January 23, 2020
Pediatric Literature Updates You Don’t Want to Miss! Part II
1. PEDReady Champion of the Week: Dr. Joseph J. Tepas III
We honor the life of Dr. Joseph J. Tepas, known to many of us as JJT, for a life of service to critically ill and injured children. In a way, Joe started getting Florida “PEDReady” over 35 years ago! He is remembered for his care of the injured child, advancements in the management of traumatic brain injury, and his skill in neonatal surgery.

Dr. Tepas was instrumental to the development of Florida's state trauma system and the first pediatric-specific trauma registry, the National Pediatric Trauma Registry. He was a surgeon dedicated to his patients who also understood the importance of evidence and data to inform decisions. “JJT” was a strong advocate for organ donation and a transplant recipient himself.

Every year, the Pediatric Trauma Society presents a research award in his name. Learn more about the award here .

Dr. Tepas and his colleagues developed and published the Pediatric Trauma Score in 1987. You can see examples of the score below, the components of which are still used as a basis for most pediatric trauma triage and alert systems.
*Tip: use the correct-sized BP cuff or you may end up with a falsely low or elevated BP!

Stay tuned for upcoming PEARLs on Florida’s Pediatric Trauma System and trauma-related education.
Full Citation: Tepas JJ, Mollitt DL, Talbert JL, Bryant M. The Pediatric Trauma Score as a predictor of injury severity in the injured child . J Pediatr Surg. 1987;22:14-18
2. Pediatric Literature Updates
Pediatric Interfacility Transfers
Does it seem like there are more pediatric interfacility transfers lately? Well there are, and it is causing the “perfect storm” in pediatric emergency care, especially in rural areas. The capability of hospitals to provide definitive inpatient pediatric care is decreasing and transfers are increasing, even for simple diagnoses like dehydration, pneumonia and asthma. The article Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016” found:

  • ED visits among rural children to hospitals in the lowest capability category increased from 12.6% in 2008 to 39.1% in 2016.
  • Total pediatric ED transfers increased by 27.7% with increases in all volume and urbanicity categories, except at primarily pediatric institutions. The sharpest increases occurred in low-volume and rural hospitals.

There has not been a corollary increase in pediatric transport teams, so what does this mean for pediatric readiness?

  • Community EDs may have to wait longer for transport of children to tertiary care such as trauma centers or children’s hospitals.
  • Local EMS agencies that are already over capacity may be asked to assist in transporting children over long distances to tertiary care, taking them out of local service for hours.
  • Be sure to maintain a list of air and ground services that transport children in your area.
  • Florida PEDReady is working on a contact list of key pediatric tertiary centers and transport agencies.

Article: Michelson KA, Hudgins JD, Lyons TW, et al. Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016 . Pediatrics. 2020;145(1): e20192203.

Commentary: Gausche-Hill M. Emergency and Definitive Care for Children in the United States: The Perfect Storm . Pediatrics. 2020;145(1):e20193372. 
Pediatric Readiness in EMS

Two recent landmark articles were published in January, calling for pediatric services to be embedded into the EMS infrastructure and emphasizing:

  • Pediatric-focused education and training
  • PECCs
  • Pediatric performance improvement practices.
Technical Report: Owusu-Ansah S, Moore B, Shah MI, et al. COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE, SECTION ON EMERGENCY MEDICINE, AAP EMS SUBCOMMITTEE, SECTION ON SURGERY. Pediatric Readiness in Emergency Medical Services Systems . Pediatrics . Jan. 2020; 145(1): e20193308.

Joint Policy Statement: Moore B, Shah MI, Owusu-Ansah S, et al. AAP and the AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE AND SECTION ON EMERGENCY MEDICINE EMS SUBCOMMITTEE, AAP AMERICAN COLLEGE OF EMERGENCY PHYSICIANS EMERGENCY MEDICAL SERVICES COMMITTEE, AAP EMERGENCY NURSES ASSOCIATION PEDIATRIC COMMITTEE, AAP NATIONAL ASSOCIATION OF EMERGENCY MEDICAL SERVICES PHYSICIANS STANDARDS AND CLINICAL PRACTICE COMMITTEE, AAP NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS EMERGENCY PEDIATRIC CARE COMMITTEE. Pediatric Readiness in Emergency Medical Services Systems . Pediatrics . Jan. 2020;145(1): e20193307
3. Educational Resources
PEM on the Frontlines—Building a Peds-Ready ED Webinar

The National Pediatric Readiness Project (NPRP) has launched a Community of Practice (COP) that provides peds-ready resources for hospitalists. Their latest webinar by Drs. Sarah Alander and Christopher Valente was uploaded last week.
Updated Pediatric Disaster Topic Collection from ASPR TRACIE

In November, the Office of the Assistant Secretary for Preparedness and Response (HHS ASPR) updated their  Pediatric Disaster Topic Collection  from TRACIE (Technical Resources, Assistance Center, and Information Exchange). This collection provides resources that can help healthcare facilities, healthcare coalitions, and other health and medical providers to consider the specialized care and resources needed for children prior to, during, and after an incident. Resources are categorized in topics that include access and functional needs, burns, explosives and mass shootings, family reunification and support, healthcare facility evacuation/ sheltering, and hospital surge capacity and immediate bed availability.
" When a Child Dies: The Parents' Perspective"
by Peter Antevy, MD via EMS World
Accompanying podcast: "The Death of a Child: Supporting the Family"

Do you have a pediatric death or bereavement policy? Please share by emailing pedready@jax.ufl.edu .
Thanks for being a Pediatric Champion!
The Florida PEDReady Program
pedready@jax.ufl.edu | 904-244-8617