April 24, 2020
Pediatric Asthma During COVID-19
1. Announcements
Florida EMSC bids farewell to EMLRC’s Director of Communications, Samantha League. Sam was instrumental in updating the FL PEDReady website and launching the PEARL newsletter. Good luck on your new position with Project Opioid!

The in-person June EMSC Advisory Committee meeting and Gathering of Eagles conference has been postponed due to COVID-19. The committee will continue via online meetings and conference calls.

Appointment of EMSC Advisory Committee members, chair and liaison positions are on hold due to the DOH COVID-19 response.

A Florida PEDReady PECC meeting was conducted online April 14. If you are interested in being the PECC or pediatric liaison for your agency or ED, please email pedready@jax.ufl.edu .

A new order of FL PEDReady Communication Cards are on the way! Email pedready@jax.ufl.edu to receive laminated sets for your agencies and EDs. Requests have been received for French and French Creole translations. Our team is working on developing a limited number of sets with these languages.

The FL PECC subcommittee is working on a Ten Commandments of Pediatric EMS Care (led by Sarah Earley).

Online education opportunities are being evaluated for EMSC Day on May 22.

A literature review is being conducted regarding the use of TXA in pediatric trauma . Existing pediatric TXA protocols are also being collected and reviewed. If you have one to share, email pedready@jax.ufl.edu .

A multidisciplinary, 2-hour pediatric trauma learning module is being developed in collaboration with the Florida Trauma System Advisory Council.
2. Asthma and COVID-19
COVID-19 has dramatically altered the way we treat asthma and other respiratory diseases in children and adults. Issues include limiting aerosolized treatments, shortages of MDIs and other medications. Many EMS agencies are now using epinephrine and/or terbutaline in their asthma protocols in place of MDIs. These drugs were used years ago before albuterol and controller medications became standard care. 
Florida PECCs are requesting pediatric-related COVID-19 and asthma protocols. Email pedready@jax.ufl.edu to share your resources.
Pediatric Epinephrine Dosing for Acute Asthma (1:1000 concentration: 1mg/mL):
  • SC or IM: 0.01 mg/kg/dose then reassess, may repeat q 20 minutes up to 3 doses; Max dose = 0.5 mg/dose
  • IM usually preferred, follow local protocols and monitor cardiac and respiratory status

Terbutaline is another option for older children, though not as well studied:
  • SC 0.01 mg/kg, adolescent/adult dosing recommendation for bronchospasm is 0.25 mg. Reassess, repeat q 20 min if needed up to 3 doses.
  • Currently terbutaline sulfate injection is not FDA recommended for patients < 12 years of age because of insufficient clinical data to establish safety and effectiveness. There are pediatric dosing references that give recommendations for children age 6 years and older of 0.01 mg/kg SC with a maximum single dose of 0.25 mg.
  • Follow local protocols, medical direction; monitor cardiac and respiratory status

General recommendations and controversies for pediatric asthma patients during COVID:
  • Corticosteroid treatment is currently not recommended for the treatment of COVID-19–induced lung injury or shock outside of a clinical trial
  • There is no current evidence that steroids should be avoided in asthma patients during the COVID-19 pandemic (learn more in this article)
  • Children with asthma should remain on their current asthma medications.
  • Parents should be encouraged to have an ample supply of all asthma medications and warned that there may be future shortages of asthma medications including inhaled corticosteroids 
3. PEDReady Champions of the Week: You!
Thank you to all health care professionals who are balancing work, COVID-19, childcare and homework. You are superheroes!
4. Education & Resources
New PEDReady Resources:
1) AHA Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19 including Pediatric Cardiac Arrest Algorithms (Published April 9, 2020). 
  • There continues to be extreme controversy over intubation vs. SGA vs. BVM with filter
  • EMS agency protocols will vary based on medical direction, geography, expertise and individual situation
2) COVID-19 literature summaries and resources:
3) Is your pediatric volume down? Use the time for education!
  • See the free access 2019 ACEP Pediatric Simulation website including hospital and EMS drill scripts and debrief guides, Peripheral Brain Booklets, and video simulations
4) The Undifferentiated Pediatric Ingestion: What to Expect and How to React. Written by some of our favorite Florida EM docs! (Zaza Atanelov, MD, MPH, Sonja Eagle, Gregory Jasani, MD, Shiva Kalidindi, MD, MPH, MSEd, FAAP, FACEP, Robyn Hoelle, MD, FACEP)
Prehospital Peds: Lawsuits & Lessons Learned
Free webinar expires today
1.0 CME available for pre-hospital providers
Hosted by EMLRC

Whether on the ground or in the air, when it comes to pediatric emergency airway management, real-life examples can be stranger than fiction. Using closed medical malpractice cases, Scott DeBoer, RN will teach pre-hospital providers how to avoid, or at least survive, an airway malpractice suit.
The ABC's of Covid-19: A CNN/Sesame Street Town Hall for Kids and Parents
April 25, 2020 at 9:00 am | Free

Join experts and Sesame Street characters -- including Elmo, Abby Cadabby, Rosita and Grover -- as they answer questions submitted by families! Covid-19 issues such as education, anxiety, screen time and playdates will be discussed.
Webinar: Anabolic Steroids Abuse
April 27, 2020 at 2:00 pm
1.0 CME available | hosted by EMLRC

Dr. Jay Ladde will highlight the growing use of these dangerous substances in adolescents, with a focus on the signs and symptoms that all emergency providers should recognize in these patients.
5. Poetry Corner
If for COVID-19
By Rudyard Kipling (1865–1936); adapted for COVID-19 by Dr. Phyllis Hendry

If you can keep your head when all about you
Are losing theirs and blaming it on you or COVID;
If you can trust yourself when everyone doubts if they are safe,
But make allowance for their doubting too:
If you can distance and not be tired by distancing,
Or, being lied about, don't deal in lies,
Or being hated don't give way to hating,
And yet don't look too good, nor talk too wise;

If you can dream with masks, gloves and goggles yet not make dreams your master;
If you can think and not make thoughts your aim,
If you can meet with Triumph and Disaster
And treat those two impostors just the same.
If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
And stoop and build'em up with worn-out tools;

If you can make one heap of all your pre-COVID winnings
And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings,
And never breathe a word about your loss:
If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: "Hold on!"

If you can talk with patients, caregivers, colleagues and keep your virtue,
Or walk with Kings and Administrators nor lose the common touch,
If neither foes nor loving friends can hurt you,
If all people count with you, but none too much:
If you can fill the unforgiving minute
With sixty seconds' worth of distance run,
Yours is the Earth and everything that's in it,
And which is more you'll be a COVID survivor and saint, my dear one! 
Stay Safe, Pediatric Champions!
The Florida PEDReady Program
pedready@jax.ufl.edu | 904-244-8617