicted Trauma – A Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care. 2025; DOI: 10.1080/10903127.2025.2457141

Link to FULL Compendium

https://naemsp.org/position-statement/prehospital-trauma-compendium-management-of-geriatric-trauma-patients-a-position-statement-and-resource-document-of-naemsp/

Brought to you by The National Association of EMS Physicians (NAEMSP) and Missouri Emergency Medical Services for Children (MO-EMSC).

Hosts: Dr. Joelle Donofrio-Odmann and Dr. Joseph Finney

Website: https://sites.libsyn.com/414020

In this SHORT episode, we discuss one of the most common pediatric respiratory emergencies, croup, and what EMS providers need to know during peak viral season. Drawing from real-life experience and current field trends, we review how to recognize upper airway obstruction, differentiate it from lower airway conditions, and manage severe cases prehospitally.

Listeners learn why children's smaller airways make them especially vulnerable to swelling, how to tell croup from foreign body aspiration, and when to escalate care. Join us as we walk through the stepwise management of croup, including:

• Recognizing stridor and assessing severity

• Using nebulized (racemic) epinephrine and dexamethasone effectively

• Knowing when IM epinephrine may be lifesaving

• Avoiding unnecessary albuterol in upper airway disease

• Calming and positioning strategies to minimize distress

We also highlights the Westley Croup Score, a simple clinical tool to grade croup severity based on stridor, retractions, air entry, cyanosis, and level of consciousness — helping EMS providers communicate clearly with receiving teams and guide treatment intensity.

We emphasize timely hospital notification, monitoring for recurrence as nebulized epinephrine wears off, and when to consider admission.

For more examples of respiratory distress and croup symptoms in children, visit:
🔗 KidsHealth NZ – Signs That Children Are Struggling to Breathe

Brought to you by The National Association of EMS Physicians (NAEMSP) and Missouri Emergency Medical Services for Children (MO-EMSC).

Hosts: Dr. Joelle Donofrio-Odmann and Dr. Joseph Finney

Website: https://sites.libsyn.com/414020

GET CEU CREDIT THROUGH PRODIGY EMS

Episode 15 of the Pediatric EMS Podcast focuses on the case of a pediatric out-of-hospital traumatic cardiac arrest. Dr. Finney and Dr. Romeo Ignacio discuss the unique management priorities for traumatic arrest and how it differs compared to medical cardiac arrest. The episode recounts a real-life incident involving a child struck and pinned under an SUV, detailing the prehospital response, interventions, and decision-making process.

Guest Expert

Romeo Ignacio Jr., MD.

Dr. Romeo Ignacio is the Trauma Medical Director at Rady Children's Hospital and the Section Chief of Pediatric Surgery, affiliated with UC San Diego. A former EMT and a 24-year U.S. Navy veteran, he specializes in pediatric trauma care

1. Differentiate Between Traumatic and Medical Cardiac Arrest:

   • The approach to traumatic cardiac arrest is distinct from medical arrest, with hemorrhage control and volume resuscitation taking precedence over standard CPR and epinephrine administration.

2. Follow the MARCH Algorithm for Trauma Management:

   • Prioritize Massive hemorrhage, Airway, Respirations, Circulation, and Hypothermia/Head Injury, ensuring a systematic approach to treating the most life-threatening issues first.

3. Blood Products Over Crystalloids for Volume Resuscitation:

   • If available, whole blood or blood products should be used to restore circulation in hemorrhagic shock, as excessive crystalloid fluids can dilute clotting factors and worsen coagulopathy.

4. Minimize On-Scene Time and Focus on Rapid Transport:

   • Definitive care for traumatic cardiac arrest requires hospital-level interventions; therefore, providers should avoid unnecessary scene delays and focus on rapid transport while continuing interventions en route.

5. Avoid the "H-Bombs" in Pediatric Traumatic Brain Injury (TBI):

   • Prevent Hypoxia, Hyperventilation, and Hypotension, as these factors increase mortality in pediatric trauma patients. Controlled ventilation and maintaining adequate oxygenation and perfusion are key to improving outcomes.

THANK YOU

Special Thank you to Monarch Fire Protection District and the amazing paramedics who continue to care for critically ill and injured patients each and every day.