PEDS TRAUMA REPORT Year in Review

PEDIATRIC TRAUMA REPORT

AN OVERVIEW OF UPSTATE’S PEDIATRIC TRAUMA CENTER PROGRAM

2021-2022

PEDIATRIC TRAUMA

If a child is in a situation where they need immediate care for life-threatening injuries, a pediatric trauma center provides all the resources. Not every hospital would have a trauma surgeon waiting there for the patient, as well as ICU and nursing teams specifically trained to care for pediatric trauma patients. Upstate is proud of the role it plays for the children and young teens of our region The Region’s Only Level-One Trauma Center

Letter from Program Leadership

Upstate’s Golisano Children’s Hospital’s Level 1 Pediatric Trauma Center is a vital resource for Central New York (CNY). It is the only Level 1 Pediatric Trauma Center in the CNY Region, and is one of only seven ACS verified level I Pediatric Trauma Centers in the state of New York. Currently, we are one of the busiest Pediatric Trauma Center in New York State.

As a Level I Pediatric Trauma Center, Upstate is available to serve the pediatric community 24 hours a day, 7 days a week, 365 days a year to ensure that children with injuries of all types receive the best evaluation and treatment possible. Caring for patients from infancy to 14 years of age, the Pediatric Trauma Center has the necessary resources and education to treat the most severely injured patients in the CNY Region.

To maintain its verification status, the Pediatric Trauma Program must go through a rigorous evaluation process by the American College of Surgeons Committee on Trauma (ASC-COT) every three years. This

Location of Level I and II

Pediatric Trauma Centers, US

Sources: GAO analysis of American Trauma Society data (data) Map Resources (map). GAO-17-334

Note: To identify trauma center locations, we used 2015 data from the Trauma Information Exchange Program of the American Trauma Society. “High-level pediatric trauma center” refers to level I and level II pediatric trauma centers. In 2015, there were 136 high-level pediatric trauma centers in the United States.

process helps to maintain our high standards and ensure our commitment to providing the best care to the populations we serve.

ACS verification involves not only a responsibility to our patients but also to the regional Emergency Medical Services (EMS) and other hospitals in the area. Focus is placed on meeting ASC-COT, New York State Department of Health (NYSDOH) and Upstate University Hospital standards during the entire continuum of care. This begins with injury prevention and proceeds through the acute hospital phase to rehabilitation and/or follow up care. Areas such as quality improvement, outreach, and education are continually being evaluated based on the most current best practices and evidence-based research.

We are excited to share with you our Pediatric Trauma Report, highlighting those areas that make our Pediatric Trauma program one of the best in New York state. We hope you enjoy learning about the people and services involved in our achieving the distinction of being an ACS verified Level I Pediatric Trauma Center.

Kim Wallenstein, MD, PhD Pediatric Trauma Medical Director

Jill Hayward, MPH, BSN, RN, CPN Pediatric Trauma Program Manager

UPSTATE PEDIATRIC TRAUMA REGION

The CNY Trauma Region itself consists of 14 counties, serving 1.7 million people and in 2021-2022 included transfers from 33 referring hospitals.

According to the NYSDOH, Golisano Children’s Hospital’s Level 1 Pediatric Trauma Center sees among the highest volumes of pediatric patients in the state. In the past two years

approximately 7,602 patients aged 0-14 years presented to Upstate Golisano Children’s Hospital with an identifiable injury. Of these, 937 were admitted and 1,379 met the specific criteria to be entered in the trauma registry.

As a Level I Pediatric Trauma Center, Upstate receives patients in need of specialized pediatric services that are

not offered at non-trauma centers within the region. In 2021-2022, Upstate received 757 pediatric patients from 33 Outside Hospitals (OSHs), accounting for 55% of the registry entrants. Twelve hospitals in particular accounted for 37% of those transfers.

Top 12 Hospitals that Tranfer patients to Upsate Pediatric Trauma Center 2021-2022

Syracuse

WHAT MAKES A PEDIATRIC LEVEL I TRAUMA CENTER UNIQUE

Trauma has been reported as the most common cause of pediatric mortality and disability. In fact, according to the ACS, more children die from injury than from all other causes combined. It is imperative to have systems in place that are developed based on knowledge, experience, and skill to help reduce the negative secondary effects and long-term medical and psychological problems that often follow a traumatic injury.

Children are not just small adults. There are anatomical and physiological differences that must be factored in when providing care for a child. In addition, there are differences in the mechanisms of injury in the various stages of childhood. These differences must be considered when anticipating the potential injuries sustained and providing the most effective treatment plans. Statistics have shown that there are increased rates of survival when a pediatric patient receives care at a Pediatric Trauma Center. The circumstances surrounding injury in children necessitate a unique response to major trauma and the allocation of specialized pediatric resources.

As the region’s only Level 1 Pediatric Trauma Center, Upstate Golisano Children’s Hospital takes a comprehensive approach to trauma. Childhood injury is a major public health concern, and there must be processes in place to evaluate and improve systems of emergency medicine and provide the highest quality of pediatric trauma care.

This high-quality care begins with injury prevention, continues with pre-hospital services and hospitalbased trauma care, and does not end until follow up care and/or rehabilitation has been established.

Pre-Hospital

The primary goals of EMS in the pre-hospital setting are to prevent further injury, initiate resuscitation and provide safe and timely transport to the appropriate location. The Center for Disease Control (CDC) publishes field criteria to assist EMS providers in the decision-making process when it comes to the appropriate location of transport. NYSDOH Division of Emergency Medical Services for Children (EMSC) further recognizes

the importance of an appropriate transport destination, stating that, “children should be transported from the field to a level 1 or 2 Pediatric Trauma Center if they meet CDC field trauma triage guidelines and are able to arrive within 60 minutes of injury.”

Communication through an Activation System

In addition to transport, part of pre-hospital care includes notifying Upstate that a patient is on the way. This communication between EMS and the Pediatric Emergency Department (PED) is through Upstate’s Trauma Activation System and is based on a defined set of criteria. Once the information is received, a page is sent out alerting the necessary teams who can then make the essential preparations to facilitate safe and efficient medical treatment. Thus, care of the trauma patient begins before the patient even arrives at Upstate. The activation level determines what personnel is required to be present and the expected period of time in which they must arrive.

Levels of Activation:

A Level I trauma is the highest activation and is initiated for a patient who meets a certain mechanism of injury criteria and/or has unstable vital signs consistent with life threatening injuries. The Trauma Surgeon is required to be at the patient's bedside within 15 min of the patient's arrival. A Level II trauma is activated for patients who have stable vital signs pre-hospital but have either sustained or potentially have a severe injury. For both levels, the appropriate resources, including such areas as the Operating Room, Pediatric Intensive care Unit (PICU), radiology and blood bank are set in motion, and the full system prepares for whatever immediate care is needed. A Trauma Consult is another form of activation and is used when the patient has sustained a traumatic injury and is stable, but must be evaluated by the trauma team to determine an appropriate disposition and plan of care

DEDICATED PEDIATRIC EMERGENCY DEPARTMENT (PED) AND PERSONNEL

As a Level 1 Pediatric Trauma Center, Upstate has a dedicated PED consisting of staff that is well trained and experienced in pediatric emergencies. As the size and age of the child must always be considered when preparing for and treating an injured child, factors such as weightbased drug dosages and equipment sizes must be considered. Pediatric Emergency Medicine providers are familiar with the specific nuances of pediatric care and have the formalized education, clinical training and experience to anticipate occurrences that may arise frequently in or are unique to the pediatric population.

In order to respond to a pediatric trauma activation, pediatric

emergency department nursing staff follow a strict orientation process and must go through a specialized trauma-focused training program which includes taking several nationally recognized and hospital-based courses.

In addition to highly trained personnel, the PED and Trauma Bays have specialized equipment that is tailored to care for pediatric patients.

Dedicated Pediatric Trauma Surgeons

At the center of the Pediatric Trauma Center at Upstate are the team of highly trained and experienced Pediatric Trauma

Surgeons who are always available. This surgical commitment is essential for the trauma center and entire pediatric trauma system to effectively operate. The pediatric surgeon serves as the leader of the resuscitation team and participates in the initial evaluation and resuscitation for the most critically injured patients. They are also responsible for coordinating all aspects of care throughout the trauma patient’s stay.

To serve in this role, the trauma surgeons must have met certain training requirements including board certification, clinical involvement, performance improvement and continuing education.

Kim Wallenstein, MD, PHD Tamer Ahmed, MD Michaela Kollisch-Singule, MD Andreas Meier, MD, MEd Jennifer Stanger, MD, MSc

Dedicated Pediatric Trauma Surgeons

Dedicated Liaisons and Mid-level Providers

To be certified as a Level I Pediatric Trauma Center, there is a requirement to have specific surgical subspecialities that are available to support the pediatric patient's treatment needs. At the forefront of these subspecialties are neurosurgery and orthopedics who must be present

There are additional liaisons who provide input to our trauma system team:

Matthew Thornton, MD

Matthew Sullivan, MD

Ravikumar Hanumaiah, MD

Sarah Harding, MD

Satish Krishnamurthy, MD

Venkata Sampathi, MD

and respond within 30 minutes to the most critically injured patients based on patient needs. Other equally important subspecialties include critical care physicians, child abuse providers, otolaryngology, ophthalmology, anesthesia, and radiology.

accepting responsibility for the admission and further workup of the patient is critical to smooth transition of care. An important piece of that trauma team includes mid-level providers who are instrumental in ensuring that all the necessary steps are taken to provide the high-quality care that happens here at Upstate.

Communication between the Trauma Team and the surgical service

Angela Wratney, MD Erin Hanley, MD Anand Majmudar, MD, Sara Fisher, NP Doug Sandbrook Pediatric Critical Care Emergency Dept Radiology EMS liaison

Rajin Shahriar, MD Zulma Tovar-Spinoza MD Jadwiga Bednarczyk, MD Orthopedics Neurosurgery Anesthesia

DEDICATED SERVICES

RANGE OF COMPREHENSIVE PEDIATRIC CARE

Critical to a Level 1 Pediatric Trauma Center is the availability of a Pediatric Intensive Care Unit (PICU) and Pediatric Operating Room (OR) to accept and participate in the treatment of critically injured children. The PICU at Upstate a has a designated trauma room with highly trained dedicated staff who are well prepared to accept a trauma patient at a moment's notice. Upstate has 24/7 OR capability to emergently treat critically injured children, with pediatric resources always available.

Social Work, Case Management, Child Life and Chaplain Services

Another integral part of the services that are provided here at Upstate is the involvement of Social Work, Case Management and Spiritual Care. Social work is available 24/7 to support families during times of crisis, including assisting with insurance issues, providing support in decision making, providing referrals for accommodations, and assisting with services as patients and families adjust to the injuries sustained that may necessitate future lifestyle changes. Case Management assists with referral for home equipment needs or to other long-term care services. Child Life personnel interact through play and communication to reduce the anxiety that often accompanies hospitalization, enabling patients to better cope with the medical

environment. Spiritual Care meets with families to assess what services they can provide and to support children and their families in times when the future may be uncertain and when there are tough choices to be made.

Rehabilitation

An important part in the continuum of care is assessing the rehabilitation needs of an injured child and preserving optimal functional recovery. Rehabilitation benefits from input from a multidisciplinary team including a physical medicine and rehabilitation provider, physical therapist, occupational therapist, pain control specialist, nutritional therapist, and psychologist who can perform post-traumatic stress evaluation and intervention. At Upstate we have a dedicated inpatient rehabilitation unit for those patients who need intensive specific therapy as well as outpatient services which specialize in both the physical and mental health recovery following a traumatic injury.

The availability of all these services is part of what makes Upstate unique in their ability to effectively care for pediatric patients. These services work together to ensure that the child brought to our pediatric trauma center has the best team possible for their care.

Outpatient Services are supported by Cathleen Caltabiano, PPCNP-BC, Surgery, Inpatient Mental Health Screening are supported by Pediatric Clinical Psychologists including Kathryn Hagen, PsyD

David Kanter, MD, Assistant Professor, Physical Medicine and Rehabilitation

What Verification Means and Why It is Important

The American College of Surgeons, Committee on Trauma (ACS-COT) established a Verification, Review and Consultation (VRC) Program to assist hospitals in their evaluation of trauma readiness and to improve overall trauma care. This verification process is conducted every 3 years over a rigorous 2-day site visit in which the entire trauma program is reviewed using Resources for Optimal care of the Injured Patient as a guide in the process. In addition to reviewing all aspects of medical care provided (from pre-hospital to rehabilitation), other categories such as hospital commitment to the success of the trauma program, trauma readiness, education, available resources, policies, and performance improvement measures are also assessed.

A successful verification establishes the distinction that a program has succeeded in meeting the demanding requirements established by the ACSCOT. Few hospitals have been able to achieve this recognition. In New York State there are currently 7 Level I Pediatric Trauma Centers and 6 Level II Pediatric Trauma Centers. Proudly, Upstate has held the distinction of being a Level I Pediatric Trauma Center since 2013 and has continued to provide comprehensive, reliable, specialized pediatric trauma care of the highest standard since its first verification. Maintaining an ACSverified level I pediatric trauma center

verification provides a significant, farreaching service to the Central New York trauma region and community.

Spotlight- Child Life

A Certified Child Life Specialist is a healthcare professional who plays a vital role in the treatment of the injured child by focusing on the psychosocial, emotional, and developmental needs of children and families during medical encounters.

The Child Life Specialist holds a bachelor's or master's degree in Child Life or a related field that includes education in child development, medical aspects of hospitalization, developmental disabilities, and educational modalities. In addition, candidates must complete a 600-hour internship and successfully pass a certification exam given by the Association for Child Life professionals.

How does Child Life support the Trauma patient?

The Child Life Specialist is part of the activation team that receives an alert. At the moment the alert is received, the child life specialist mentally begins the preparation for what the pediatric trauma patient might need based on the patient’s age and potential injury. They are well versed in the medical evaluation, diagnostic tests and initial treatment process that takes place in

the trauma bay. They are at the patient’s bedside every step of the way to give the patient a friendly face to focus on and can explain to the child the details of what is happening in a manner that the child can understand. They play a vital role in decreasing anxiety in an unfamiliar world.

Whether the patient’s next step is to the OR, PICU or Pediatric Surgical Floor, there is a child life team member to assist the patient and family throughout their entire hospital stay.

Child Life Therapist Jessica Baker describes her role: “In addition, I can help parents have difficult conversations with patients in relation to injury and loss. I also provide developmentally appropriate resources for parents to talk with siblings about the patient’s injuries. Another significant role is normalizing the hospital and providing patients with play opportunities throughout their admission. We aim to meet the individual needs of every patient and family we work with.”

Ann Botash, MD Co-Director CARE Program

Alicia Pekarsky, MD Co-Director CARE Program

Kristin Razawich, PNP CARE Program

NON-ACCIDENTAL TRAUMA

About 1 in 7 children experienced child abuse and neglect in the last year.

Source: CDC reports

Child maltreatment is a leading cause of death and disability in the nation and New York State and a serious public health concern.

The very young are most at risk, with the victimization rate highest for children younger than 1 year of age, with younger children being the most vulnerable to death as a result of their injuries.

Diagnosing and treating child abuse is a complex process with additional education and training needed among providers who care for children. Child Abuse Pediatricians (CAPs), certified by the American Board of Pediatrics, have additional specialized training and experience in child abuse. Upstate is fortunate to have the Child Abuse Referral and Evaluation (CARE) Program and the Inpatient Child Abuse Pediatrician services available.

Founded in 1990, the CARE Program, through its offices at the McMahon Ryan Child Advocacy Center (CAC), provides medical evaluations for children who are suspected of being maltreated or abused.

The CARE team consists of two American Board of Pediatrics certified Child Abuse Pediatricians, specially trained nurse practitioners, a nurse, and social workers who work together in managing suspected child and adolescent victims of maltreatment

In the Fall of 2020, the CARE program expanded to include its Child Abuse

Pediatrics (CAP) consult service to better serve inpatient needs. This has been a highly successful service to ensure that all appropriate medical evaluations, communications with investigative agencies and safety plans are taking place.

Over the past few years, the child abuse team, together with the trauma team and other Non-Accidental Trauma (NAT) subcommittee members (PED providers, inpatient providers, SW, radiology, nursing quality and administration, and IMT) devoted time and resources to updating our Non-Accidental Trauma Protocols and guidelines. These guidelines are important in assisting the standardization of care as it relates to the identification of and treatment of NAT.

In 2021 and 2022, 169 patients (excluding burn) were entered into the trauma registry with a mechanism of injury of suspected physical NAT. The most common injury noted in these patients was that of bruises/contusions, with other common injuries including extremity fractures, skull fractures, and brain hemorrhages.

The child abuse team played a crucial role in the evaluation and treatment of these patients to ensure that all aspects of the protocols were in place, to aid the primary team in medical treatment and follow-up care as well to assist in the coordination of a safe discharge plan.

What are Children’s Advocacy Centers?

Children’s Advocacy Centers are child-friendly facilities that offer safety, security and a wide range of victim services for children and families that have been exposed to violence and abuse. These communitybased centers and their staff serve as first responders in allegations of all types of child abuse, and they provide direct services to children in need and in crisis. The CAC response works to reduce the impact of child abuse by bringing together law enforcement, criminal justice, child protection, forensic interviewers, prosecution, mental health, medical and victim advocacy professionals in a child-friendly setting to investigage abuse, hold offenders accountable, and most importantly help chilcren heal from the trauma of abuse.

OUTREACH & EDUCATION

As the Central New York Region’s Level I Pediatric Trauma Center, it is Upstate’s responsibility to be a resource to the medical community to promote the highest-level of care to trauma patients.

Interacting with hospitals and EMS agencies in our trauma region allows a better understanding of the care that they provide and the resources they possess.

Trauma research identifies current best practices for the care of trauma patients which is shared through formal educational programs.

National certification programs are conducted for EMS providers, nurses, advanced practice providers and physicians both at Upstate and throughout our trauma region.

The pandemic created challenges to traditional methods of visiting

outside hospitals and conducting educational programs.

Virtual visits replaced those conducted on-site at outside agencies.

Virtual classrooms and on-line learning modules replaced traditional lectures while in-person sessions were still necessary for skills training and testing.

Funding

Regional Training Center grant funding helped to support several courses (ATCN, RTTDC and PCAR). The grant supports emergency preparedness training which includes trauma education. The Regional Training Center is funded by the New York State Department of Health through the national Hospital Preparedness Program

Distinct types of training and resources are available for physicians and nurses on the delivery of trauma care.

grant. The Patil Grant, through the department of Pediatrics, also helped to support the funding for several pediatric nurses to be able to take PCAR.

Follow-up Letters

Hospitals that transfer patients to the Trauma Center receive a monthly report with specific information regarding those patients. The data provided includes patient disposition, diagnoses and procedures performed. Included with the data are three process improvement (PI) projects that can be implemented at the referring hospital, utilizing the data in the report, to assist in evaluating the care they provided. The PI projects are Airway Management, Hospital Length of Stay and Shock.

Follow-up reporting to EMS agencies occurs quarterly. This report includes Emergency Department disposition, hospital disposition, diagnosis, and hospital length of stay information. Suggested PI projects are Field Activations for Trauma Codes and Scene Time.

Education Programs Offered

Course Name

ATCN (Advanced Trauma Care for Nurses)

ATLS (Advanced Trauma Life Support) at Upstate

ATLS (Advanced Trauma Life Support) at Fort Drum

ATOM (Advanced Trauma Operative Management)

RTTDC (Rural Trauma Team Development Course)

Stop the Bleed

PCAR (Pediatric Care After Resuscitation)

TNCC (Trauma Nurse Core Course)

Trauma Resuscitation - Remote

Trauma Resuscitation - Upstate

INJURY PREVENTION

Injury Prevention

PREVENTABLE INJURIES ARE THE #1 KILLER OF CHILDREN IN THE U.S.

Every year, 8,000 families lose a child because of a preventable injury. When a child dies, the lives of families are changed forever.

Injury Prevention is a vital part of a Level I Trauma Center. In a Pediatric Trauma Program this means identifying the most frequent injuries among the pediatric population and developing programs to address these top injurie.

Programs can focus on preventing injury through education and enforcement as well as making environmental modification to prevent further injury when an accident does occur. This can interventions in the home, when at play and on the road.

2020, both sexes, all ages, all races -

COLLABORATION WITH COMMUNITY PARTNERS

Covid-19 Impact on Injury Prevention Efforts

While we are all social distancing during the coronavirus pandemic, our homes are not just a place for us to live—they have become our offices, schools and playgrounds. Even as families try to stay home as much as possible during the coronavirus pandemic, there are times when a trip in the car with the kids is essential.

The Upstate New York Safe Kids Coalition is committed to identifying the most prevalent causes of unintentional injury for the children of our community, through advocacy, education and the use of proven injury prevention strategies stimulate changes in adult and child behavior and the environment to reduce the incidence of these injuries.

To support parents and caregivers during COVID-19, Safe Kids Upstate NY was able to provide parents and caregivers online and virtual resources which could be accessed. These resources enabled the proper fitting

of car seats as well as other measures to keep children safe around cars. Utilizing new ways to provide information and education through means like QR codes and other new inventive tools was necessary to still provide our community with resources it needs. The goal in 2021 was to provide outreach and resources that specifically address our communities’ injuries so that there is a decreased risk for our most precious future, our children

Upstate NY Safe Kids collaborates with the Upstate University Pediatric Trauma Department to reach the mission goals to keep kids safe. Pediatric Trauma and Safe Kids Upstate NY are of the shared belief that unintentional injuries are predictable and preventable. Pediatric Trauma and Safe Kids can provide accurate and on-going injury prevention information to our community. Both in collaboration can provide community programs,

outreach and events while supplying support and reinforcement to the programs of our injury prevention partners in the communities that are served.

The Syracuse Mets are one of nearly 20 community partners and events the trauma team collaborates with each year.

PEDIATRIC TRAUMA PROGRAM

The Pediatric Trauma Program consists of a team of individuals whose main priority is ensuring optimal care for the pediatric trauma patients while fulfilling all of the requirements of the ACS. In addition to patient care that the members of the trauma team provides, the department must ensure that the

Pediatric Trauma Team

data from the patient charts is accurately captured in the trauma registry. This data is analyzed for completeness and adherence to standards is scrutinized. Opportunities to improve care must be identified and action plans put in place to ensure that the quality of care received at Golisano’s Level I

Pediatric Trauma center remains at the highest level. Members of the pediatric trauma department belong to professional organizations dedicated to the care of trauma patients and children.

Jill Hayward, MPH, BSN, RN, CPN Pediatric Trauma Program Manager

Performance Improvement Coordinator – currently hiring

Miranda Wasilenko, RHIT, CAISS Jerome Morrison, RN

Liz Sapio, BS, CPE Susan Pierpoint Pediatric Trauma Registrar Outreach and Education Safe Kids / Pediatric Injury Pediatric Trauma Registrar Coordinator

Kim Wallenstein, MD, PhD Pediatric Trauma Medical Director

For more information on Pediatric Trauma programs: