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Hazardous Materials Response

Questions and Answers Initial Response Considerations 1 What is the best way to plan for potential hazardous material (HAZMAT) incidents in a particular region or community? Management of HAZMAT incidents begin well before the alarm goes off. Every organization involved in HAZMAT response should perform a comprehensive vulnerability analysis to identify any and all potential threats for their particular community. This includes working with governmental organizations,…

Blast Injuries

Questions and Answers 1 Why is this chapter important and what is the chance that an EMS provider will see injuries from a blast or explosion? The frequency of blast injuries due to military conflict and terrorist activities has increased dramatically in the last 15 years. Injury patterns that used to be seen only in military conflicts are now being seen outside of these areas of conflict…

Radiation and Radiation Injury

Questions and Answers 1 Is it safe to treat patients who have been exposed or contaminated during a radioactive disaster? This is the first question because it is the most important. Like any other situation in the field, safe is a relative term. There are three primary sources of danger: the origin of the radiation, the hazards of the disaster environment, and the patient. By maintaining…

Biological and Chemical Terrorism

Questions and Answers 1 What is the importance of preplanning regarding chemical and biological terrorism? Without preplanning, the risk of injury or death to first responders is greatly increased. Each responding organization should develop standard operating procedures (SOPs) to implement personal protective equipment (PPE) use, decontamination of casualties, and technical decontamination of first responders. Individual SOPs should be part of the overall incident response plan. Frequent…

Mass Casualty Evacuation and Patient Movement

Questions and Answers 1 What are casualty collection points that are used during a mass casualty incident? These are areas that have been designated to move patients from the scene of the incident. They need to be in a safe area, usually a distance from the scene, and should not be accessible to the public. The collection points usually coincide with the levels of triage to…

Prehospital Triage for Mass Casualties

Questions and Answers 1 What is a mass casualty incident (MCI)? The World Health Organization describes an MCI as a disaster and major incident characterized by a quantity, severity, and diversity of injuries in patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care. Multiple resources, such as EMS, police, hospitals, and equipment, will likely be depleted/exhausted during…

General Principles in Disasters and Mass Casualty Incidents

Questions and Answers 1 What is a disaster? A disaster is defined by the World Health Organization as a sudden ecologic phenomenon of sufficient magnitude to require external assistance. Essentially, it is any event that overwhelms the capabilities of a particular service. For example, a multicar accident on a highway can easily overwhelm the nearest trauma center if there are multiple serious injuries or a power…

Thermal Burns and Inhalation Injuries

Questions and Answers 1 What is the prevalence of burn injuries in children in the United States? Over 250,000 children require medical attention for burns; of these, 200,000 are scald injuries. Males outnumber females 2:1. Approximately 15,000 kids per year require hospitalization for burn injuries. Burns and fires kill 1100 children aged 14 years and under in the United States each year. Children aged 5 years and under…

Extremity Injuries

Questions and Answers 1 You are en route to the local children’s emergency department having picked up a 3-year-old male who fell off the monkey bars at a playground. The patient has a left elbow deformity ( Fig. 44.1 ). What are key characteristic features of pediatric bones compared to adult bones that can affect presentation and management? The presence of a growth plate or physis. The…

Chest, Abdominal, and Pelvic Injuries

Questions and Answers Case: You are called to the scene of a moderate-speed (45 miles per hour) motor vehicle crash and find a 10-year-old female in the back seat, restrained with a seat belt. Her mother’s vehicle was “T-boned” on the driver’s side, causing the vehicle to rollover several times. She is awake and alert. Her vital signs are blood pressure 110/76, heart rate of 110…

Pediatric Cervical Spine and Spinal Cord Injuries

Questions and Answers Case: You respond to the scene of a motor vehicle collision to find a 5-year-old child complaining of neck pain. She does not report any other complaints. 1 What challenges do children present in evaluation of neck injuries? Young children are not always able to reliably communicate the extent or even location of their injuries. You must rely on observation of their behaviors…

Pediatric Head Injuries and Facial Trauma

Questions and Answers 1 A 12-year-old male steps too close to another golfer’s backswing and is hit in the right eye by the club. How can you prevent further eye damage on the way to the emergency department (ED)? You should physically protect the eye as well as avoid an increase in intraocular pressure (IOP), which can cause secondary injury. Anchor the protective shield on bones…

Technology-Dependent Children

Questions and Answers 1 What is the definition of a “technologically-dependent child?” Technology-dependent children are those who are reliant on a medical device to augment (or completely replace) a vital bodily function to sustain life. 2 What are the most common classes of technologies used by technology-dependent children? Respiratory support, nutritional support, indwelling venous catheters, cerebrospinal fluid shunts. Case: You respond to a call at a…

Seizures

Questions and Answers 1 What is the definition of a seizure? Sudden occurrence of signs and/or symptoms causing change in motor, sensory, behavioral activity, or consciousness due to abnormal neuronal electrical activity in the brain. Seizures account for about 1% of all emergency department (ED) visits for children <18 years old. 2 What is an unprovoked seizure? Seizures that occur due to unknown etiology or no immediate…

Respiratory Distress Emergencies

Questions And Answers Pneumonia 1 You are called to the house of a 7-year-old male. His mother tells you that he has been coughing for about a week. Yesterday, he developed a fever up to 103°F and today he began coughing more and seemed to be struggling to breathe. What are the first steps in assessing this child? You should always use the Pediatric Assessment Triangle…

Chest Pain and Syncope

Questions and Answers Chest Pain Case: You are called to evaluate a 12-year-old boy with no medical history who has been complaining of chest pain over the last few hours. He reports the pain as central, sharp, and worse with deep inspiration. He denies any additional symptoms. He reports that he helped his father over the weekend move some firewood but denies any other increased physical…

Altered Mental Status

Questions and Answers 1 What does altered mental status (AMS) mean? AMS is synonymous with an altered level of consciousness. It encompasses the spectrum of responsiveness between a patient’s baseline level of consciousness and a comatose state. It alerts the provider that an underlying condition is causing the patient to act in an abnormal or altered way. 2 What terms should be used to describe altered…

Shock

Questions and Answers 1 What is shock? Shock is inadequate blood flow (and therefore oxygen delivery) to meet tissue demands. 2 Why is early recognition and treatment of shock important? Early recognition and treatment of shock are associated with improved outcomes, with decreased morbidity and mortality. As shock progresses, it often becomes more refractory to treatment. 3 What is the difference between compensated and uncompensated shock?…

Cardiac Arrest and Arrhythmias

Questions and Answers 1 What is the most common cause of cardiac arrest in children? Respiratory failure. In sharp contrast to adults, cardiopulmonary arrest in infants and children is most often associated with hypoxia, respiratory failure, and respiratory arrest. While arrest in adults is often triggered by myocardial ischemia and dysrhythmias, children typically have no primary cardiac dysfunction. A child in cardiac arrest must be supported…