Reigniting passion in emergent care: Empowering advocacy in transforming pediatric trauma hypothermia outcomes from scene to ER

Background: Emergency nurses and frontline clinicians across Canada are familiar with the diamond of death, a core principle in emergency education. Despite this knowledge, hypothermia remains a predictable and preventable complication in trauma care particularly among pediatric patients. Children are especially vulnerable due to immature thermoregulation, a risk factor heightened when urgent surgical intervention limits rewarming time. Trauma-associated hypothermia is directly linked to increased morbidity and mortality. Empowering emergency nurses and frontline clinicians to advocate for early, aggressive temperature monitoring and management is essential to improving outcomes and upholding excellence in pediatric trauma care. At the conclusion of this 60 min presentation, participants will be able to: 1. Review current evidence and research demonstrating the relationship between shock, trauma-associated hypothermia and accelerated mortality in pediatric patients. 2. Analyze data from local trauma registry to identify trends and opportunities for improvement. 3. Describe clinical rationale supporting early and aggressive temperature monitoring and management in pediatric trauma care. 4. Identify evidence-based approaches to temperature regulation and management in pediatric trauma, promoting advocacy and a standard of excellence in care. Methods/Implementation: Local trauma Data was reviewed from Dec 2019-June 2023 to include 103 pediatric patients with a recorded trauma score of Injury Severity Score (ISS) >12 who required operative services in their care pathway. Of note, patients who did not have any temperature recorded in the emergency department portion of their journey were excluded. Components included in the multivariate analysis: hypothermia, age of patient, season of trauma, ISS, and mortality. Evaluation/Results: • Patients ranged from 0–17 years of age with a mean of 12.8 and median of 14 years • ISS ranged from 12–75 with a mean of 23.8 and a median of 22 • 29.1 patients presented to emergency already hypothermic (<36°C), 44.7% were normothermic and 26.3% had no temperature documented (removed from review) • Mortality rate was 5.8% • Of the population who proceeded to an operating room in their care pathway, 65.8% were normothermic in the emergency room but were unable to regulate their temperature and became hypothermic at the first set of operative vitals (32%) Implications and Lessons Learned: Local trauma data revealed that over one-third of pediatric trauma patients were hypothermic at the scene, with many remaining or becoming hypothermic in the emergency department. These findings underscored the need for practice change and led to the integration of temperature regulation as a fundamental component of pediatric trauma care. The adoption of standardized warming protocols—including fluid warmers, active rewarming, and forced-air warming—reinforced through focused staff education and trauma focused simulation, has enhanced proactive hypothermia management. This work emphasizes the pivotal role of frontline nursing and clinician advocacy in driving practice change and improving pediatric trauma outcomes.