Care of the Pediatric Trauma Victim in the Field

Care of the Traumatically Injured Child in the ER or Trauma Center

Care of the Traumaically Injured Child in the ICU

Ethnic, Cultural, and Religious


Course Test


When field personnel respond to the scene where there is a pediatric victim, one of their prime considerations needs to be to prevent or reverse any effects of hypoxia, since hypoxia is the usual pathway to death; although the specific cause may differ.  The children who die most immediately after a traumatic injury die from one of the following conditions:  airway compromise or respiratory arrest; hemorrhagic shock; or neurological injury.  The field personnel must prioritize their care to begin with the assessment and stabilization of life-threatening injuries.  This begins with an assessment of the Airway, Breathing and Circulation (including hemorrhage control) while making sure that the cervical spine is stabilized.  The child is also assessed for Disability and level of consciousness, and Exposure.  As this is occurring, the field team is gathering information to assist in the triage decisions about stabilization, resources and transport.  This information includes specifics as to mechanism of injury, location of injuries and the over-all condition of the patient and any past medical history (Hazinski, 1992).  The triage decision also has to include where the victim is (what type of terrain, accessibility), what hospital facilities are available at that time and what methods of transportation are available.  Usually guidelines are quite specific as to where patients have to be transported given their condition and location.  These guidelines will have been developed within an area based upon resources available and with the greatest positive outcome for the patient as the priority.  To assist the field personnel and hospital staff in their decision making, several tools have been devised to cause decision making to be more objective and consistent.  An additional goal is to have the patient treated at the most appropriate facility to assure high quality patient care and the most positive patient care outcomes.  These tools are scoring systems which assist in determining the severity of the injuries sustained and in predicting patient outcome.  The tools are only as good as the people using them and all personnel need to be carefully trained in their use, both in scoring and in interpreting the data.  These tools have evolved and will continue to improve as trauma care is refined.  Some of the original scales used for adults have now been modified for use with children.  Two are included in this paper for reference (Table 1 and Table 2).

The specific hospital and Emergency Medical System in which the nurse is working will decide which form will be used in that system.  It is imperative that personnel completing the forms do so as accurately as possible.  Patient care depends upon their accuracy; but research about trauma and decisions about emergency response systems also may be based upon the data from those initial scoring scales. 


Eyes opening
Score > 1 Year  < 1 Year
4 Spontaneously Spontaneously
3 To verbal command  To shout
2 To pain  To pain 
1 No response No response


Best motor response
6 Obeys Spontaneous
5 Localizes pain Localizes pain
4 Flexion-withdrawal    Flexion-withdrawal   
3 Flexion-abnormal (decorticate) Flexion-abnormal (decorticate)
2 Extension (decerebrate)     Extension (decerebrate)    
1 No response No response


Best verbal response
Score  >5 Years 2-5 Years  Birth-23 Months
5 Oriented and converses Appropriate words & phrases Smiles, coos,appropriately
4 Disoriented & converses Inappropriate words Cries; consolable
3 Inappropriate words Persistent cries or screams Persistent, inappropriate crying and/or screaming
2 Incomprehensive sounds Grunts Grunts; agitated/restless
1 No response No response No response

Note:  From Severe Head Trauma (p.5) by J. Simon, 1988.  Presented at Pediatric Emergencies, Williamsburg:  Resource Applications

  Severity Category
Component +2 +1 -1
Size >20 Kg 10-20 Kg <10 Kg
Airway    Normal Maintainable Unmaintainable
CNS Awake Obtunded Comatose
Systolic BP >90 mm Hg  90-50 mm Hg <50 mm Hg
Open wounds None  Closed fracture Open/multiple fractures
Cutaneous   None  Minor Major/penetrating
      Total (points) ______________

Neff, Janet and Pamela Kidd.  Trauma Nursing, The Art and Science.  Mosby, 1993, pages 541-542.