The pre-hospital care of injured children should follow the same pathways as for adults (Section 4). Please use the JRCALC guidelines (and the paediatric physiological values printed on the back of the triage tool) for all paediatric patients.
07.a.i Triage tool
- Apply within 10 mins of arrival (same as in the adult).
- Call for help. NCS can give advice and guide the stabilisation and transfer.
→ Section 4.b
Trauma triage tool
07.a.ii Monitoring standards and initial management
Children involved in trauma should have the same multi-modality monitoring as applied to adults.
→ Section 4.c
Care on scene
07.a.iii Tranexamic acid
Early use of tranexamic acid is to be considered for all paediatric patients with trauma and significant haemorrhage. Use within 3 hours of injury is recommended. See formulary for dose.
07.a.iv Pain
Analgesia should be provided to all major trauma children as per the patient requirement and the training of the crew members. The East of England Ambulance Service currently allows the following:
a. Critical care paramedics only:
Ketamine (under PGD) > 6yrs titrated to weight
IV paracetamol – from birth titrated to weight
b. Paramedics:
Oral – Morphine suphate – vials 10mg in 5ml – as per JRCALC guidelines 2013
IV Morphine sulphate – 10mg in 1ml – as per JRCALC guidelines 2013
Entonox – if capable of taking instruction
Co-codamol 30/500 > 12yrs
Oral paracetamol as per JRCALC guidelines 2013
c. Enchanced care teams:
can use any available methods of analgesia
07.a.v Pre-alert
There should be an early pre-alert through NCS to the receiving hospital ED about an injured child (less than 16 years of age) so that the specialists required in stabilisation are available as the child reaches the Emergency Department. Please clearly state ATMISTER, the age of the child and request for the Paediatric Trauma team. The trauma units will decide the composition of the paediatric trauma team in their set-up based on the resources; for children less than 6 years of age, it’s preferable to have relevant speciality consultants involved in the resuscitation and stabilisation on arrival to the ED.