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HomeMy WebLinkAboutacems-trauma-retriage-pediatric Alameda County Emergency Medical Services Agency Click here for all Administrative Policies 1 | P a g e Pediatric Emergency Trauma Re-Triage (Age ≤ 14) Effective: 8/24/2023 Review: 8/24/2026 Approved: Link to Record of Revisions and Approvals I. Purpose This policy is intended for pediatric patients whose needs are generally known immediately or soon after initial arrival, based on clinical findings. Avoid any unnecessary studies (e.g., CT scans or angiograms), and do not delay transport for paperwork/diagnostics not ready at the time of departure. II. Procedure STEP ONE – Determine Level of Severity Blood pressure / perfusion: • Hypotension or tachycardia (based on age-appropriate chart below) or clinical signs of poor perfusion (see below) • Need for more than two crystalloid boluses (20 ml/kg each) or need for immediate blood replacement (10 ml/kg) Neurologic: • GCS Less than 12 (pediatric scale – see verbal scale below) • GCS Deteriorating by 2 or more during observation • Blown pupil • Obvious open skull fracture • Cervical spine injury with neurologic deficit Anatomic criteria: • Penetrating injuries to head, neck, chest, or abdomen Respiratory criteria: • Respiratory failure or intubation required Provider judgment: • Patients, who in the judgment of the evaluating emergency physician, are anticipated to have a high likelihood for emergent life- or limb-saving surgery or other intervention within 2 hours. ***Important Pediatric Re-Triage Exceptions***  Pregnant patients of any age should be transferred to an adult trauma center.  Major Burns should be preferentially transferred to one of the burn centers. Alameda County Emergency Medical Services Agency Click here for all Administrative Policies 2 | P a g e  STEP TWO – Arrange Emergency Transport Contact the Pediatric Trauma Center: ED Physician to ED Physician communication to confirm acceptance of the patient to the closest most appropriate Pediatric Trauma Center. Call 9-1-1 Directly: Request a “Code 3 Ambulance” for an “emergency trauma re-triage” patient. ***If patient exceeds Paramedic Scope of Practice, arrange for RN or MD staff to accompany Paramedic or EMT in the ambulance during transport, or arrange for a Critical Care Transport (CCT) ambulance instead.*** STEP THREE – Provide Additional Paperwork Prepare Paperwork/Diagnostics: Provide any additional paperwork, by whatever means appropriate, not ready at the time of patient departure. (See Pediatric Trauma Center Contact Information table below). Do not delay transport for paperwork or diagnostic imaging. Age-Appropriate Vital Signs Age Weight Heart Rate Systolic BP Pediatric Length-Based Tape Newborn 3-5 Kg 80-190 65-104 Grey -Pink 1 Year 10 Kg 80-160 70-112 Purple 3 Years 15 Kg 80-140 75-116 White 5 Years 20 Kg 75-130 75-116 Blue 8 Years 25 Kg 70-120 80-112 Orange 10 Years 30 Kg 65-115 85-126 Green Alameda County Emergency Medical Services Agency Click here for all Administrative Policies 3 | P a g e Pediatric GCS – Verbal Scale (<2yrs) 5 Coos and Babbles 4 Irritable 3 Only cries to pain 2 Only moans to pain 1 None Pediatric Clinical Signs of Poor Perfusion Cool, mottled, pale or cyanotic skin Low urine output Lethargic Prolonged capillary refill Pediatric Trauma Center Contact Information Trauma Center Contact Number for Acceptance Fax Number for Paperwork/Diagnostics UCSF Benioff Children’s Hospital (510) 428-3240 (510) 601-3934