EMSC Connects

August 2025; Volume 14, Issue 8

Utah Emergency Medical Services for Children

Pedi Points

Tia Dickson RN, BSN

PCH Trauma RN, Utah EMSC Nurse Clinical Consultant

Even in trauma-heavy seasons, EMS crews face infectious threats just as serious as crash injuries. Measles can spread explosively when people skip shots, and bird flu in animals signals a real risk for spillover to humans. Being prepared, vaccinated, vigilant, and well-equipped. These are essential to keep yourselves and your patients safe.

Expert Input

All the Infectious Fun You Can Have in One Day

Hilary Hewes MD

Intermountain Primary Children’s Hospital ED Attending Physician

Summary from Jul 14th, 2025 PETOS

“I will start out by saying that I do believe in vaccination. I think it’s one of the most important scientific advancements we’ve had in the history of mankind and they have saved millions of people over time”

In her presentation, Dr. Hilary Hewes walks EMS providers through some of the most pressing infectious disease concerns they may face in the field—often without warning. With humor and urgency, she reminds us that even during peak trauma season, infectious diseases like measles and avian influenza (bird flu) can pose serious threats to both providers and patients.  

Measles

Once nearly eliminated in the U.S., measles is making a troubling comeback. It’s one of the most contagious viruses on the planet—far more infectious than influenza or even Ebola. Dr. Hewes explains that measles can remain airborne in a room for up to two hours, meaning even brief exposures in enclosed spaces like an ambulance can lead to infection. Outbreaks in the U.S. have mostly been tied to international travel and pockets of unvaccinated populations. This poses a risk to EMS professionals who may encounter measles cases before a diagnosis is confirmed, especially in communities with low MMR (measles, mumps, rubella) vaccination rates.

• As of July 22, 2025, the CDC reports 1,319 confirmed measles cases across 40 U.S. jurisdictions, making it the worst outbreak since 1992

• In 2024, there were only 285 cases, making the 2025 count nearly five times higher

• Of these cases in 2025, 87% (1,154 of 1,319) are associated with outbreaks (i.e., clusters of three or more cases)

• There have been three confirmed fatalities, all in unvaccinated individuals (two children in Texas and one adult in New Mexico)

• Around 11% of cases (approximately 128 people) required hospitalization, with especially high rates (nearly 19%) among children under five

Vaccination works!

Dr. Hewes emphasized that

• MMR vaccine is highly effective ~93% with one dose, ~97% with two.

• Herd immunity requires 95% coverage, but many areas (including parts of Utah) are below that.

• Most measles infections are among the unvaccinated.

• EMS providers should check their vaccination status, especially those born before 1980 or without records.

• In special situations (like travel or outbreak exposure), early MMR doses may be given to infants or to accelerate second doses.

• Vaccination protects you, your team, and your patients, especially before symptoms are obvious.

Typical Clinical Features

• Koplik spots are pathognomonic but infrequently reported in recent outbreaks

• This is when they are most infectious

Days 3-4: Rash

• Prodromal (URI) symptoms peak

• Koplik spots fade

• Rash appears: blanching, which manifests first at the hairline and spreads from head downward over 3 days, ultimately moving where ever including the palms and soles

• The rash will appear different on different skin tones

Major complications of measles

1. Pneumonia – the most common and deadly complication

Dr. Hewes emphasized that pneumonia is the leading cause of measles-related deaths.

2. Encephalitis and severe neurologic diseases

Neurological issues are rare but highly serious. Roughly 1 in 1,000 measles cases develop acute measles encephalitis, with symptoms including fever, seizures, and altered mental status. This carries a mortality rate of 10–15%, and survivors often face lasting cognitive or motor deficits 

Dr. Hewes also discussed acute disseminated encephalomyelitis (ADEM) an autoimmune response occurring shortly after measles rash and the far-more-rare but fatal subacute sclerosing panencephalitis (SSPE), a progressive disease that manifests years later in children infected early in life. It typically shows up 5-15 years after the measles infection

3. Otitis media, croup, and gastrointestinal complications

Dr. Hewes noted otitis media (ear infection) occurs in 7–10% of cases—especially in children—and may lead to hearing loss. Measles croup (laryngotracheobronchitis), marked by tracheal inflammation, can be life-threatening in young children. 
Additionally, diarrhea and dehydration occur in around 8% of cases, often worsening malnutrition and contributing to disease severity

4. Exposure-sensitive or rare complications

• Keratoconjunctivitis and corneal ulcers, which in cases of vitamin A deficiency can lead to permanent blindness.

• Myocarditis, glomerulonephritis, and thrombocytopenic purpura, which are uncommon but significant.

Dr. Hewes stressed that EMS providers, who may be first on scene, should know these serious complications and always err on the side of caution with infection control, early recognition, and referring patients for medical evaluation when measles is possible.

Measles is not a mild rash illness. Here’s the bottom line:

• The MMR vaccine safely teaches your immune system how to fight measles effectively.

• Because measles doesn’t rapidly change, that protection remains relevant over time.

• Two doses provide near-complete immunity.

• Community vaccination protects everyone, even those who can’t get vaccinated.

• The minimal risk associated with vaccination is far outweighed by the danger of infection.

• Use this opportunity to reinforce vaccination messages, especially for MMR and flu, among colleagues and patients.

• Maintain strong infection‑prevention protocols: PPE, hand hygiene, mask use, and respiratory precautions.

Safety in your ambulance

● Recommended PPE:

• Gloves

• Eye protection

• N95 respirator

• Gown for transport, if entering a home, or if you may otherwise come into contact with items that have been sneezed or coughed on.

● Notify receiving facilities of potential measles cases enroute.

● Disinfect all equipment and rig surfaces with hospital grade disinfectant. Consider taking it out of service for 2 hours following exposure.

Measles Misinformation

Vitamin A does not prevent measles and can be toxic in high doses. Vitamins and supplements are not regulated by the FDA and may not contain consistent or accurate amounts of active ingredients.

Pertussis (Whooping Cough)

In her presentation, Dr. Hilary Hewes also covers pertussis (whooping cough), emphasizing its resurgence due to waning immunity and lower vaccination rates. Pertussis is highly contagious and particularly dangerous for infants under 6 months, who are too young to be fully vaccinated and at highest risk for complications like apnea, pneumonia, and seizures. Adults and teens often have milder symptoms but can still spread the infection unknowingly, especially since immunity from childhood vaccines or prior infection fades over time. Dr. Hewes urges EMS providers to ensure they are up to date on their Tdap booster, not just to protect themselves, but also to help prevent passing the disease to vulnerable patients. The vaccine against pertussis has been around since the 1940s and good scientific data supports it’s use.

Bird Flu (H5N1 Avian Influenza)

Dr. Hilary Hewes highlights avian influenza (H5N1) as an emerging concern for EMS providers, particularly due to its unusual spread to U.S. dairy cattle and rare human infections. While human-to-human transmission is currently very limited, the virus’s presence in mammals increases the risk of future mutations. Most human cases so far have been mild, often limited to eye irritation (conjunctivitis) but exposure risk is highest for those in close contact with infected animals, especially without proper protective gear. Dr. Hewes urges EMS providers to stay informed, use appropriate PPE when dealing with symptomatic individuals with animal exposure, and reinforce public health messages, especially around avoiding raw (unpasteurized) milk, which could carry the virus.

Hemolytic Uremic Syndrome (HUS)

Tularemia

Conclusion

We want to make sure you’re up to date on new and emerging infectious disease threats. Always protect yourself, we need you healthy and on duty. Know the facts, and be a source of reliable, factual medical information.

Everyone has a lot of opinions about vaccination. Questions are great. Feel free to explore alternative vaccination schedules, but don’t turn your back on the vaccines we’ve had for decades: the ones with really good safety data and proven effectiveness. Vaccination is safe and effective in protecting the public from many known and dangerous diseases.

Protocols in practice

Deep Dive

CME credit for this issue

News from National EMSC

News from Utah EMSC

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

Aug 11th, 2025 – Derm Issues with Robert Sylvester DNP, APRN, CPNP-PC

Sep 8th, 2025 – Patient Perspective with Seantae Jackson

Oct 13th, 2025 – Miguel Pineda – Eye injuries

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

EMS Education Night – St. George

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?