This document outlines pediatric emergency competencies for EMS providers, including respiratory emergencies like airway obstruction, lower airway disease, and respiratory distress; shock; seizures; and sudden infant death syndrome. It also covers patient assessment procedures, respiratory system anatomy, circulatory system overview, respiratory and airway emergency management, shock treatment, altered mental status causes, seizure first aid, dehydration treatment, fever reduction, injury management, disaster triage, signs of child abuse and neglect, and details on sudden infant death syndrome.

1. Pediatric Emergencies

2. National EMS Education
Standard Competencies
Pediatrics
• Upper airway obstruction
• Lower airway reactive disease
• Respiratory distress/failure/arrest

3. National EMS Education
Standard Competencies
Pediatrics (cont’d)
• Shock
• Seizures
• Sudden infant death syndrome

4. National EMS Education
Standard Competencies
Pediatrics (cont’d)
• Upper airway obstruction
• Lower airway reactive disease
• Respiratory distress/failure/arrest
• Shock

5. National EMS Education
Standard Competencies
Pediatrics (cont’d)
• Seizures
• Sudden infant death syndrome
• Gastrointestinal disease

6. National EMS Education
Standard Competencies
Patients With Special Challenges
• Recognizing and reporting abuse and
neglect
• Health care implications of:
– Abuse
– Neglect

7. Communication With the
Patient and the Family
• You may have more than one patient.
– Caregiver may need help and support.
• A calm parent contributes to a calm child.
– An agitated parent means child will act same
way.
• Remain calm, efficient, professional, and
sensitive.

8. Growth and Development
• Between birth and adulthood, many
changes occur.
• Thoughts and behaviors:
– Infancy: first year of life
– Toddler: 1 to 3 years
– Preschool-age: 3 to 6 years
– School-age: 6 to 12 years
– Adolescence: 12 to 18 years

9. Respiratory System (1 of 10)
• Anatomy of airway
differs from adults.
– Pediatric airway is
smaller in diameter
and shorter in
length.
– Lungs are smaller.
– Heart is higher in
child’s chest.

10. Respiratory System (8 of 10)

11. Circulatory System (3 of 3)

12. Patient Assessment
• Patient assessment steps
– Scene size-up
– Primary assessment
– History taking
– Secondary assessment
– Reassessment

13. Primary Assessment (1 of 19)
• Form a general
impression.
– Use pediatric
assessment
triangle (PAT).
• 15- to 30-
second
structured
assessment tool
Source: Used with permission of the American Academy of Pediatrics, Pediatric Education
for Prehospital Professionals, © American Academy of Pediatrics, 2000.

14. Primary Assessment (7 of 19)
• Hands-on ABCs
– For pediatric patient you will now perform a
hands-on ABCs assessment.
• Airway
• Breathing
• Circulation
• Disability
• Exposure

15. Respiratory Emergencies and
Management (2 of 5)
• Signs and symptoms of increased work of
breathing:
– Nasal flaring
– Grunting respirations
– Wheezing, stridor, other abnormal sounds
– Accessory muscle use
– Retractions/movements of child’s flexible rib
cage
– In older children, tripod position

16. Respiratory Emergencies and
Management (3 of 5)
• As the patient progresses to possible
respiratory failure.
– Efforts to breathe decrease.
– Chest rises less with inspiration.
– Body has used up all available energy stores
and cannot continue to support extra work of
breathing.

17. Airway Obstruction (1 of 8)
• Children obstruct
airway with any
object they can fit
into their mouth.
• In cases of trauma,
teeth may have
been dislodged
into the airway.
Source: © Jones and Bartlett Learning. Photographed by Kimberly Potvin.

18. Airway Obstruction (2 of 8)
• Blood, vomitus, or other secretions can
cause severe airway obstruction.
• Infections can cause obstruction.
– Croup is an infection in the airway below the
level of the vocal cords.
• Usually caused by a virus
– Epiglottitis is an infection of the soft tissue
above the level of the vocal cords.

19. Airway Obstruction (3 of 8)

20. Cardiopulmonary Arrest
• Cardiac arrest in pediatric patients is
associated with respiratory failure and
arrest.
– Children are affected differently by decreasing
oxygen concentration.
• Adults become hypoxic, heart gets irritable,
and sudden cardiac death comes from
arrhythmia.
• Children become hypoxic and their hearts
slow down, becoming more bradycardic.

21. Shock (1 of 12)
• A condition that develops when the
circulatory system is unable to deliver a
sufficient amount of blood to the organs
– Results in organ failure and eventually
cardiopulmonary arrest
• Compensated shock is the early stage of
shock.
• Decompensated shock is the later stage of
shock.

22. Altered Mental Status (1 of 2)
• Abnormal
neurologic state
– Understanding
developmental
changes and
listening to
caregiver’s opinion
are key.
– AEIOU-TIPPS
reflects major
causes of AMS.

23. Seizures (2 of 5)
• Common
causes of
seizures

24. Meningitis (7 of 8)
Source: © Mediscan/Visuals Unlimited

25. Dehydration Emergencies and
Management (3 of 3)
• Treatment
– Assess ABCs and
obtain baseline
vital signs.
• If severe, ALS
backup may be
necessary for IV
access.
• Transport to
emergency
department.
Source: Credit line>Courtesy of Ronald Dieckmann, M.D.

26. Fever Emergencies and
Management (3 of 4)
• Accurate body temperature is important for
pediatric patients.
– Rectal temperature is most accurate for infants
and toddlers.
– Under tongue or arm will work for older children.

27. Injuries to Specific Body
Systems (7 of 14)

28. Disaster Management (1 of 4)
• JumpSTART triage system
– Intended for patients younger than 8 years and
weighing less than 100 lb
– Four triage categories
• Green
• Yellow
• Red
• Black

29. Disaster
Management (4 of 4)
Source: © Lou Romig, MD, 2002.

30. Child Abuse and Neglect
• Any improper or excessive action that
injures or otherwise harms a child
– Includes physical abuse, sexual abuse, neglect,
and emotional abuse
– More than 2 million cases reported annually
• Many children suffer life-threatening injuries.
• If abuse is not reported, likely to happen
again.

31. Signs of Abuse (5 of 10)
• CHILD
ABUSE
mnemonic
may help.

32. Signs of Abuse (10 of 10)
• Shaken baby syndrome (cont’d)
– Shaking tears blood vessels in the brain,
resulting in bleeding around the brain.
• Pressure from blood results in an increase in
cranial pressure leading to coma and/or
death.
• Neglect
– Refusal or failure to provide life necessities
• Examples are water, clothing, shelter,
personal hygiene, medicine, comfort,
personal safety.

33. Sudden Infant Death Syndrome
(1 of 2)
• Unexplained death after complete autopsy
• Leading cause of death in infants younger
than 1 year
• Most cases occur in infants younger than 6
months.
• Impossible to predict