Thursday, February 13, 2014

The Child Trauma Kit

A commercial tourniquet on five year-old's arm.
Too big!
Thankfully, major trauma to children is not common. Even less common is major trauma to children due to violence.

However, since we are in the interest of being prepared for the eventuality of all disasters, we might as well cover the horrid reality of violent trauma to your child.

In my Realities and Legalities of Child Snatching series I touched on the possibility of your child being injured in an altercation between a parent and a kidnapper and that commercial trauma kits do not often account for the size differences and special needs of children.

First, in the interest of brevity I'm going to skip talking about trauma kits, what is in them and how to use them. For the purpose of this blog I'm going to assume you have one and have been trained in its use. If you don't have one and don't know how to use it I highly recommend you seek out a combat medicine class.

I want to talk specifically about children and at what ages your trauma kit and skills might need a little adjusting.

Soon after children hit puberty, while they are technically and legally still children, their bodies develop quickly into adult capabilities. While medical dosing and treatment might be different, for trauma management your average junior to senior high school students may not need any specialized equipment. That may not be the case for every child so assess your own child and what you might need for him or her but for the most part you can use a standard trauma kit on post-pubescent children with adequate results.

Prepubescent and adolescent children (called pediatrics in the medical community), on the other hand, are not miniature adults. They can handle some traumas well but not others and their bodies are often not able to compensate for injuries like an adults.

They have different blood pressures, pulses and breathing rates. They cannot take the blood loss an adult can and their lungs often give out far faster than an adult's. Depending on the age, their lungs also cannot handle aggressive positive pressure from artificial ventilation like an adult. When children suffer major traumas they need specialized care and quickly.

The number one cause of heart failure in a child is respiratory distress (they cannot breathe). So a child that is struggling to breathe can deteriorate quickly into a child who's heart is not beating.

Taking those things into consideration let's consider an absolutely worst case scenario:

Your child has been shot. Be this an active shooter event, a shooting at a school function, etc, you are now the sole provider for your child until paramedics arrive.

You have your trauma kit. A lot of the products in that kit such as gauze, surgical sponges, duck tape, occlusive dressings, will directly apply to trauma in children but let's talk about what may not and what you might want to keep an eye out for and add for your child.

Make sure your fingers at least touch
around a child's extremity for best results.
Many people who carry trauma kits buy them prefabricated off the internet. These kits often come with easy-one-hand-use tourniquets such as the CAT or SWAT-T. While many of them may be adjustable down to pediatric sizes some are not and you may spend too much time trying to adjust the tourniquet that you could be spending getting the bleeding under control.

Your hand.

An adult's hand is often the perfect tourniquet for a young child. Encompass the fingers 1-2 inches above the wound and squeeze while applying pressure on the wound with the palm or heel of the hand. The combination of pressure and squeezing off blood flow can get bleeding under control quickly or buy you time to adjust your other tools or direct someone in adjusting your equipment or improving a tourniquet. To see if your hands are big enough, try to encompass your child's arms or legs at their thickest points (the thigh and the upper arm). If your fingers don't touch at the back, know that you may need to improvise a tourniquet for that extremity.

A triangular bandage is quickly applied to
this tiny 2 year-old's arm.
Triangular bandage.

A triangular bandage can make a great tourniquet and can often be applied faster than some commercial products. I recommend carrying at least two or three triangular bandages in case you need more than one tourniquet (think Boston Bombing) and they come in handy for many other purposes. You can buy boxes of twelve off of Amazon for less than $10.

Pressure Bandages:
As with tourniquets, pressure bandages often come in trauma kits and can be too big for some little bodies or take too much time to apply with all the excess material.

A fantastic alternative to a commercial pressure bandages is gauze and Coflex or Self-Adherent Stretch Sensi-Wrap. It can be torn to size and provides very good pressure (even to tourniquet tightness if you wrap it tight enough). It comes in different widths and is a fantastic thing to throw in any trauma bag even for adult trauma.

Things to Consider Adding:

A nasal and/or oral airway kit.

As I said before, the number one reason for cardiac arrest in children is respiratory distress and children's lungs often give our faster than an adults. After you've controlled bleeding, if the child is quiet, gasping for air or seems to not be breathing well you may have to preform CPR on that child and breathe for him or her at any moment. Take time to consider the normal breathing rate for your child so that you can better gauge what it is too fast or too slow. Children's airways are small and while an oral or nasal airway is not as good as intubation, it will at least keep the tongue out of the back of the throat and keep the mouth slightly open while you preform breaths for the child.

A good tip to remember is if a child is crying, he's breathing. The sounds of your child screaming in such a situation should be music to your ears. A quiet child that is injured is one you need to watch very carefully for respiratory distress and heart failure.

Pediatric airway adjuncts are not big but they do take up space. Many people who carry them prefer to carry the whole kit in case they need to help others. If you are strapped for space, however, you can pick out the airways that will fit your children and put those in your kit. Whether you carry the whole kit or not, it's still a good idea to measure out the airways for your children so that you don't have to take time measuring them under duress.

Click this link for step-by-step instructions on measuring and inserting an oral or nasal airway and when to use one vs the other.

Things to Tell 911:
When you call 911 be sure to specify that there is a pediatric child on scene. If someone else is making the call be sure tell them to specify "Pediatric" or "Child." Give the age, weight and injuries and what you are doing to help that child. Specifying the weight will allow paramedics to start calculating possibly needed doses for medications they may have to give on scene. If CPR is in progress be sure that is made very clear to dispatch.

Some ambulances have separate pediatric bags and med boxes they need to grab and they often will not grab that bag or box unless they know a pediatric patient is on scene. If it's a mass casualty scene they may have a larger jump kit with pediatric tools included but don't count on it. Knowing there is a pediatric on scene in advance will save time from someone having to run back to an ambulance and get the correct med box or bag.

Training You Need:
If you have a child you should know CPR. This is a must. Given choking hazards and other medical emergencies, CPR should have been something you already have been trained in. If not, get it.

If your CPR class does not include practice on inserting oral and nasal airways, ask them if they have them available to try on the dummies. Many places that teach CPR will at least have them on hand and might be willing to allow you to practice and critique your technique.

Organize your kit:
My supplies for my children are in a separate MOLLE pouch on the side of my bag vs buried with all of the other trauma stuff in the main compartments. It gives me peace of mind knowing exactly where they are and that they are easily accessible. Even if you can't make separate kits for your kids vs yourself, have them accessible and well labeled. You might not be the one using them or you might have to direct someone else in their use if you are too injured to do it yourself.

Again, thankfully, traumatic injuries to children due to violence are rare but it's better to have it and not need it than need it and not have it. That goes for tools AND skills.


Tourniquet with hand.
1. We're going to assume the blue X on this five year-old's arm is an aggressive hemorrhage.
2. Cover it with a dressing.
3. Place the heel of the hand on the dressing and apply pressure while you wrap your fingers around the arm about 1 - 2 inches above the wound. Make sure your fingers touch to stop all blood flow and squeeze.
4. If bleeding is stopped I can apply a pressure bandage with Coflex self-adhesive tape or a triangular bandage.
The smaller size Coflex might work better for such a small arm.

Tourniquet with triangular bandage.

1 comment:

  1. Just found this blog. Very excellent post right here! Being a nursing student, it's refreshing to see somebody who teaches firearms who doesn't have their head up their nether regions about medical care (and vice versa). I also read your post about the trauma kit and I think it was a great call getting trained as an EMT. Me and most of the guys I go to school with (and a good portion of the girls too) keep kits in our cars and I've known more than a couple EMT's and they pretty much do that as a matter of habit. Easily one of the coolest blogs I've found in a while.
    Rock on!