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April 2025; Volume 14, Issue 4
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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
Spring is here, marking the end of “respiratory season.” The viruses we track are below the 10% positivity threshold, so we can now declare the season over! Let look at how we interact with kids heading into trauma season.
Kids can get really nervous or scared when they need medical care, especially during emergencies. But by being friendly and positive, using distractions to take their mind off the situation, and doing comfort holds to keep them safe and calm, we can make the experience much better for them. Today, we’re going to talk about simple ways to help kids feel more relaxed and supported, even when things are tough. This not only helps them feel better emotionally but also helps their bodies heal faster.
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Pediatric Interactions, Distractions and Holds
Sheri Bothell BS, CCLS
Child Life Supervisor of Student Programing and Education
Intermountain Health, Primary Children’s Hospital
Excerpts from March 10th, 2025 PETOS
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Child life professionals aim to mitigate the impact of stress or trauma on the development and well-being of children and families. Using play as a therapeutic tool, they support growth through assessment, intervention, prevention, advocacy, and education.
Pediatric calls are high acuity, low frequency. Recent data indicates that only 8% of your calls involve patients under 18 years old. The most common patient complaints in these calls are trauma, respiratory distress, and seizures. Besides the lack of exposure, pediatric calls pose additional challenges for the following reasons:
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Children hold a unique social value, which adds complexity to care.
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Caregivers (typically parents) often become secondary patients in these situations.
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There is a strong emotional connection, as healthcare providers often identify with both the patient and the family.
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Pediatric care involves clinical challenges due to differences in anatomy, physiology, and development compared to adults.
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Communicating with children
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Future Steps: Ensure the child understands the next steps you’ll be taking. Be honest and avoid setting unrealistic expectations—never promise things like “this will be the last poke.”
Age-Appropriate Communication: Use simple, clear terms with no assumptions that the child has medical knowledge. Employ gentle language to make the experience less intimidating.
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Choices: Offer appropriate choices when possible. An EMS encounter is often unexpected, leaving little control for the child. Whenever you can, give them a sense of choice: “Would you like me to listen to your heart or lungs first?” Avoid offering false choices, don’t offer a choice when there isn’t one. “Would you like to take this medicine?”
Trusting Person: Build a relationship with the child: Take time to connect with the child, talk to them and finding common ground. If they’re wearing a Spider-Man shirt, for example, mention Spider-Man and ask them about their favorite superhero. Building rapport helps ease anxiety and fosters trust. Use their parents as a resource.
Sharing Feelings: Give them opportunities to express and validate their feelings. If they’re too young to express themselves, acknowledge what you observe: “I see all the tears, and I can tell you’re feeling sad. It’s okay to be sad.” Help the child ground themselves by exploring the 5 senses.
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Common pediatric procedures in the field
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Placing them on Oxygen:
Before using any materials to support the child, show them what you’re going to use:
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Oximeter: “I’m going to use his to check how you’re breathing. It doesn’t hurt; it just goes on your finger.”
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Nasal Cannula: Allow the child to feel it, if they want. You can explain, “Some kids say it tickles their nose.”
Trauma:
Provide step-by-step sensory information:
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Backboard: “This is a board that helps us carry your body safely.”
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IV: (See below for details.)
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C-Collar: Show the child the collar first and explain: “This is used to keep your neck still until the doctors at the hospital can check it. Some kids say it can feel frustrating not being able to move your neck like usual, but if your body stays relaxed, it can feel a little better.”
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Lead Stickers: Show the child the stickers and let them feel the sticky side. Explain: “These stickers will help us see how your body is working on the computer.”
Broken Bones:
Before using any materials to support the broken bone, show the child what you’re going to use.
Splint: “I’m going to use this to support your arm and keep it from moving.”
Describe the splint and, if the child wants, allow them to feel it.
With all of the above, let the child know that you’ll be doing the work, and their job is to:
a) Take deep breaths (and ask the parent to help coach the child).
b) Squeeze a parent’s hand.
Validate the child’s feelings:
“Thank you for telling me you’re hurting.”
Engage the child in conversation to help distract them from the pain.
IV Starts:
Provide Step-by-Step Sensory Information:
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Tourniquet: “This is a big rubber band that will help us see and feel your vein.”
“You’re going to feel a tight squeeze on your arm.” (If possible, place the tourniquet over the sleeve to prevent pinching.)
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Alcohol Swab: “We’re going to clean your arm. It will feel cold and wet, and you might even smell it.”
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Poke: Ask the child if they would prefer you to count before the poke or if they’d rather not know.
Tip: If possible, show the child the catheter without the needle beforehand so they can see and feel it.
If the IV insertion is unsuccessful, avoid blaming the child for movement or stating that their veins didn’t cooperate.
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Comfort Plan for Needle-Based Procedures
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At Primary Children’s we have implemented a comfort plan for needle-based procedures. Using distraction and our pain relieving tools. This plan is discussed with parents and the child before the needle-based procedure.
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Caring for Patients with Sensory Needs
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Keep in Mind
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Experiencing the field through your senses
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What is normal for the patient?
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Use the parents for a resource
Helpful Tools
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Noise Cancelling Headphones
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Ask the parent what triggers/escalates the child’s behavior.
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Dim the lights
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What sounds can you control?
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Tone of voice
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Rx to help them regulate
Click on the picture to connect with our Autism training specialist Jeff Wilson.
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Biggest Indicator of Resiliency in Pediatrics:
Returning to their baseline state: A key sign of resiliency in children is their ability to return to their previous emotional or physical state within 15–20 minutes after a procedure.
If this doesn’t happen, the following steps should be taken:
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Decrease stimulation: Minimize external distractions or stimuli to help the child regain calm.
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Validate emotions: Acknowledge and affirm the child’s feelings to help them feel understood.
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Allow emotional expression: Provide a safe space for the child to express their emotions, whether verbally or through other means.
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Deep Dive:
(EMSC doesn’t endorse any particular product but PCH is using this tool and we will be distributing these at our next PECC conference. This is one example.)
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How to Use Comfort Holds During a Procedure
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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 all video links above.
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Practice your agency policy for interacting with children using your own equipment
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News from Primary Children’s Hospital
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Reminder for EMS (Spring Runoff/Cool Water Drowning Season)
If there’s a potential pediatric ECMO candidate, bypass other hospitals and transport directly to Primary Children’s Hospital in Salt Lake. If possible, obtain a water temperature reading at the scene.
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Construction Refresh
As of April 7th the Primary Children’s ambulance entrance will be closed. EMS will enter through the Decon area, Room 4, and into the ED. Signs will be posted, and security will meet ambulances to unlock the double doors. When the Charge Nurse (PFC) is notified of incoming EMS arrivals, they will inform security so they can unlock the outside doors. This same process applies for direct admits. LifeFlight direct admits will notify their communication center, who will then alert security. If security is delayed, we will be monitoring the cameras to assist EMS.
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Process change – how can you get your face sheets for billing?
Primary Children’s has revised the process for distributing face sheets to EMS crews. Recognizing the importance of this information for billing, they aim to ensure the new process does not hinder your ability to receive compensation.
The following SBAR is from the PCH ED Nurse Manager Cydney Greenhalgh.
Situation: EMS and Life flight crews need face sheets to enable them to bill for services. We can no longer print these out until information has been verified by registration.
Background: We have given these out to crews for many years, but there have been issues with the validity of information, (insurance and demographics) that were listed on the face sheets. This has caused problems with billing, and we have been told by compliance and legal that the information we give out to the agencies needs to be verified. The corporation asked us to no longer print face sheets for EMS crews.
Assessment: EMS crews have not been happy with the change as they have to wait in line for registration to be able to get this information. They also don’t fully understand why this change has taken place.
Recommendation: If the unit clerk and/or charge nurse are busy and cannot get information to the crew we will ask them to go to registration. If they are available, there will be a printed-out instruction sheet at the desk by the HUC’s and charge nurses. We will write the patient’s FIN number on the sheet and give this to the crews. They need this paper so they can have the follow-up email and fax number so they can eventually get a face sheet by contacting the Health Information Management (HIM) Department later.
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In the News
Are you tracking Measles outbreaks and community vaccination status?
Then you need to know about the CORI Map and the Measles Outbreak Response from Johns Hopkins’ Center for Health Security https://t.co/bbpgk1c58a [t.co].
National Pediatric Disaster Coalition https://npdcoalition.org/
EMSC Pulse
National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!
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National Telecommunicator Week
April 13th-19th honors the dedication and service of public safety telecommunicators, including 9-1-1 operators, who are vital to emergency response.
We want to thank Utah’s dispatchers, we are chaos without you!
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Thank you Greg Nelsen
Greg Nelsen has been Utah EMSC’s go to pharmacist for many years. He has also done incredible things for pediatric disaster readiness. He is moving out of state and we want to sing his praises and tell him that he will be missed!
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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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PECC development
For Utah hospital and EMS Agency PECCs
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For All PECCS
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.
EMS providers and PECCs can attend Zero Fatalities for free!
See the scholarship registration code below and come participate in one of the most engaging conferences of the year.
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New PEAK (Pediatric education and advocacy kit) available
In recognition of Child Abuse Awareness Month, EIIC is pleased to share the PEAK: Child Abuse. It is estimated that one in four children in the United States are abused or neglected, and it is essential that healthcare providers are equipped with the resources to effectively identify and respond to these situations.
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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, May 20th, 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 – RSVP below
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
Apr 14th, 2025 – ETCO2 with Stephanie Spanos, MD
May 12th, 2025 – No PETOS, the EMSC will be attending a national meeting
Jun 9th, 2025 – Pediatric Prevention Programs with Michelle Jamison
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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**Scholarships are available for EMS with the code ZFEMS25 CME will be provided for EMS providers.
ZeroFatalities.com/summit for registration and conference details.
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Other pediatric education for all
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Free Pediatric Skills Day for EMS – St. George
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UPTN Conference – St. George
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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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