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November 2025; Volume 14, Issue 11
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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
When a kid takes a hit to the face or eye, what you see might not tell the whole story. Beneath a bit of swelling or a bloody nose could be something serious — a hidden airway issue, a brain injury, or a fracture around the eye. That’s where your quick thinking and sharp assessment come in. The way you read the scene, spot those subtle clues (like double vision or a sunken eye), and choose the right destination can make all the difference for that child’s recovery. You’re the first critical link in a chain that can save vision, protect airways, and change outcomes — no pressure, right?
*Caution, this issue contains graphic medical images.
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Pediatric Ocular and Facial Trauma
Miguel Pineda, MD
Emergency Medicine, ED Attending, St, George Regional Hospital
Excerpts from October 13th, 2025 PETOS
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Dr. Pineda walked through facial and eye trauma in children.
Key points:
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Children’s bones, soft tissues, and healing patterns differ from adults.
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Even minor-looking injuries can hide serious problems.
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Field assessment is crucial for airway, vision, and fracture concerns.
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Transport and destination decisions affect outcomes significantly.
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Ocular and facial trauma may appear dramatic; always assess for additional injuries, secure the airway, and treat pain.
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The nose is vulnerable in children because it sticks out from the face.
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Epistaxis
Epistaxis (nosebleed) is common after trauma or spontaneously, often from the front of the nose.
In the field, have the patient sit upright, lean forward, and apply direct pressure to the soft part of the nose for 10–15 minutes. Transport if bleeding is heavy, won’t stop, or is from the back of the nose, or if the patient has other injuries, signs of shock, or clotting problems.
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Nasal and Septal Fractures
Nasal and septal fractures usually result from trauma and can cause pain, swelling, bleeding, and deformity.
In the field, control bleeding, avoid unnecessary pressure, and transport if there is significant deformity, septal hematoma, difficulty breathing, or associated facial trauma. Early evaluation is important to prevent complications and preserve function and appearance.
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Nasal Lacerations
Nasal lacerations are cuts to the nose, often from trauma, that may bleed and be painful.
In the field, control bleeding and clean gently, but transport if there is significant tissue damage, suspected cartilage involvement, or an open fracture. Timely medical evaluation is important for proper healing, infection prevention, and cosmetic outcome.
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In children, the mouth and airway are smaller and their tongues take up more space. Their teeth and jaw are softer, and their bones are more flexible. Because of this, even small injuries to the mouth or face can cause bigger problems with breathing or bleeding compared to adults.
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Dental Fractures/Avulsion
A dental fracture is when a tooth is broken but remains in the mouth, while a dental avulsion is when the tooth is completely knocked out of its socket.
Send directly to a pediatric dental trauma center or oral maxillofacial surgeon if the child has:
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Avulsed permanent teeth (tooth completely knocked out) – especially front teeth.
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Intruded permanent teeth (tooth pushed into the jawbone).
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Teeth fractured with pulp exposure (the “nerve” visible).
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Severe soft tissue injuries of the mouth (lacerations that may need sutures).
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Fractured jaw or suspected facial fractures.
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Multiple dental injuries or high-risk mechanism (e.g., car crash, fall from height).
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Other considerations:
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Children under 5 years old with serious dental trauma may need specialized care even for less severe injuries.
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Time-sensitive: Permanent teeth avulsion should ideally be treated within 60 minutes for the best chance of saving the tooth.
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EMS Management:
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Always assess airway, breathing, circulation first.
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Pain management: give age-appropriate analgesics per protocol.
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Tongue Lacerations
Pediatric tongue lacerations are common in children due to falls or trauma; because the tongue is highly vascular, these injuries can bleed heavily, may interfere with breathing or swallowing. They may bleed heavily and cause pain, but most are minor. In the field, control bleeding with direct pressure, keep the airway clear, and transport if the cut is large, deep, involves the tip or base of the tongue, affects breathing, or continues to bleed despite pressure.
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Lip Lacerations
Lip lacerations are cuts to the lips, often from trauma, and may bleed significantly.
In the field, control bleeding with direct pressure and keep the area clean. Transport if the laceration is deep, involves the vermilion border, affects function, or continues to bleed, as proper repair is important for healing and cosmetic outcome.
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Mandible Fractures
A pediatric mandible fracture is a break in a child’s lower jaw. It usually happens from falls, sports injuries, or accidents. Symptoms can include pain, swelling, difficulty opening the mouth, or misaligned teeth. Treatment depends on the type and severity of the break and may include pain management, jaw rest, or surgery. Children’s bones heal faster than adults, but prompt care is important to prevent long-term problems with chewing, speaking, or jaw growth.
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EMS Management:
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Airway: Ensure airway is clear; watch for swelling or bleeding.
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Stabilize Jaw: Keep jaw still; have child gently bite on soft cloth or gauze.
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Pain & Swelling: Apply ice; keep child calm.
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Transport: Rapidly to pediatric-capable facility; avoid jaw movement.
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Children’s ears are smaller, softer, and more flexible than adults’, with thinner ear canals and eardrums. Because of this, they are more easily injured by blunt trauma, foreign objects, or sudden pressure changes. Even minor impacts can cause bleeding, perforation, or swelling, and infections can spread more quickly. EMS providers should handle pediatric ears gently and inspect carefully for signs of injury.
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Eardrum Perforation
Eardrum perforation is a tear or hole in the tympanic membrane, often caused by trauma, sudden pressure changes, or infection. It can lead to pain, bleeding, hearing loss, or fluid drainage. Children are at higher risk because their eardrums are thinner and more fragile, so gentle assessment and prompt referral are important.
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Auricular Hematoma
An auricular hematoma is a collection of blood between the ear’s cartilage and skin, usually from blunt trauma. It causes swelling, tenderness, and a ‘puffy’ appearance. If not treated quickly, it can harden and deform the ear (cauliflower ear). Children’s ears are more vulnerable, so prompt recognition and referral for drainage are important.
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Pinna Laceration
A pinna laceration is a cut or tear on the outer ear, often caused by trauma. Because the ear is mostly cartilage with thin skin, bleeding can be deceptive but significant.
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In children, the face is more than skin, it’s muscles, nerves, and ducts. Even minor trauma can affect movement, sensation, and function, so pediatric facial injuries can be more serious than they first appear.
When assessing a child’s face in the field, look beyond obvious cuts or bruises. Check for swelling, asymmetry, or deformity, and assess movement, sensation, and function of the eyes, mouth, and facial muscles.
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Facial Lacerations
Facial cuts that are large, deep, keep bleeding, or involve the eyes, lips, or nose need transport for medical care. Small, clean cuts that stop with pressure can be treated in the field.
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Facial Fractures
Facial fractures are breaks in the bones of the face, often from trauma. Common signs include pain, swelling, bruising, deformity, bleeding from the nose or mouth, loose teeth, or trouble moving the jaw or eyes.
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Pediatric Isolated Facial Trauma per the UPTN (Hospital) Guideline
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In children, the eye is still developing, which makes it more at risk for injury. The bones around a child’s eye are softer and provide less protection than in adults, so even a small amount of force can cause serious damage. Because kids may not be able to describe their vision changes well, it’s important to always check for eye injuries carefully after any head or face trauma. Rapid visual acuity testing includes testing the patient’s ability to read print, count fingers, identify hand motion, and differentiate light from dark.
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Subconjunctival Hematoma
A subconjunctival hematoma happens when a small blood vessel breaks under the clear surface of the eye, causing a bright red patch. It looks alarming but is painless, doesn’t affect vision, and usually heals on its own without needing transport.
In the field, management is supportive. Reassure the patient and caregivers, avoid pressure or rubbing of the eye, and transport only if there are vision changes, pain, or other signs of serious injury.
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Corneal Abrasion
A corneal abrasion is a scratch on the clear front of the eye, causing pain, tearing, and redness. Transport if there is vision loss, severe pain, or a suspected penetrating injury; minor scratches can be referred for follow-up.
In the field, treatment is supportive: keep the eye closed or patched if tolerated, avoid rubbing, flush with clean saline if a foreign body is present.
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Hyphema
A hyphema is blood in the front chamber of the eye, usually from trauma. It can cause pain, blurred vision, and sensitivity to light.
In the field, keep the patient sitting upright, protect the eye with a shield (do not apply pressure), and always transport for evaluation, as hyphema can threaten vision and lead to complications.
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Eyelid Laceration
An eyelid laceration is a cut on the eyelid, often from trauma. It may bleed and affect the eye’s ability to close.
In the field, control bleeding with gentle pressure (avoid pressing on the eye), cover with a clean dressing, and transport for prompt evaluation and possible repair, especially if the eyelid margin, canaliculus, or eye itself may be involved.
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EOM Entrapment
Extraocular muscle (EOM) entrapment occurs when a fracture of the orbital bones traps an eye muscle, usually after facial trauma. Patients may have pain with eye movement, double vision, and limited ability to move the eye.
In the field, do not try to move the eye, protect the eye with a shield, and urgent transport is required for surgical evaluation.
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Vision Loss
Vision loss from retinal detachment or lens dislocation can happen after trauma. Patients may notice sudden flashes, floaters, a curtain over their vision, or blurry vision.
In the field, protect the eye, avoid any pressure, and transport urgently for ophthalmology evaluation—these conditions can lead to permanent vision loss if not treated quickly.
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Global Injury
A globe injury is serious trauma to the eyeball itself, such as a rupture or penetrating wound. Signs include severe pain, vision loss, irregular pupil, or visible eye contents. In the field, do not apply pressure, cover the eye with a rigid shield, and transport immediately for emergency ophthalmology care.
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Retrobulbar Hematoma
A retrobulbar hematoma is bleeding behind the eye, often from trauma, which can increase pressure and threaten vision. Patients may have severe pain, swelling, proptosis (bulging eye), and vision loss.
In the field, do not apply pressure, keep the patient calm, and transport immediately—this is an emergency that may require rapid surgical intervention.
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Pediatric Isolated Orbital Trauma per the UPTN (Hospital) Guideline
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In pediatric ocular and facial trauma, stay calm—don’t freak out. Focus on a systematic assessment: check vision, examine the eyes and face, and identify injuries that need urgent transport. Follow your protocols, use UPTN guidelines, and consult medical control as needed. A calm, organized approach ensures the best outcomes for your patients.
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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 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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EMSC Pulse
National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!
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Spread the Word
The Intermountain Primary Children’s Hospital – Taylorsville campus is open. It provides an alternative to the Emergency Department for a child or teen experiencing a behavioral health crisis. Check the flyer to know which children should be transported there.
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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.
www.pediatricreadiness.org to start preparing today.
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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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ENA passes resolution in support of PECCs
The Emergency Nurses Association (ENA) delegation voted overwhelmingly, 95% in favor, to adopt GA25-02A: Designation of a Nurse Pediatric Emergency Care Coordinator (PECC) in Every ED. The vote, held at ENA’s General Assembly in New Orleans last weekend, underscores ENA’s strong commitment to Pediatric Readiness and the essential role of PECCs. Pictured at right are the authors of the resolution (several of whom are members of the EMSC community), just after the vote.
PECCs ensure EDs are prepared to care for children by supporting policies, equipment, training, and quality improvement. Studies show that EDs with designated PECCs consistently achieve higher Pediatric Readiness scores. Learn more about PECCs.
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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, November 18th, 2024, 10:00 AM
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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)
We’re thrilled to announce that our PETOS lecture series is now eligible for both RN and EMS CME credit!
CME certificates are now digital and available instantly through CloudCME, where you can also access your transcript anytime.
The lectures are presented by physicians and pediatric experts from Primary Children’s Hospital. The format is informal; inviting questions and discussion.
Upcoming topics
Nov 10th, 2025 – Courtney Lawrence – Pediatric Burn Injury
Dec 8th, 2025 – Matthew Steimle – Cardiac Emergencies
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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Other pediatric education for all
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Teen to Adult Healthcare Transition Summit
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Intermountain Pediatric Emergency Care Conference (I-PECC)
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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
The University has an EMS education website.
When? Wednesdays 12 – 1 pm (MT)
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University of Utah Injury Prevention Learning Series
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Pediatric Injury Prevention Resources
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St. George EMS Education Night
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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 (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.
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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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