Dr. Regina Yaskey is a Pediatric Emergency Medical Physician with Rainbow Babies and Childrens Hospital (RB&C)

She recently concluded an EMS fellowship in 2022 and is our Pediatric EMS Physician for the EMS Institue

Developed her love for disaster medicine and thus EMS from her family experiance during the Ebola crisis in West Africa

Disaster preparedness is a big part of her job at RB&C

Pediatric disaster management is relatively new topic born out of Oklahoma city bombing and many other incidents involving Peds since

Pediatrics are not just small adults

Airways smaller

Obligate nose breathers, a simple cold can make a patient work to breath

Increased metabolic demands

Respiratory reserve not as great

Suction underutilized - not going to vagal kids out - simple easy skill with maximal impact

Pediatric Assessment Triangle - "Doorway exam"

Appearance - How do they look? Tone, instructiveness,  appropriate reaction, consolably

Work of Breathing - Grunting, retracting, breath sounds, stridor

Circulation - Mottled, in mouth, lips, finger tips, cyanosis

AABC - Appearance, Airway, Breathing, Circulation

Cultural differences may lead to under vaccination and atypical cases in this population

GCS Trends should be done by same person to minimize subjectiveness

If unable to calculated, explain presentation in plain English

Simple things with impact

Suction 

Oxygen

Advanced Airways

Cuffed ETT - may need to half size and just enough air to seal 

Listen for leak, visualize chest rise and fall

Common calls

Seizures - febrile common, rate of rise of temp triggers seizure. IF truly status epilepticus, bag them!

Anaphylaxis - singular system = allergic reaction - multiple system = anaphylaxis (Hives, GI problems, resp distress, wheezing, angioedema, vitals) What's the status of the epi pen? Do not be reserved with the epi in kids, have narrow threshold for failure and will tolerate the epi well.

Asthma - Steroids underutilized in EMS, early administrations (in EMS care) improves outcomes. Safe to re-dose if have already taken albuterol. Epi and mag can be helpful in severe cases. Will benefit from fluid boluses for insenable losses of body water. 

Not So Common

Chronic Kids - Parents usually know the most

Need to go to major centers, local hospitals ill equipped to handle complex pediatric cases like this 

PMH of utmost importance - congenital kids may be abnormal, what's "normal" for this kids

The parents often better know their kids physiology better than we will ever. Ask, Listen

Ask the weight!

Red Flags for abuse / neglect / care issues

EMS eyes and ears for the hospital

Our job is to protect the child! Our job is to report, CPS job to follow up

We are legally required to report

Document objectively - objective observation

Suicidal ideation is tricky in kids, parents may be in denial and resistant to care

Sign off without parents - call medical control. 

Equipment Specific to Peds

Weight appropriate restraints for kids are required

Plastic car seat, or made for EMS device

Safe care and transport has come along way

MVA's with kids

Picture worth a thousand words

Work up the kids

Understand limitations of your pediatric reference material

Broslow only has resuscitation meds, not medical care doses

Responsoft calculates dose, but not volume

Still not little adults