PEDIATRIC SYMPOSIUM

Megan has over 20 years of experience in emergency and trauma medicine and experience with pediatric primary care and school-based nursing experience. Megan holds certifications as a Certified Emergency Nurse and Certified Pediatric Emergency Nurse. She is also an active EMT, Paramedic Student, and EMS instructor. Megan graduated cum laude honors from Regis College in 2007 with her Bachelor of Science in Nursing degree and summa cum laude honors from the University of Hartford in 2019 with a Master of Science in Nursing Public Health degree. Megan obtained her EMT in 2003 from Northeastern University. Currently, Megan is the Program Coordinator for the CT EMS for Children State Partnership Grant.

Although calls for critically ill and injured pediatric patients are rare, the care these patients receive by Emergency Medical Services (EMS) is critical to their outcomes. Currently, there is variation in the pediatric training and continued medical education requirements for prehospital providers. Simulation is a valuable tool to help practice not only low-frequency, high-stakes clinical scenarios, but also high-frequency pediatric scenarios such as anaphylaxis, asthma, or newborn resuscitation. There are substantial barriers to pediatric simulation access in the prehospital setting: the high cost of simulators, equipment and consumables, the lack of access to trained simulation technicians, faculty, and subject matter experts, as well as lack of access to peer-reviewed simulation curricula. EMS SimBox is a free, online, open-access, medical education platform developed to empower providers to build their own skills and capacity to conduct pediatric simulations without access to a simulation center or expert. We have created a set of eight simulation scenarios specifically tailored and contextualized to the prehospital setting. Each case includes a video of real or animated patients next to corresponding pre-recorded vital signs and expert-reviewed, case-specific educational content. SimBox has been successfully used to improve the self-efficacy of prehospital providers caring for acutely ill children 1 and to identify and measure practice deviations from standardized resuscitation protocols in the prehospital setting. The goal of this presentation is to introduce EMS SimBox, showcase uses of SimBox in the prehospital setting, and ultimately empower prehospital educators and providers to conduct SimBox pediatric simulations.

Sofia Athanasopoulou, MD completed her residency in pediatrics at Yale and is currently a pediatric emergency medicine fellow at Yale. She is the innovation and case creation lead of SimBox, an open-access pediatric simulation platform and the incoming junior board member of the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE). With a special interest in prehospital emergency care, she has served as the pediatric simulation coordinator for the Yale Center for Emergency Medical Services (EMS), and the academic medical center partner for Alaska EMS.

This lecture will discuss the evidence based advanced resuscitation techniques as they relate to the care of critically ill pediatric patients. While focused on the advanced techniques, it would be cavalier to not mention some of the basic techniques, as many of the advanced techniques are based on excellent basic resuscitation skills.

From an airway perspective, this lecture will discuss advanced airway management including supraglottic airways and the placement of surgical airways.

The second section will focus on the recognition and treatment of disorders of breathing, including tips and pearls to assist in the identification of the etiology of respiratory distress.

The section discussing circulatory issues, will review IV/IO access, CPR, the PALS algorithms and then move on to discuss cardioversion techniques, defibrillation, transcutaneous pacing.

For those of us who care for critically ill patients, we know that the ability to anticipate the next steps whenever possible can truly help save a life. This lecture will highlight simulation medicine as an excellent education modality to allow pre hospital staff to familiarize themselves with protocols and resuscitation algorithms, develop their communication and team leader skills and also to learn advanced resuscitation techniques and procedures and prevent procedural skill decay.

There will be multiple tips and tricks throughout the lecture, many of the them not information that would be found in a book but rather the result of the experience that comes with having cared for pediatric patients in both a free standing pediatric and general ED over the past seventeen years.

After completing my medical degree from the University of the West Indies and internship at the Queen Elizabeth Hospital in Barbados, I relocated to Connecticut and completed the UConn EM residency and the UConn PEM fellowship programs. Post fellowship, I accepted a faculty position at Connecticut Children’s Medical Center (CCMC) a level 1 trauma center. While working there, in order to augment the EM residents’ exposure to pediatric critical care, I initiated an educational simulation series entitled The Critically Ill Pediatric Patient in the ED, designing simulation cases based on the ACGME educational milestones.

Seven years later an opportunity developed to transition to St Francis Hospital and Medical Center as the Section Chief of Pediatric Emergency Medicine. This facility is a 600+ bed level 1 trauma center and urban regional referral center with a high volume (90,000 patients/year) ED. Hiring included the expectation of bringing PEM expertise to improve pediatric care and education. I continue to work at the CCMC ED and participate in UCONN EM resident education. At St. Francis I review and provide feedback on pediatric cases. I have led several QI projects related to the care of pediatric patients in a general ED and also instruct ED nurses, techs, EMS and physician colleagues through both in situ simulation and sessions in the simulation center.

Two years ago, I accepted the role of Physician Advisor to the Simulation Team at St Francis and started a community outreach program, teaching via simulation in community ED’s in CT. The following year I became core faculty to the UCONN EM residency program and just recently I accepted the position of Assistant Program Director of the UConn EM residency. Over the past 17 years I have enjoyed mentoring high school students, EM residents and PEM fellows in both official and unofficial capacities.

When not caring for patients, teaching or mentoring, I enjoy traveling with my husband and children particularly to warm climates, reading and thanks to the pandemic, ice cream making.

Dan Malley has been in EMS for over a decade, graduating from Stony Brook University Paramedic Program in 2015. He graduated with a bachelor’s in healthcare economics from the City University of New York in 2019. He is a board-certified critical care and flight paramedic. Presently, he is a member of the pediatric critical care transport team at Yale New Haven Children’s Hospital.

Pete Davekos has many years of EMS experience. Since 2015, Pete has been specializing in pediatric critical care transport working in several hospital-based transport programs. In addition to his clinical duties, he is involved with CT EMS-C outreach, clinical education, and research. Presently, he is a flight paramedic at Yale New Haven Children’s Hospital.

Pediatric Burn Care is an interactive lecture concentrating on initial management, Airway management, fluid resuscitation, Burn depth, Total Body Surface Area (TBSA) calculations, American Burn Association (ABA) referral criteria, comfort management, and mass casualty. An interactive case study is part of the lecture as well. Burn unit care is also discussed.

Rich Grady, BSN, RN, is the nurse manager of Perioperative and Outpatient Services at Shriners Children’s Boston. Rich has more than 30 years of experience treating all types and severities of burns at Shriners Children’s Boston. He has worked as a technician, staff nurse, charge nurse and nurse manager.

Rich is a certified Advanced Burn Life Support (ABLS) instructor, travelling regionally to facilitate a one-day American Burn Association approved course focusing on immediate care of the burn patient up to the first 24 hours post injury. ABLS programs support emergency preparedness, mass casualty incidents focusing on triage, burn survivability, prioritizing transport of patients and patient treatment.

Advances in prehospital care have led to marked improvement in outcomes in out-of-hospital cardiac arrest (OHCA) for adults. However, outcomes for children have failed to improve. In this presentation, we review the current state of Pediatric OHCA (p-OHCA) management and outcomes. We will critically evaluate airway maneuvers, scene time, CPR quality, and medications. We will identify opportunities for allowing EMS clininicians to work up to their scope of practice and optimize outcomes for children in the low-frequency but high acuity management of pediatric cardiac arrest in the prehospital setting. The talk concludes with a discussion on the role of termination of resuscitation in pediatric out-of-hospital cardiac arrest.

Dr. Matthew Harris is an advocate, researcher, and subject matter expert in pediatric prehospital and interfacility care. Dr. Harris has been involved in EMS since 1998. He has been a junior volunteer, EMT, paramedic, field physician, and now medical director during his 26-year history with prehospital care. Dr. Harris is trained in pediatric, pediatric emergency medicine, and EMS & Disaster Medicine, and is board certified in all his specialties. Dr. Harris sits on several regional, state, and federal committees aimed at improving outcomes of children in the prehospital and interfacility setting.

The objective of this presentation is to give the pre-hospital provider some pediatric specific knowledge and tools to enable them to provide appropriate and definitive care. The approach of the presentation is to build on the knowledge and skills they already have and build their confidence in delivering care to the pediatric trauma patient. The content will cover some differences between pediatric and adult trauma patients, including mechanism and how it impacts the index of suspicion for injury in a pediatric patient. It will also discuss transport options – securement devices for transport, destination choices (closest hospital vs Pediatric Trauma Center), & mode of transport (when to call for a helicopter).

Lola has been a nurse for almost 40 years. Early in her career she spent 10 years at Cook County Trauma in Chicago. She has been a flight nurse for over 25 years. Starting with AeroCare (Fixed Wing) International Air Ambulance in Illinois, then CalStar (Rotor Wing) in California, then DHART (Rotor Wing) in New Hampshire, and currently works on the Yale in New Haven Children’s Hospital Transport Team (Ground Ambulance and Rotor Wing). Much of her career has been pre-hospital scene response. She has also participated in education for EMS providers, transport peers, and Residents, teaching locally and nationally.