Pediatric Trauma in the Field
Objective: Use pediatric vital-sign red flags, keep them warm, and do not undertriage a quiet child.
Why This Is Hard
The 4-year-old looks okay after a 40 mph MVC because the BP is “normal.” Then they arrest in the truck. ACS/CDC 2021 field triage: pediatric physiologic criteria exist because adult numbers lie.
- Use a length-based tape for weight and equipment. Guessing is how tubes miss.
- Keep them warm. Hypothermia plus bleeding is deadly.
- A silent child after trauma is a red flag, not a well child.
Field Rules (Education)
- Compensate then fall off a cliff. Tachycardia and delayed cap refill show up before hypotension.
- Field triage: abnormal peds GCS/vitals, penetrating torso/head/neck, chest wall instability, two or more long-bone fractures — highest-level pediatric trauma center available.
- Airway: occiput positioning, modest volumes. See pediatric airway.
- Family: one calm parent if it helps the airway. Do not let a screaming scene steal your primary survey.
Field Pitfalls
- Using adult BP cutoffs.
- Undertriage because they are crying (crying can be good). Quiet is worse.
- Cold wet sheets.
Practice
60-second drill
Partner: 6-year-old ejected, HR 170, BP 90, quiet. Destination and the vital that worries you more than the BP.
Related: Triage, Pediatric airway.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACS/CDC 2021 Field Triage Guidelines — pediatric physiologic and anatomic criteria
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.