Pediatric Emergency Assessment — EMT Field Protocols

← PROTOCOLS

Patient Info (optional)

Enter age or weight to filter page content

Age

Yrs

Weight (if no age)

SCENE SIZE-UP & BSI

Step 1

First 15–30 Seconds

Pediatric Assessment Triangle (PAT)

Observe from across the room BEFORE touching — all three corners simultaneously.

👁 Appearance

TICLS Mnemonic

Tone — muscle tone, flaccid?
Interactiveness — alert, engaged?
Consolability — settles with parent?
Look / Gaze — tracking, eye contact?
Speech / Cry — strong, weak, absent?

🪵 Work of Breathing

Listen & Look

Abnormal sounds — grunting, stridor, wheezing
Retractions — subcostal, intercostal, suprasternal
Tracheal tugging (late, serious sign)
Nasal flaring
Abnormal positioning (tripod, sniffing)

🩸 Circulation to Skin

Visible from distance

Pale — shock, blood loss, fear
Mottled — poor perfusion
Cyanotic — respiratory failure
Flushed/Red — fever, heat exposure
Cap refill > 2 sec = concerning

⚠ If child is crying/screaming: Airway is open. If infant is inconsolable — that itself is a significant red flag.

⚠ IMMEDIATE LIFE THREAT IDENTIFIED?
Airway failure / Respiratory collapse / Shock / Unresponsive

YES — Critical

⚡ Manage & Transport NOW

BLS Open & position airway — padding under shoulders, neutral position

BLS Suction nasal passages — bulb syringe if < 6 months

BLS BVM if apneic or inadequate — avoid hyperextension

ALS Activate ALS immediately

BLS O₂ for SpO₂ < 94%

BLS Rapid transport — assess en route, parent in front if critical

NO — Continue

Proceed with Full Assessment

Patient stable — build rapport, continue systematic evaluation. Keep parent close. Start toe-to-head for young children.

Step 2

Know Your Patient

Age Group & Developmental Norms

Ask parent/caregiver: "Is this normal behavior for them?" — they are your best resource.

Age Group	Expected Behavior	Key Risks	Assessment Tip
0–2 mo Neonate	Eats, sleeps, cries. Recognizes voice & smell. Cannot distinguish faces. Consolable by caregiver.	Inconsolability is a major red flag. SIDS risk. Sepsis presents subtly.	Should calm with familiar voice/smell. Not consolable → investigate urgently.
2–6 mo Infant	Recognizes caregivers visually. Smiles. Aware of surroundings. Explores with mouth.	Choking. Rolling off surfaces. RSV season respiratory risk.	Distract with toy or shiny object. Avoid balloons (choking hazard).
6–12 mo Older Infant	Mobile — rolling, crawling. Puts everything in mouth. Stranger anxiety developing.	Falls (head-heavy, top-heavy balance). Choking. Head injury.	No stranger anxiety at this age = red flag. Keep parent in view.
1–3 yr Toddler	Mobile and fearless. Basic speech. Beginning to walk. Curious about everything.	Poisoning. Falls. Choking on food (can't fully chew). Burns.	Assess toe-to-head. Don't corner them. Let them hold equipment if possible.
3–6 yr Preschool	Imaginative. Magical thinking. Understands cause/effect. Responsive to praise.	Pedestrian trauma. Falls from heights. Foreign body ingestion.	Talk them through every step. Oversell courage, underdeliver pain. Use play.
6–12 yr School Age	Logical thinking. Modesty developing. Can describe symptoms accurately.	Sports injuries. Bicycle trauma. Beginning risk-taking behavior.	Respect modesty. Ask them directly — they can provide good history. Head-to-toe OK.
13–18 yr Adolescent	Adult-like. Privacy concerns. May minimize symptoms. Peer influence.	High-risk trauma. Substance use. Mental health. Sexual health issues.	Consider speaking to teen privately. Treat like adult for history.

Step 3

Age-Referenced Vitals

Vital Signs by Age

Use a reference card or Broselow tape — do not rely on memory. BP often not taken in < 2–3 yrs; use skin signs + cap refill instead.

Newborn

Heart Rate

100–160

Resp Rate

30–60

Sys BP

60–90

1–12 mo

Heart Rate

100–160

Resp Rate

25–50

Sys BP

70–100

1–3 yr

Heart Rate

90–150

Resp Rate

20–30

Sys BP

80–110

3–6 yr

Heart Rate

80–140

Resp Rate

20–25

Sys BP

80–110

6–12 yr

Heart Rate

70–120

Resp Rate

15–20

Sys BP

85–120

Min Sys BP formula: 70 + (2 × age in years)

Weight estimate: Use Broselow tape — color-coded dosing

Pulse location: Brachial (<1yr) • Femoral • Carotid

Lung sounds: Listen anterior, armpit level — not posterior

Step 4

Hands-On Evaluation

Physical Assessment

Airway & Breathing

Position — neutral head, pad under shoulders for infants

Suction nose first (obligate nose breathers < 6mo)

Count RR — light hand on abdomen (diaphragmatic breathers)

Expose chest — look for retractions, tracheal tug

Never place straps over stomach — blocks breathing

Circulation & Neuro

Cap refill — forehead or chest (<2 sec = OK)

Skin: pale/mottled/cyanotic/flushed — all meaningful

Blood glucose — heel poke in young children; check if lethargic

Fontanelle — bulging (↑ICP) or sunken (dehydration)

AVPU — Alert / Voice / Pain / Unresponsive

📌 Exam order: Toe-to-head for infants/toddlers/preschool (less threatening). Head-to-toe for school age+. Do painful procedures (glucose check, IV) last after primary assessment.

Step 5

Interactive Differential

Find the Problem — Age + Symptoms

Select the patient’s age group, then filter by presenting symptoms to identify likely conditions and jump to management.

① Select age group

② Filter by symptoms (select all that apply)

⚠ Red Flags

Always Investigate

Pediatric Red Flags & Abuse Indicators

Inconsolable Infant

Infant not consoled by caregiver voice/touch — always significant regardless of age. Suspect pain, sepsis, or intracranial injury.

No Stranger Anxiety (6–12 mo)

By 6 months, infants should react to strangers. Absent fear in this age group can indicate altered mental status or neglect.

Femur Fracture in Young Child

A broken femur requires significant force — extremely rare from normal play. Always consider non-accidental trauma.

Bruising on Pre-Mobile Infant

"Those who don't cruise, don't bruise." Any bruising on a non-mobile infant should raise suspicion.

Story Doesn't Match Injury

Mechanism inconsistent with developmental stage or injury pattern. Changing story between providers. Talk to parents separately.

Bulging Fontanelle

In a calm, upright infant — indicates increased intracranial pressure. Consider meningitis, hemorrhage, or hydrocephalus.

🚨 CHILDREN COMPENSATE WELL — THEN DECOMPENSATE RAPIDLY. Trust your gut. When in doubt, transport.

🚑 Transport Decisions & Safety

Consider patient condition, facility capabilities, and transport device — not just nearest hospital

⚡ Critical Patient

Activate ALS immediately
Consider pediatric trauma center
Parent in front seat
Pre-notify receiving facility
PDMate / NeoMate on stretcher
Bypass local ER if needed

📋 Stable Patient

Parent in back — reassures child
Car seat on gurney if appropriate
Captain's chair (5-pt harness > 6yr)
PDMate for 10–45 lbs
NeoMate for < 10 lbs (neonates)
Never transport prone

🏥 Facility Selection

Pediatric ER if available nearby
Trauma center for multi-system injury
Call medical control if unsure
Stabilize first if needed
Reassess q5 min (critical) q15 (stable)