Prehospital Trauma Compendium: Pediatric Severe and Inflicted Trauma – A Position Statement and Resource Document of NAEMSP

Pediatric trauma patients have unique physiology and anatomy that impact the severity and patterns of injury. There is a need for updated, holistic guidance for Emergency Medical Services (EMS) clinicians and medical directors to optimize prehospital pediatric trauma guidelines based on evidence and best practice. This is especially pertinent to pediatric severe and inflicted trauma, where prehospital evaluation and management determine the overall quality of care and patient outcomes. This position statement addresses the prehospital evaluation and management of pediatric severe and inflicted trauma and is based on a thorough review and analysis of the current literature.
Emergency Medical Services (EMS) clinicians should receive initial and ongoing pediatric-specific training in trauma patient assessment, which includes an understanding of pediatric anatomy and physiology and continuous monitoring for changes in vital signs.
Initial and ongoing training of EMS clinicians should include the recognition of signs of shock, including the Shock Index Pediatric Adjusted (SIPA) score, altered mental status, and other pathophysiology associated with severe trauma in pediatric patients.
Vital signs should be assessed in all pediatric patients with trauma, including heart rate, respiratory rate, pulse oximetry, blood pressure, and motor Glasgow Coma Scale (GCS) score.
EMS clinicians should be trained to identify likely inflicted injuries, with an emphasis on cutaneous injuries and injuries sustained by children with comorbidities.
EMS clinicians should be trained to identify physiological factors and mechanisms of injury associated with more severe trauma.
When clinically appropriate, key prehospital interventions for severe and/or inflicted trauma in children should include judicious use of crystalloid fluids, administration of blood for hemorrhagic shock when available, prevention of hypoxia and hypotension especially in patients with traumatic brain injury (TBI), adequate assessment and treatment of pain, and appropriate transport to a pediatric trauma center.
EMS systems should work with regional partners including local and specialized facilities to establish guidelines for the appropriate triage of pediatric trauma patients from a scene and for the interfacility transfer to higher levels of trauma care, especially in rural areas.
EMS clinicians should receive regular continuing education about pediatric trauma with an emphasis on pediatric patient assessment and infrequently performed invasive procedures, with use of hands-on simulation and case review when able.