Pediatric Triage & Assessment Tools for EMS

Ensuring Effective and Efficient Care

July 10, 2024

Announcements

HRSA Acknowledgement Statement�

• This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $83,352 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

Presenters

Mark Sparkman, MD

Associate Program Director EMS Fellowship

Associate Professor, Clinical Emergency Medicine

UT Health, San Antonio

Objectives

1. Provide an overview of existing pediatric triage tools and systems (e.g., JumpSTART, Pediatric Assessment Triangle).
2. Explain why pediatric patients require different triage approaches compared to adults.
3. Identify common challenges faced during pediatric triage in the field.
4. Use case studies to show how pediatric triage tools are applied in real-life situations.

Triage

• Rooted in the French word trier
• Napoleonic Wars

Francois Gerard, The Battle of Austerlitz on December 2nd, 1815

Introduction to Pediatric Triage

• Definition of triage in EMS
• Importance of accurate pediatric triage

Goals in Pediatric Triage

• Rapid Assessment
• Prioritization
• Appropriate Resource Allocation

Unique Challenges in Pediatric Emergencies

• Communication Barriers
• Physiological Differences
• Emotional Factors
• Size and Equipment
• Recognition of Symptoms

Understanding Pediatric Physiology

• Differences in anatomy and physiology
• Developmental stages impact assessment
• Common pediatric conditions and emergencies

Understanding Pediatric Physiology

• Differences in anatomy / physiology
• Infants / small children
• Big Heads
• Relatively shorter limbs
• Higher BSA to mass ratio

Proportional Differences

Meet The Robinsons, Walt Disney Animation Studios

Understanding Pediatric Physiology

• Proportionately larger tongue
• Smaller Airways

Proportional Differences

PhotoAC

amazon.com

Understanding Pediatric Physiology

• Higher heart rate
• Lower blood pressure

Proportional Differences

Understanding Pediatric Physiology

• Renal System
• Metabolic Rate
• Immune System

My Modern Met

Developmental Stages & Impact on Assessment

• Neonates (0 - 1 month)
• Infants (1 - 12 months)
• Toddlers (1 - 3 years)
• Preschoolers (3 - 5 years)
• School-age (6 - 12 years)
• Adolescents (13 - 18 years)

Respiratory Distress & Asthma

• Increased work of breathing
• Positioning
• Diaphragm
• Accessory Muscle use
• Retractions
• Intercostal
• Suprastenal
• Cyanosis

Common Pediatric Conditions & Emergencies

Textbook of Clinical Otolaryngology. Springer, Cham.

Gastroenteritis & Dehydration

• Lethargic
• Looks tired
• Not resisting exam
• Sunken
• Eyes
• Fontanelle
• Dry
• Mucosa
• Lacks tears
• Urine production down
• Skin
• Pale or gray
• Slow capillary refill
• Poor turgor

Common Pediatric Conditions & Emergencies

(RehydrationProject.org)

Febrile Seizures

• Children 6 mo. to 5 years
• Fever
• Types
• Simple
• Complex
• Febrile Status Epilepticus

Common Pediatric Conditions & Emergencies

• RED FLAGS
• AMS
• Lethargy / irritable
• Meningismus
• Bulging Fontanelle
• Focal neurological findings
• Age < 6 mo. or > 6 years

Anaphylaxis

• Skin
• Angioedema
• Bronchospasm
• GI symptoms
• Hypotension

Common Pediatric Conditions & Emergencies

Doctors Dose - Quora

1 organ system is an allergic reaction

2 organ systems, anaphylaxis.

Infectious Diseases

• Naive Immune System
• Hygiene
• Close Quarters
• Poor Hand Washing
• Hands in mouth/ nose
• Higher Respiratory Rate
• Tick-borne Disease

Common Pediatric Conditions & Emergencies

Science Photo Library

National Geographic

Trauma & Injury

• Leading Cause of Death
• Higher Risk
• Increased Activity
• Lack of Judgement
• Body Habitus
• Less Developed Coordination

Common Pediatric Conditions & Emergencies

YouTube

eBay - cherry_kiwi

What is Pediatric Triage?

• Detailed definition of triage
• Comparison: adult vs. pediatric triage
• Key objectives:
• identifying severity
• urgency of conditions
• immediate interventions
• Family Centered Care

Pediatric Assessment Triangle (PAT)

• Appearance, Work of Breathing, Circulation to Skin
• Importance of the PAT in initial assessment

PAT: Appearance

• Detailed indicators:
• muscle tone
• interactiveness
• consolability
• look/gaze
• speech/cry
• Examples of abnormal behaviors

PAT: Work of Breathing

• Detailed indicators: abnormal breath sounds, abnormal positioning, retractions, nasal flaring
• Examples of abnormal findings
• Implications of abnormal work of breathing

PAT: Circulation to Skin

• Detailed indicators: pallor, mottling, cyanosis
• Examples of abnormal findings
• Implications of poor circulation

PAT in Action

You respond to a 1-year-old whose parents report that he has been lethargic and had difficulty breathing for the past hour.

JumpSTART Triage Tool

• Introduction to JumpSTART tool
• Purpose and history
• Overview of the triage process
• Mass Casualty Situations

JumpSTART Steps

Detailed steps

• Ability to walk
• Respiratory effort
• Perfusion
• Mental status

*evaluate infants first

in secondary triage

*

JumpSTART: Ability to Walk

• Criteria for assessment
• What to do if the child can or cannot walk
• Examples and implications

*

*evaluate infants first

in secondary triage

JumpSTART: Respiratory Effort

• Assessing breathing: present, absent, labored
• Ventilation support considerations
• Examples and implications

JumpSTART: Perfusion

• Checking pulse and capillary refill
• Indicators of poor perfusion
• Examples and implications

JumpSTART: Mental Status

• Assessing consciousness and responsiveness
• Use of AVPU scale (Alert, Verbal, Pain, Unresponsive)
• Examples and implications

JumpSTART Color Coding System

• Explanation of the color codes: Red (Immediate), Yellow (Delayed), Green (Minor), Black (Deceased)

Modified Pediatric Glasgow Coma Scale (GCS)

• Introduction to the GCS
• Importance in pediatric triage
• Modifications for age appropriateness

GCS: Eye Opening

• Scoring system: spontaneous(4), to speech(3), to pain(2), none(1)
• Examples for different ages
• Implications of scores

GCS: Verbal Response

• Scoring system: oriented(5), confused(4), inappropriate words(3), incomprehensible sounds(2), none(1)
• Age specific modifications
• Examples and implications

GCS: Motor Response

• Scoring system: Obeys commands(6), localizes pain(5), withdraws from pain(4), abnormal flexion(3),
• abnormal extension(2), none(1)
• Age specific considerations
• Examples and implications

Case Study: Scenario 1

Applying Triage & Assessment Tools in the Field

• Integrating PAT, JumpSTART, and GCS
• Steps for effective use in real life scenarios
• Tips for quick and accurate assessment

Case Study: Applying JumpSTART

• Step-by-step application of JumpSTART to the scenario
• Triage decisions and prioritization

Case Study: Applying PAT

• Step-by-step application of PAT to the scenario
• Findings and initial management

Case Study: GCS Application

• Step-by-Step application of GCS to the scenario
• Interpretation of scores and management

Challenges in Pediatric Triage

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• Variability in children’s responses to injury/illness
• Limited resources and time constraints
• Emotional and psychological challenges for EMS providers

Real-World Applications

• Examples of successful pediatric triage in real emergencies
• How these tools have improved outcomes

Technological Aids in Pediatric Triage

• Overview of technological tools that aid triage
• Apps and devices for real-time assessment and decision-making
• Future trends

Summary of Key Points

• Structured Assessment
• Prioritization of Care
• Enhanced Communication
• Training and Preparedness

Summary of Key Points

• Pediatric Assessment Triangle (The P.A.T.)
• JumpSTART
• Glasgow Coma Scale

Summary of Key Points

• Application of Pediatric Triage Tools
• Integration into Protocols
• Simulation and Training
• Quality Improvement / Assurance Initiatives
• Feedback Mechanisms
• Adaptation to Emerging Needs

Improving Triage Skills

• Continuous Education
• Simulation exercises
• Peer reviews and feedback

Policy and Protocols

• Importance of standardized protocols
• Integrate triage tools into protocols
• Examples of effective policies

Conclusion

• Ultimately, effective pediatric triage embodies a commitment to excellence in emergency medical care, prioritizing the well-being of our youngest and most vulnerable population. By valuing structured assessment, timely intervention, and continuous learning, we uphold our duty to provide compassionate and proficient care in every pediatric emergency scenario.

Questions

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Sam Vance, MHA, LP

Program Manager, EMSC State Partnership, Texas

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1102 Bates Ave., Suite 1850

Houston, TX 77030

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• Office: 832-824-EMSC (3672)
• Email: spvance@bcm.edu
• www.bcm.edu/emsc

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Special thanks to Kathleen Adelgais, MD, MPH EMSC Colorado!

To Receive Continuing Education Credit

Questionnaire Instructions to Receive Continuing Education Credit:

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1. Use the QR code or the link at left to access the feedback survey and assessment.
2. Complete your survey and assessment at the end of this learning event, completing only one survey per participant. The survey completion deadline is June 7, 2024

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Certificates will be emailed to the email you provide on the feedback survey within 7 – 10 days of survey completion.

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Questions? Contact us at emsctexas@bcm.edu

https://forms.office.com/r/hCaUvd1Dzu

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