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February 2025; Volume 14, Issue 2
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Utah Emergency Medical Services for Children
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Pedi Points
Tia Dickson RN, BSN
PCH Trauma RN, Utah EMSC Nurse Clinical Consultant
While hanging injuries in children are rare compared to other forms of trauma, they carry unique challenges for EMS providers. As EMS providers, your role in the early recognition and intervention can impact outcomes. These situations are often among the most emotionally challenging in emergency medical services. Understanding the management of these injuries may ease provider stress.
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Management of Hanging Injury by EMS Providers
Stuti Das, MD MSc
Pediatric Emergency Medicine Fellow, PGY-6
Primary Children’s Hospital
Excerpts from January 13th, 2025 PETOS
The management of hangings is a often requested topic by EMS providers. These calls are often sad and disturbing, especially for responders on the front line.
Strangulation injuries are those that results from a compressive force to the neck, leading to vascular and airway occlusion.
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Such forces might include hanging or strangulation
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Strangulation is implicated in 10% of violent deaths in the United States
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Hanging is the second most common form of death by suicide
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Hanging is suspension by the neck resulting in asphyxia and death.
Near hanging refers to survival following a hanging incident. This can still result in potentially devastating injuries which may progress to death, or serious long-term morbidity.
The exact number of kids who get hurt from near-hanging is not fully known, but older studies say it could be between 0.3% and 0.7% of kids who need serious hospital care. Younger kids often get hurt from things like car windows, curtain cords, power cords, and high chairs. Teenagers, on the other hand, may get hurt because of risky behaviors like “autoerotic asphyxiation,” which is when they try to choke themselves to feel a certain sensation, or by suicide.
Recently, a dangerous trend on TikTok called “the blackout challenge” became popular. In this game, kids try to strangle each other to experience a weird, euphoria-like feeling right before passing out.
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Common Injuries
Asphyxiation: Compression of the airway and blood vessels in the neck, leading to hypoxia and hypercarbia.
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Cerebral Injuries: swelling in the brain, can make the spaces that hold fluid in the brain smaller. The grey matter (the part of the brain that helps with thinking and movement) can lose its normal shape and become less clear on scans. The area of the brain called the basal ganglia, which helps control movement, can also show changes. These types of injuries are very serious and can affect a person’s ability to think and move properly.
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Cervical Spine Fracture: fractures of the spine associated with hangings represent a critical concern due to the risk of severe neurological impairment and respiratory failure. Prompt recognition and treatment of these injuries are essential to prevent further complications and to manage the airway and breathing.
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Typical Case: 12-year-old female found hanging from a closet rod, conscious but unable to move limbs
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Considerations for neurogenic shock
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High Cervical Spine Injury: Damage to the cervical spinal cord can lead to neurogenic shock.
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Loss of Sympathetic Tone: Damage to the spinal cord or brain disrupts the sympathetic nervous system, leading to vasodilation (widening of blood vessels)
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Decreased Systemic Vascular Resistance: This vasodilation causes a significant drop in blood pressure.
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Bradycardia: The heart rate slows down due to unopposed vagal activity, as the sympathetic nervous system is impaired.
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Traumatic Hematoma: a collection of blood outside the blood vessels due to trauma, specifically caused by the pressure or force exerted during the act of hanging. The location and severity of the hematoma depend on the specifics of the injury and the forces involved during the hanging. These can continue to expand and occlude the airway.
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Initial management would include stabilizing the airway especially if the symptoms of upper airway obstruction are present
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labored or noisy breathing (stridor or gasping)
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Difficulty breathing (retractions, increased work of breathing)
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Cyanosis
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Inability to speak or changes to voice
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Changes in mental status (irritability, confusion)
Attempt intubation once and then again, if unsuccessful, insert an Igel or LMA. If that is unsuccessful and BVM is inadequate, consider a surgical airway.
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Hanging Injury considerations for pediatrics
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Less risk of laryngeal and cervical vertebral injury in children.
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Children are generally at increased risk of presenting with significant airway compromise from strangulation injuries due to the smaller size of their larynx and the relative laxity of their soft tissues.
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Neck hematomas and tissue edema have the potential to expand more quickly and can have a more dramatic effect.
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Children often present as a result of clothesline-type injuries and falls onto handlebars. With this mechanism they can present in respiratory distress from tracheal injury rather than with the prolonged periods of hypoxia seen in circumferential strangulations.
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Prevention
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Remove drawstrings from outerwear, such as jackets and sweatshirts, for young children. Drawstrings can catch or become entangled with objects, such as a car door, school bus doors or playground slides.
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Do not allow infants and young children to wear scarves, necklaces, ribbons or other strings around their necks.
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Tie up or cut all window blind and drapery cords.
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Make sure the spaces between guardrails and bed frames, and between the headboard/footboard and mattress, are less than 3.5 inches.
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Skills refresher:
IO Infant Child Needle Selection and
Insertion Technique
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Cricothyrotomy, Surgical Airway Procedure for Difficult Airway
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For additional guideline direction check out the UPTN website or the new app, “Utah PTN” on android and apple devices.
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CME credit for this issue
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Training officers may review the topic above as a team training AND perform a simulation/skills check as directed. Once complete, send a roster of participants to Utah.PETOS@gmail.com and those listed will be issued 1-hour of CME credit from the Bureau of EMS, DPS.
Individuals who don’t have a training officer can get CME credit on their own by viewing a PETOS presentation in our archives and completing the instructions on the webpage.
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Skills checking
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Review the newsletter content with your team.
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Watch both video links above.
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Practice your agency policy for difficult airway based on the practice scope of your providers:
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EMTs: practice BVM, oral and nasal airways, etc
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AEMT: LMA, Igels, etc
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Paramedics: Intubation and cricothyrotomy
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On Dec. 23, H.R. 6960, the “Emergency Medical Services for Children Reauthorization Act of 2024,” was signed into law. The legislation – championed by Rep. Buddy Carter, Rep. Kathy Castor, Rep. John Joyce, Rep. Kim Schrier, Sen. Bob Casey and Sen. Ted Budd – sustains the work of the EMSC Program in ensuring high-quality emergency care for children across the United States.
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Many EMSC partners and child health advocates supported this bill, including advocates from the American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Hospital Association, Children’s Hospital Association, Emergency Nurses Association (ENA), EMSC State Partnership Programs, and Pediatric Pandemic Network, among others.
Thank you for your advocacy on behalf of children. You can read the official White House press release here or read a press release from ENA here.
Or, join our work to save lives through Pediatric Readiness here.
Happy new year,
The EMSC Program
Part of the Health Resources and Services Administration
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EMSC Pulse
National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!
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PEAK: Procedural Sedation has launched!
Delivering safe and effective procedural sedation for pediatric patients is critical to providing high-quality emergency care.
To support EDs in meeting these needs, EMSC has developed a Pediatric Education and Advocacy Kit (PEAK) on procedural sedation.—all free and open access. View the resources here. [trm4toyab.cc.rs6.net]
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Autism awareness training (agency and hospital)
If your agency is interested in the John Wilson Autism training or in receiving the free autism kits, contact Jeff Wilson, PM @jeffwilson122615@gmail.com.
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Do you know about the Medical Home Portal?
The Medical Home Portal is a unique source of reliable information about children and youth who have special health care needs (CYSHCN) and offers a “one-stop shop” for their:
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PECC development
For Utah hospital and EMS Agency PECCs
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Come to the Southern PECC Workshop, registration now open
EMS and Hospital PECCs are encouraged to attend a PECC workshop yearly and our next one is happening in St. George May 8th, 2025. Join your EMSC staff and pediatric experts from PCH. Get to know other PECCs, receive education and resources that will help in your role. Register below.
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Hospital PECCs
Pediatric Readiness in emergency departments (EDs) has gained national attention this fall, with new research showing that ensuring all EDs are well-prepared to treat children could save 2,143 lives each year. The most effective strategy for improving Pediatric Readiness in EDs? Designating clinicians, ideally both a nurse and physician or advanced practice provider, in the role of a pediatric emergency care coordinator (PECC). To help support clinicians in the PECC role, the Emergency Medical Services for Children (EMSC) Program has released the first three modules in a PECC learning module series. These modules include step-by-step instructions for evaluating the readiness of your ED, strategies for getting buy-in to develop the PECC role, PECC job descriptions, and more! The modules are free and open-access. View them here.
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Here is a promotional package (including sample newsletter/email text, social media posts, and graphics) for your use. Please share through your networks.
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Understanding the PECC role
For hospital PECCs
For EMS PECCs
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PECC quarterly meeting
You will receive an invitation with the link through email. If you are a PECC and don’t receive this invitation, contact our program manager, Jared Wright jaredwright@utah.gov.
When?
Tuesday, Feb 18, 2024, 10:00 AM
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Southern PECC workshop
PECCs are encouraged to attend an in-person PECC workshop each year to receive up-to-date pediatric training, direction for your PECC role, and to participate in networking with other PECCs statewide. These workshops are free to designated hospital and agency PECCs. We will offer one in the northern part of Utah and one in the southern part each year.
When?
May 8th – followed by a pediatric skills workshop for all EMS on the 9th
Where?
St. George Regional Hospital, St. George, Utah
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Pediatric education from Utah EMSC
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Pediatric Emergency and Trauma Outreach Series (PETOS)
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PETOS (pediatric emergency and trauma outreach series)
This lecture provides 1 free CME credit from the Office of Emergency Medical Services, DPS for EMTs and Paramedics. The lectures are presented by physicians and pediatric experts from Primary Children’s Hospital. The format is informal; inviting questions and discussion.
Upcoming topics
February 10th, 2025 – Firearms Injury with Katie Russell, MD
02:00 PM Mountain Time (US and Canada)
Join Zoom Meeting
https://zoom.us/j/98193757707?pwd=UzdNeXppQUdtZ01KZUp2UFlzRk9vdz09
Meeting ID: 981 9375 7707
Password: EmscPCH
Archived presentations can be viewed and also qualify for CME credits. You can access them at https://intermountainhealthcare.org/for-professionals/PETOS.
To obtain a completion certificate—follow the instructions on the website
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Emergency Pediatric Course – NAEMT
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Zero Fatalities Safety Summit
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You’re invited to join traffic safety officials and advocates for the 2025 Zero Fatalities Safety Summit, April 28—29, at the Mountain America Exposition Center in Sandy, Utah. The summit will include presentations and sessions on topics that are related to traffic safety, pedestrian and bike safety, enforcement, engineering, driver education, child passenger safety, occupant protection, trucking, DEI, and other topics related to reaching a goal of Zero Fatalities. The 2025 Safety Summit is an opportunity for traffic safety officials and advocates to share experiences, opportunities, and successes to improve safety in our communities. CME will be providing for EMS providers..
Register before March 7 for early bird pricing. Visit ZeroFatalities.com/summit for registration and conference details.
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Other pediatric education for all
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Current Concepts in Neonatal and Pediatric Transport Con.
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February 19-21, 2025
47th Annual Current Concepts in Neonatal and Pediatric Transport Conference
https://intermountain.cloud-cme.com/transport2025
Radisson Hotel Downtown Salt Lake City, UT
*Virtual Option available
22 possible AMA and ANCC credits and Respiratory Care Credit
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University of Utah pediatrics ECHO 2025
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The Pediatrics ECHO is back! For those new to Pediatrics ECHO, you can earn CME for participating in a case-based learning session with experts in a variety of pediatric topics.
You can view previous session recordings and other programs on the Project ECHO page. CME is available for participation in these classes.
More Information
Note the University has a new EMS education website.
When? Wednesdays 12 – 1 pm (MT)
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University of Utah injury prevention learning series
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University of Utah’s EMS trauma grand rounds
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Hospital-focused pediatric education
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Primary Children’s pediatric grand rounds
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Offered every Thursday, September-May
Offering both RN and MD CME
The pediatric grand rounds weekly lecture series covers cutting-edge research and practical clinical applications, for hospital and community-based pediatricians, registered nurses, and other physicians and practitioners who care for children of any age.
Every Thursday, 8 a.m. to 9 a.m. from September through May in the 3rd Floor Auditorium at Primary Children’s Hospital and at Lehi a broadcast will be held in the education center (1st floor in rooms 1 & 2).The lectures are also broadcast live to locations throughout Utah and nationwide. Click on this link to view the broadcast: https://www.youtube.com/channel/UCNQP-M_3-PdPDvnICr2Fjpg
Connect live
Click here for the PGR PCH YouTube channel to find the live broadcast. Archives (without continuing education credit) will be posted here within 1 week of the broadcast.
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Emergency Medical Services for Children Utah, Bureau of EMS, Department of Public Safety
The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system.
Email: tdickson@utah.gov
Website: https://ems.utah.gov/
Phone: (801) 707-3763
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