STARS Train the Trainer Class (TtT)

Balancing Act

Pdf Summary

This document is an EMS-focused introduction to caring for children with medical complexity and technology dependence, emphasizing that these patients experience out-of-hospital emergencies at roughly twice the rate of other children and that preventable negative outcomes occur. It highlights a major mismatch between EMS expectations and training, citing surveys where most providers reported no formal training in emergency tracheostomy care.<br /><br />Key pitfalls include limited destination options, misinterpreting atypical “baseline” findings, over-reliance on caregivers, lack of usable advanced directives in the field, failure to follow specialty letters, and omission of critical emergency medications (e.g., stress-dose steroids or clotting factor). The assessment section notes that findings such as nystagmus, tetany, tremor/tics, stertor, cyanosis, abdominal distention, unilateral weakness, and ataxia may be baseline; nonverbal pain tools may be needed. Initial evaluation frameworks (AVPU/PAT) are emphasized.<br /><br />Technology dependence is defined as reliance on devices to maintain vital functions (e.g., tracheostomy, mechanical ventilation, gastrostomy). Tracheostomy care is presented as time-critical: “the trach is the problem until proven otherwise,” with a stepwise approach—verify patency/placement, suction and oxygenate, ventilate via bag-to-trach as needed, and perform an emergency trach change if obstruction persists or the child deteriorates (“when in doubt, change it out”). Home ventilator transport considerations include oxygen flow capability, avoiding transport with water sources, securing equipment, monitoring battery life, and using bag ventilation to troubleshoot high/low pressure alarms.<br /><br />Other device-related emergencies include cerebral shunt malfunction (vomiting, lethargy, irritability, seizures, headache, “something’s not right”) and baclofen pumps. Scenarios reinforce recognition and treatment priorities: adrenal insufficiency crises (stress-dose steroids, shock/hypoglycemia), ketogenic diet patients with hypoglycemia and ventilator alarms, and congenital heart disease where calming, cautious fluids, antipyretics, and targeting baseline saturations (often 70–85%) may be preferable to aggressive oxygen.<br /><br />The closing message stresses listening, slowing down, involving caregivers appropriately, establishing the child’s baseline, and ongoing training—because “One Kid Counts.”

Keywords

EMS pediatric medical complexity

technology-dependent children emergencies

out-of-hospital pediatric emergencies

emergency tracheostomy management

bag-to-trach ventilation and suctioning

home ventilator transport considerations

baseline atypical pediatric assessment

advanced directives and specialty care plans

cerebral shunt malfunction recognition

adrenal insufficiency crisis stress-dose steroids