EMSC Connects

September 2025; Volume 14, Issue 9

Utah Emergency Medical Services for Children

Pedi Points

Tia Dickson RN, BSN

PCH Trauma RN, Utah EMSC Nurse Clinical Consultant

Utah EMTs and paramedics should care about skin emergencies in children because the skin can give early warning signs of serious health problems. A strange rash, hives, or swelling might not seem like a big deal at first, but in some cases, they can be the first signs of dangerous conditions like severe allergic reactions, infections, or rare illnesses that can get worse quickly. Kids often can’t explain exactly how they feel, so their skin can help “speak” for them. If EMS can spot these signs early, they can help kids get the right care quicker and possibly save their lives.

Expert Input

Dematologic Urgencies and Emergencies in Children

Robert Sylvester DNP

Director, Pediatric Nurse Practitioner Specialty Track Program

University of Utah-College of Nursing

Summary from August 11th, 2025 PETOS

Most skin problems show up after a few days of feeling sick with things like cough, sore throat, or fatigue. Families usually call for help when the child suddenly wakes up feeling much worse.

Case #1

A 5-year-old boy presents to the ED with 5-6 days of low-grade fever, malaise, cough and sore throat. Child “much worse” today with new skin lesions on the hands, face and torso. He has conjunctivitis and dry cracked lips..

• Meds: Acetaminophen, ibuprofen

• Temp 38.9° C; appears ill

Stephens-Johnson Syndrome (SJS)

Stevens-Johnson Syndrome (SJS) is an emergency because it can quickly become life-threatening. Blistering and swelling in the mouth, throat, or eyes can make breathing or swallowing difficult. Large areas of skin peeling act like a severe burn, putting the patient at risk for infection, fluid loss, and hypothermia. SJS can also affect organs like the liver, kidneys, and lungs, and symptoms can worsen rapidly. Because of these risks, early recognition, protecting the skin, managing the airway, and urgent transport to the hospital are critical.

SJS – EMS Quick Guide

What it is: Rare, serious reaction affecting skin & mucous membranes, often from a medication reaction or infection.

Signs/Symptoms:

• Flu-like (fever, fatigue, sore throat)

• Red/purple rash → blisters → skin peeling

• Mouth, eyes, genitals often affected

• Painful, high infection risk

EMS Priorities:

• Protect skin, avoid friction

• Monitor airway, breathing, circulation

• Manage pain & comfort

• Rapid transport to hospital/ICU/burn unit

• Avoid giving medications unless ordered

Red Flags:

• Widespread skin peeling

• Trouble breathing or swallowing

• Eye pain or vision changes

Case #2

13-year-old girl who over 4 days developed cough, headache, mild fever, sore throat and a mild rash on the face. The rash began spreading and skin tenderness

brought her to the ED.

Toxic Epidermal Necrolysis (TEN)

Toxic Epidermal Necrolysis is a rare, life-threatening skin reaction, often from medications, where large areas of skin peel and blister like a severe burn. Patients may have fever, pain, and mucous membrane involvement in the mouth, eyes, and genitals. TEN can cause airway problems, fluid loss, infection, and organ failure. On scene, EMS should protect the skin, monitor airway and vital signs, manage pain, and transport urgently to a hospital or burn/ICU unit.

TEN – EMS Quick Guide

What it is: Rare, severe skin reaction, usually from a medication reaction. Large areas of skin peel/blister, like a major burn.

Signs & Symptoms:

• Flu-like: fever, fatigue, sore throat

• Widespread rash → blisters → skin loss

• Mouth, eyes, genitals often affected

• Severe pain, high risk of infection

EMS Priorities:

• Protect skin; avoid friction and pressure

• Monitor airway, breathing, circulation

• Manage pain and provide comfort

• Rapid transport to hospital with burn/ICU capability

• Avoid unnecessary medications

Red Flags:

• Large areas of skin peeling

• Difficulty breathing or swallowing

• Eye pain or vision changes

• Signs of shock (low BP, rapid pulse)

Call comes in for 9 month old girl has been acting “punky” for a couple days, with fever, poor appetite, and decreased energy. This morning her “skin started to fall off”.

Staph Scalded Skin Syndrome (SSSS)

Staphylococcal Scalded Skin Syndrome (SSSS) is a rare but serious skin reaction caused by toxins from a staph infection. It usually starts with fever, fussiness, and redness around the mouth or skin folds, then spreads quickly to look like a bad sunburn with blisters or peeling skin. For EMS, the emergency is fluid loss (like a burn), pain, and risk of infection once the skin barrier is damaged. Watch for fever, widespread redness, fragile or peeling skin, and signs of dehydration or shock. Kids with suspected SSSS need rapid transport and supportive care—treat it like a burn patient.

SSSS – EMS Quick Guide

What It Is: Caused by toxin-producing Staphylococcus aureus, skin looks like a severe sunburn with blistering and peeling, it is most common in infants and young children.

Signs & Symptoms:

• Fever, irritability, poor feeding

• Painful red rash, starting around mouth/skin folds → spreads quickly

• Fragile skin that peels with light touch (Nikolsky sign)

• Risk of fluid loss, dehydration, hypothermia, sepsis

EMS Priorities

• Airway, Breathing, Circulation – treat as any critically ill child

• Prevent Fluid Loss – cover with clean, non-stick sheets/blankets (like burn care)

• Pain Control – minimize handling, keep comfortable

• Temperature Control – avoid hypothermia, keep warm

• Fluids – establish IV/IO if possible, anticipate large needs (similar to burn resuscitation)

• Monitor for Shock – tachycardia, poor perfusion, delayed cap refill

• Rapid Transport – to pediatric-capable facility, ideally burn center or children’s hospital

Red Flags for EMS

• Widespread skin sloughing

• Lethargy or altered mental status

• Signs of sepsis (fever, tachycardia, hypotension)

• Dehydration/shock

Case #4

Eczema Herpeticum

Eczema herpeticum is a serious skin infection that happens when the herpes virus spreads through areas of eczema. It looks like clusters of painful, punched-out blisters that can spread quickly and may be accompanied by fever, not feeling well, or swollen lymph nodes. For EMS, the emergency is the risk of the infection spreading to the blood, eyes, or brain, which can be life-threatening. Watch for widespread painful blisters, fever, lethargy, or eye redness. These kids need rapid transport for antiviral treatment—think of it as a “skin sepsis” emergency.

Eczema Herpeticum – EMS Quick Guide

What It Is: Herpes simplex virus infection spreading through eczema patches. Appears as clusters of painful, punched-out blisters that spread fast. Most common in infants and children with eczema.

Signs & Symptoms:

• Painful blisters/erosions on face, neck, or body

• Fever, irritability, malaise

• Swollen lymph nodes

• May look similar to bacterial infection, burns, or sepsis

EMS Priorities

• Airway, Breathing, Circulation – standard pediatric care

• Infection Risk – use gloves, eye protection; avoid touching lesions unnecessarily

• Pain & Comfort – minimize handling, keep child calm

• Eye Protection – ask about eye pain, redness, or drainage (risk of vision loss if virus spreads)

• Monitor for Sepsis – fever, tachycardia, poor perfusion, lethargy

• Rapid Transport – to pediatric-capable hospital for IV antivirals

Red Flags for EMS

• Lethargy or altered mental status

• Fever with widespread blisters

• Signs of dehydration or poor perfusion

• Eye involvement (red, painful, draining eyes)

Conclusion

Urgent pediatric skin conditions like these are rare but can become life-threatening very quickly. Many of these cases start with the same story; fever, irritability, and a rash that can look like many other things. EMS providers are not expected to diagnose these conditions in the field, but early recognition of sick children, proper PPE, and watching closely for signs of shock are critical. Because Primary Children’s serves a large catchment area, you may find yourself transferring these patients from community hospitals. Even if you only see one of these cases in your career, your ability to stabilize, protect yourself, and get the child to definitive care can make all the difference.

Protocols in practice

Deep Dive

CME credit for this issue

News from National EMSC

News from Utah EMSC

September is National Preparedness Month!

The Pediatric Pandemic Network (PPN) recently published a list of resources to prioritize pediatric preparedness during the month of September:

Prioritizing Pediatric Preparedness During National Preparedness Month

They will be highlighting different resources throughout the month, including this blog written by Dr. Dennis Ren, repurposed through Children’s National:

Family Emergency Preparedness: A Parent’s Guide to Peace of Mind 

Hospital NPRP is right around the corner

We are excited to announce that the next National Pediatric Readiness Project (NPRP) assessment of Emergency Departments (EDs) across the U.S. is set to launch in March 2026, reflecting updated national guidelines and growing momentum in pediatric emergency care.

Launch Date: The next NPRP assessment of Emergency Departments (EDs) nationwide will begin in March 2026

Purpose & Importance: This national assessment supports ongoing efforts to improve Pediatric Readiness and pediatric emergency care consistency.

Momentum:

• New research links Pediatric Readiness to improved survival.

• ACS‑COT now includes it in trauma center verification.

• Media coverage is increasing awareness.

NPRP assessments evaluate EDs on a 100-point scale and provide customized reports to help close gaps in pediatric emergency care. With research showing that high pediatric readiness can reduce child mortality by up to 76%, the stakes are high—and the tools to improve are available now. EDs can access toolkits, quality dashboards, checklists and more at www.pediatricreadiness.org to start preparing today.

PECC development

For Utah hospital and EMS Agency PECCs

Understanding the PECC role

For hospital PECCs

• EMSC has launched its first pediatric emergency care coordinator (PECC) learning module for ED-based PECCs. You are invited to view the module and provide feedback.

For EMS PECCs

• EMS PECC resources can be found on the EIIC website here.

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, Aug 19th, 2024, 10:00 AM

Save the date

Pediatric education from Utah EMSC

Pediatric Emergency and Trauma Outreach Series (PETOS)

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

Sep 8th, 2025 – Patient Perspective with Seantae Jackson

Oct 13th, 2025 – Miguel Pineda – Eye injuries

Nov 10th, 2025 – Courtney Lawrence – Pediatric Burn Injury

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

Emergency Pediatric Course – NAEMT

Need a Pediatric Education Course for Recertification?

Contact Jared Wright at Jared.wright@utah.gov

Other pediatric education for all

Intermountain Pediatric Emergency Care Conference (I-PECC)

University of Utah Pediatrics ECHO 2025

University of Utah Injury Prevention Learning Series

These offerings are quarterly.

Register here.

To view previous sessions for all these series visit this link.

Note the University has a new EMS education website.

Pediatric Injury Prevention Resources

EMS-focused education

University of Utah’s EMS Trauma Grand Rounds

Offered every second Wednesday of even months at 2:00pm.

Click here to join

Virtual—zoom meeting

Meeting ID: 938 0162 7994 Passcode: 561313

To view archives link here https://admin.physicians.utah.edu/trauma-education/ems-grand-rounds.

The University has a new EMS education website.

Hospital-focused pediatric education

Primary Children’s Pediatric Grand Rounds

Offered every Thursday, September-May (currently on hiatus, archives available)

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.

Need follow up from PCH?