Recognizing Child Abuse: Critical Steps for EMS and First Responders

As first responders, EMS professionals often encounter situations others don’t—inside homes, in unsafe environments, and during moments of crisis. In this sobering episode of The Erik and Matt Show, Dr. Erik Axene and Matt Ball explore the critical role EMS plays in recognizing and reporting child abuse. From physical exam patterns to the "Ten Four Faces P" mnemonic, this discussion equips first responders with tools to protect children and navigate one of the most challenging aspects of the job.

Transcript

Matt: [00:00:00] On today's podcast, we will be discussing some sensitive topics. Some of the language might not be suitable for all listeners. Listener discretion is advised. Don't forget to like, share, and subscribe.

And I've had doctors tell me that all the time, that, you know, wow, it's a different world because you guys are on scene, you're in the house, you're at the accident site.[00:00:30]

Narrator: We're listening to EMS with your hosts, Erik Axene and Matt Ball.

Erik: So this is the summarize, very important topic. You know, we just filmed our child abuse lecture. So, um, uh, I know. Horrific story, uh, when I was training as a resident in California, um, there was a family, um, that, uh, the kids were [00:01:00] literally chained to beds and the wife as well.

Matt: Now, wait, were you a physician? Were you working as a doctor? In training,

Erik: in training. Training

Matt: to be a physician. And so these patients came into the hospital? To RER. By first responders or

Erik: yes, and law enforcement, sorry, I'm a details guy, a big, big deal type of thing like news stuff. So anyway, but, uh, it was horrific and I think that that's, uh, unfortunately that's, that really happened here.

And, and, uh, hopefully [00:01:30] not to that extent, but it's pretty common to have child abuse. And we talked about it over one child abuse case per minute in the U. S. It's

Matt: about 600

Erik: thousand a year.

Matt: Yeah.

Erik: 1800 more than 1800 deaths in 2021.

Matt: Yeah. So were most of those injuries, I mean, obviously there was a sexual component to those sexual, where they also like, uh, obviously, so neglect, they were malnourished, they were

Erik: malnourished.

So

Matt: what about living conditions in

Erik: the house?

Matt: Right, right, right. [00:02:00] But they were, were they like beaten abused too? Or yeah. So it was I think it was

Erik: really everything.

Matt: All of the above. Oh my gosh, I mean, that's just

Erik: You, you, you told a story too, though. You have a different perspective cause you're actually in the house.

Matt: Yeah. And we talked about that in our lecture and that's, um, you know, it's, it's huge. And I've had doctors tell me that all the time that, you know, wow, it's a different world because you guys are on scene, you're in the house, you're at the accident site and being in the house on [00:02:30] these potential abuse cases, that is a huge component.

to really look at the living conditions of these kids. Um, and it doesn't have the house doesn't have to be a rack or a mess to necessarily mean that there's abuse happening if it's physical or emotional abuse, the kid might be living in a million dollar house with a beautiful bedroom and all the other things, right?

That doesn't necessarily mean that they're not being abused, but yeah, we got called out. Um, it had just finished [00:03:00] pouring down rain. And we got called out for a welfare check. PD had called us out for a welfare check. And we showed up to this nice middle class neighborhood. You know, we're not talking, you know, we're poverty stricken.

This was a nice middle class area. Yeah. And we showed up and PD was there and you could tell by the officer's body language that they were pissed. Like you could just feel it. And they said, your patient's across the street. And we were like, okay. So we [00:03:30] go across the street. to another house. And there was this couple there that had this baby.

And they said that the dad had come home from work while it was pouring down rain and just happened to notice across the street, this little baby about 18 months old was outside of his house in just a diaper in the pouring down rain. Well, of course, being a good human being was like, What is going on?

That's

Erik: not right.

Matt: So he goes over, gets the kid, tries knocking on the [00:04:00] door, ringing the doorbell to get somebody at the house to answer. Nobody answers the door. So he's like, well, I can't just leave this kid out here, obviously. So he takes the kid back to his house with his wife, clean the kid up, dry him off, you know, all those, those things.

And they contacted authorities. So we check this kid out and then we're going over to the other house to figure out, and then the police officers meet us outside and they say, Hey, there's three more kids upstairs. We need you to check on them. We're like, okay. So we walk in the house. And like I say there's [00:04:30] there was three or four cops there and you could just tell by their body language They are just they want to kill somebody and I didn't blame them Yeah, we walked in the house house was it wasn't like a hoarder house where there was just stuff stacked everywhere, but filthy dirty Feces urine on the carpets walking up the stairs.

There was feces and urine in the car Corner by the walls and we're just like, what is going on? Walked upstairs and there was three other smaller children. I think the old, the oldest boy was about 10 or 11 down to this 18 [00:05:00] month old. Um, and just beautiful kids, just big brown eyes, just beautiful kids. And, and there was.

There was a couple of bedrooms upstairs, and I noticed that in each room, there was beds with mattresses, but the mattresses were like stained and dirty, no mattress cover, no sheets, no blankets, no nothing. And these three kids, two girls and a boy, were sitting on this dirty, filthy mattress just watching the TV in one of the rooms.

Right. And [00:05:30] nothing really wrong with them physically. There wasn't any, you know, you know, acute injuries that we were dealing with, but obviously you could tell immediately like this is off. This is not right. We took them all to the hospital. CPS was contacted, but it was just, yeah, it was just to think as, as a dad, as we said in our lecture, we're both dads.

Um, you know, to think about a child living in those conditions is just. It's hard to comprehend.

Erik: It's hard to comprehend how a parent could do that.

Matt: How anybody could do that. [00:06:00] But yes, much less to your own children.

Erik: I know.

Matt: I mean that's just crazy.

Erik: Well I think the best, or the most important part of our lecture was like we talked about at the beginning was pattern recognition.

Matt: Yep.

Erik: Being able to be really keen at organized, keen, organized, more sophisticated in our approach to looking for patterns. You know, it's not a quick, you know, quickly just kind of look at the kid. I mean, we're [00:06:30] actually trying to expose as much skin as we can. When, when the red flags start to go, we're looking at the frenulum.

Remember we talked about that as a sign of potential abuse. Looking for bruising patterns, looking for, you know. The types of maybe even contact. Yeah, frequent calls. Frequent calls. I mean, I think that there's a lot that we can do to, uh, to save these kids. Yeah. And being in the pre hospital environment, you're in a unique place.

You see more, you [00:07:00] experience more, you smell more. Yeah. Um, than I can in the ER looking at this kid in a clean bed. Sterile

Matt: environment, yeah.

Erik: Sterile environment, wearing a gown. Yeah. Obviously, I can still do my exam and look for bruises, too. Right. Um, but the context of things, I think that's something you offer.

I'll never be able to see that. Yeah. Unless you tell me about it.

Matt: Exactly. Yeah. And that's, yeah, a huge part of being the first responder is being able to, You're the eyes and ears for that kid at that point. And, and then you're the [00:07:30] voice for him. And we talked in the lecture about being a mandatory reporter.

If you're a first responder nationwide, you're a mandatory reporter. If you suspect child abuse, you are obligated to report that. But like we said in the lecture, you know, we, we talked about how the parents are probably going to be a little bit defensive. They're going to be acting weird. They're probably not going to want to let.

The child talked to you alone. They're going to be hovering over the child. They're answering questions for the child. And so, you know, on the [00:08:00] call or transporting the kid to the hospital is not the time to call CPS. I'm gonna probably do that after I transfer care to you. Let me

Erik: ask you a question. So, you're, you're at a Patients home, a little kid, you're suspicious of abuse and you know, you're going to call CPS and parents refuse to be transported.

9 1 1 was called for a seizure or whatever, maybe, and they just, and they said, yeah, no, we're not going to go. We've done this before, febrile seizures. We've had them in the past. [00:08:30] Um, I don't think we're going to be transported, but. You know, thank you very much.

Matt: Yeah.

Erik: What do you do? Yeah. What would you do?

Matt: Yeah. Well, so there's lots of resources that you have at your disposal. You know, first off, I'm going to try to use like my verbal Judo and my experience to try to find out how to convince the parents. Yeah. To let me transport this kid, you know, Hey, even though it was a febrile seizures, you know, if they've had these in the past, usually kids only have one, maybe two febrile seizures in their lifetime.

If there's a pattern here, we [00:09:00] want this kid to really be checked out by a neurologist and make sure it's not just a febrile seizure. There's something else going on. And so, you know, I'd really, you know, so use my verbal judo. If that didn't work, I'm going to, my first call would probably be to you. I'm probably calling med control and say, Hey, Why don't you talk to a doctor?

Because as the paramedic, I feel like this team, yeah, the kid needs to go, but I'm saying this to the parents, like, now you're going to talk to a doctor and a doctor is going to recommend and I'm going to go off in private before I talk [00:09:30] to you in front of the parents and let you know, like, Hey doc, I'm suspecting there's something going on here, but we need to get this kid out of here.

If that doesn't work, okay. And they still refuse, then obviously it's called a PD. If I feel that strongly that this kid is in danger. Now I'm getting on the radio or getting on the phone calling dispatch and saying, Hey, I need PD out here.

Erik: And you know, you can tell the parents to like, you get to that point where, well, I'm sorry, but you're going to have to go.

We're calling CPS on this case. It's concerning.

Matt: I'm not [00:10:00] doing that without PD there.

Erik: Correct. Yeah. That's right. And we talked about that in the lecture. Yes. Wait till you're in an area where their assistance is available and present.

Matt: Yeah.

Erik: But, but I think that when you do it, they're going to be angry and you say, well, listen, I mean, if you're willing to be transported, it's nice and easy, otherwise you're going.

You know, with PD, I mean, it's like they can, they can make the choice. They're going to be angry and then, you know, CPS will sort it out. And then if, if there's no child abuse going on, then Hey,

Matt: yeah,

Erik: they can be angry all they want, but it is, [00:10:30] there is a consequence though, to calling. If we're going to call, we better really be suspicious.

We don't want to willy nilly call on any pediatric. Case because right, right. I mean, uh, consequences and families really, I mean, they can have their kids taken away from them for a period of time. The police, you know, interviews, you know, even potential, you know, uh, um, you know, punishment or not punishment, but, um, you know, time away from your kids.

I mean, that's terrible, right? If it [00:11:00] was unnecessary, right? But like we talked about the lecture to, you know, Just like with EKGs, right? You're looking for a pattern. You don't only get EKGs on STEMIs, right? You're going to get EKGs on a lot of people that may not have even needed it. Same thing with these CPS reports.

We're going to hopefully call on more CPS cases than we need so we don't miss as many. Yeah,

Matt: because how many kids is acceptable to miss a case of abuse in?

Erik: Well, that's exactly right. There's none that

Matt: are acceptable.

Erik: And [00:11:30] the reality is we're going to miss some. I mean, I wish we missed zero. We missed about, yes, up to 64 percent in the ER.

As good as we might be, we're, we're going to miss some, some, there may be no physical sign of it. And nothing was said about anything that even hinted at a red flag, just looked like you said Yeah. It's what it looked like from the outside.

Matt: Yep.

Erik: What happens behind closed doors though could be horrific, potentially.

Matt: And a lot of times, you know, and, and I mean, [00:12:00] good Lord, turn on a documentary and watch, you know, or any of those things. These cases aren't always these horrific, there was just a case that came out about, uh, a therapist and a mom who had a massive YouTube channel, hugely successful. This mom was known on her YouTube channel for being like teaching other mothers how to mother their kids.

I don't know, they wanted, they had like four or five kids or something like that. So outward [00:12:30] appearances was like, Oh, yes. Teaching how to parent? Yeah, they, they had a very popular YouTube channel, uh, designed around how to parent their kids. And that was kind of her thing on YouTube is that she would make videos about, oh, this is my son and he's doing this or whatever the case may be.

But that was the whole gist. That was their content essentially come to find out she was abusing all of her children. She was in a lot of neglect and physical abuse. She was abusing all of them, her and [00:13:00] this counselor who is a family counselor who is also involved in this thing. They were jointly involved.

So. My point is, is that, you know, it's not going to be, you know, this terrible looking situation or these, you know, ragged looking people. These could be people living in million dollar houses that you just never can tell, you never can tell who is going to be doing these kinds of things. And so you always got to have your spidey senses up, so to [00:13:30] speak of when you walk into these calls, sad.

Erik: And it's sad to think that we're going to miss it no matter what. But if we can use that acronym, I really like it. The, the, uh, um, 10, four faces P yeah. Uh, I think that those are, um, those are, those are the types of tools that we can have. I know, um, in our department, we've talked about posting that inside the, the, the med unit, just so we have access to it, or.

Yeah.

Matt: It's one of those [00:14:00] things that you might not need to memorize, but hey, this seems weird. Let me pull that out.

Erik: And it's easy. 10 4. Yeah. It's a commonly thing. They add the FACESP later, but the 10 4 is an easy way to remember TEN stands for torso, ears, and neck. Yep. Areas where somebody less than four years old should not have injuries there, or it's at least a red flag.

Right. Less than four. And then the other meaning for four, not only is this meant as a screening tool for Children less than four years old, but it's also a reminder of bruising. Any [00:14:30] bruising in a four month old or younger. Never appropriate. We got to, we got to dig deeper on those and maybe file that report.

Faces P. F. We learned about the frenulum. Um, an important piece of anatomy to know when you're looking for abuse. Um, A, uh, angle of the jaw. Again, not, not, not normal for a kid, uh, to get a broken jaw or an injury to the angle of the jaw. Um, C, the cheeks, the fleshy part of the cheeks. [00:15:00] You know, you get, you, you fall or you.

It's normal to get a cut over the bones underlying the face in some instances, but an injury to the fatty parts of the cheek, that's not normal and that's, it should be a red flag to us. Uh, E is the eyelids, eyelids uncommon, again, protected by the, the, uh, orbit and again, an eyelid injury is a red flag.

And then the S of course, subconjunctival injuries. [00:15:30] That's the white part of the eye. Not a good thing. And then the P of course, so 10. T E N, four, faces, P. The P stands for patterns, and we talked a lot about that today. Let's talk about patterns of bruising. What are bad patterns of bruising?

Matt: Well, you know, we've, we've learned this ever since paramedic school.

Like, bruises of different stages of healing. Yep. Right, so you show up and maybe they've got bruises on this arm that they look fresh. So they're swollen, [00:16:00] they're, they're bruised. purple, red, you know, they look very fresh. And then over on this arm, you've got yellowish brownish bruises that aren't swollen.

Oh, those look like old bruises. Those look like new bruises, or maybe it has like a hand pad, you know, like where they were grabbed and pulled like. That's not, that's not normal. Right. Or we talked about, um, in the lecture, a lot of the back injuries, like, and it's terrible to think about this, but getting whipped with electrical cords or [00:16:30] belts or belt buckles or any of those things, typically that's going to be those patterns are going to be on the back.

Because what's the child going to be doing? They're trying to protect themselves, right? So they're not standing there like this. Like, go ahead and smack me with that belt. No, they're like

Erik: this. Cowering. They're protecting themselves.

Matt: And so when you see these, there's no, like a fall, isn't going to have an electrical cord shape, whip mark on the back of that doesn't happen, you know?

So, but again, you know, kid playing baseball. You know, it [00:17:00] takes a baseball to the face. Okay. That might explain a broken nose or a, you know, soft tissue injury to the cheek that the injury matches the story, but you go to a house and you've been here, you were here three weeks ago.

Erik: Johnny was playing baseball in the backyard or Johnny fell Johnny's three.

Matt: Yeah, exactly. Johnny's exactly. Yeah. Or you were just there two months ago and Johnny had a broken humerus from a fall like kids are going to break their humerus. Typically, they're going to break maybe their [00:17:30] forearms, you know, have a fuchsia injury where they, you know, get that collies fracture or something like that just doesn't match what you're saying.

You know, it's not matching what you're telling me

Erik: when you think you got to look at the injury, the mechanism and. You know Johnny was at a swing set and or play like a jungle gym, and he fell a distance at the jungle gym

Matt: Yeah,

Erik: kids play kids fall. We can have injuries and break bones. Yeah, do things like that

Narrator: right

Erik: but a Yeah.

A three year old?

Narrator: [00:18:00] Yeah.

Erik: Something less than four? Yeah. Those, those little kids aren't climbing up to high places, you know, and, or, or that little baby that, you know, oh, my three month old has got all these bruises. Well, he fell down the stairs the other night, you know, or whatever. Well, uh, yeah. These kids can, can't stand up.

Yeah. .

Matt: Well first off, that's a sign of abuse right there. If they fell the other night.

Erik: Yeah.

Matt: And they're, you're good point. You're just calling now. You know what I mean? Yeah. Like that To me, me red flag is a red flag of, oh, there's so many red flags. Why did you mean most caring parents? If [00:18:30] their kid at two or three falls down a flight of stairs, they're probably calling 9 1 1 right away.

Yeah. You know,

Erik: you know there's an infinite number of combinations of information and physical exam findings you can have. There'd be no way you and I could cover them in one one hour lecture. No, no

Matt: way.

Erik: But the patterns though, we can recognize patterns, hear the history. Uh, this doesn't fit together, even though I've never seen the shape of a wound before, but sure does look a lot like.

whatever, right? A cigarette contact. [00:19:00] Yep. Burns like that. Uh, immersion burns. We talked a lot about burns. Um, we talked the first, second, third degree burns. We talked about the, the stages of bruising. We kind of briefly talked about that in the lecture, all of these patterns, we can store them away and, and fit them up with the, the history.

And if they

Matt: don't match up, that's a red flag. Yeah. Again, like we said about STEMIs and you brought up STEMIs. It's not my job to determine if somebody's having a heart attack. It's my job to look for indicators that [00:19:30] somebody might be having a heart attack. Right. And to pass that along to you guys and other experts to look into.

That's what my job is. That's right. It's not my job to determine if that child's being abused. That's right. It's my job to go, Hmm, this isn't matching up. This house looks dirty. The kid looks malnourished. The kid's got bruises and various stages of healing. Um, It's a lot of red flags here. I'm going to report this and let the experts look into

Erik: this.

You know, it's interesting as I was, you were talking, I'm thinking to myself, I wish you'd shut up. No. Well, you're, you're [00:20:00] actually more than that though, because, you know, you talked about cardiac, right? So you're not the one in the cath lab, reperfusing those coronary arteries when you, cause you are kind of handing it off to the, like, you see it.

We've had many patients. SVT is that, is that WPW and you hand the case to me, I managed to take care of it, call the cardiologist and they do their job. If it was a STEMI, you see the STEMI on an EKG, you recognize the signs and patterns. You got the EKG, that [00:20:30] sign, that pattern you see on the EKG now triggers a new set of events.

Activate, transmit, make sure he gets the aspirin, you know, activate the cath, all that jazz. Yeah.

Matt: Yeah.

Erik: Yeah. , get 'em to the right facility. Right. And then you hand it off to the ER doctor. The ER doctor does their thing. I do my thing and then I hand it off to the cardiologist who actually does the reperfusion that actually fixes the problem.

Right. You with child abuse, you ? Mm-hmm . And me. If it came in through the front doors of the er, [00:21:00] were the cath lab. Yep. We're fixing the problem by calling CPS. That's right. We separate that kid from the abuser. 77% of abusers are parents. This is a big problem and you have the opportunity to activate the cat lab and be the

Matt: interventionalist

Erik: and get that kid safe.

And

Matt: I think, you know, it's a crew, like with everything, this is a crew issue. So, you know, a lot of times, depending on where people [00:21:30] work, you know, you might just be responding in these calls in just an ambulance. It might just be you and your partner. But, you know, if you're a company officer, If you're a driver, whatever, and you know, the paramedics or the EMTs, the paramedics, they're going to be kind of dealing with direct patient care and they might not see the condition of the house.

They might not see the kitchen and all those things where the officer or something could look in and be like, Hmm, this doesn't sound right. They're talking to the parents and the parents are, you know, Well, we got to get in there. We got to see our [00:22:00] kid because they don't want you talking in private with their kid.

So it really takes a crew effort. And so, you know, if you're that company officer, if you're that driver, that extra firefighter who's seeing more information, make sure you tell the treating EMTs and paramedics that so that they can document that information. Because, like we talked about at the end of our lecture, documentation is a huge part of this.

You know, a lot of times these cases, like I'm sure your case went to court. Oh yeah. Probably a huge court case.

Erik: Yeah,

Matt: yeah. And, uh, did you get called into [00:22:30] court on that? No.

Erik: Yeah. I just, uh, the, uh, the treating physicians, they were, they were, um, the RER is pretty big. I wasn't part of the treatment team. You were just a baby doctor's team?

Uh, no, I came to RER, but I wasn't part of the treatment team for it because in most residency programs you have a team of attending physicians with a whole bunch of residents. But it was, um, the stories of that are [00:23:00] horrific.

Matt: Yeah. Well, any of these cases are terrible, you know. Nobody wants to see a kid get hurt.

Like, I don't know if I said it in the lecture or not, but you know, the, the big hero, any hero, any firefighter movie you watch, you know, anything like that. What's the big hero scene?

Erik: Rescue the baby. Right. Where the firefighter

Matt: pulls the, pulls the kid or the baby out of the burning building. Right. And the reality is that doesn't happen very often.

You know, I've been a fireman for 20 years and I've never seen that, never done it. Um, [00:23:30] but I've been on abuse cases, you know? And so it's just as important just because you're not doing the big hero thing and all that stuff. How

Erik: heroic is that for that kiddo that's stuck with mom and dad abusing them or doesn't

Matt: even know they're a baby.

Erik: That's right. They don't

Matt: know. They're six months, a year old. They have no resources, no one to protect them.

Erik: Yeah.

Matt: Yeah. It's. It's sad to think and we talked about to about in your department where they have the pinwheels, and this is a very affluent area. You know, [00:24:00] it doesn't just happen in poor areas, you know, happens everywhere.

More than one kid every minute. That's, that's sad. Terrible to think.

Erik: It is terrible to think. 1, 800 deaths, and we talked about, say, 600, 000 abuse cases every year. New cases, not just, the abuse, it's more than that. Those are the

Matt: reported cases. Right.

Erik: Underreported, underdiagnosed problem. Huge public health emergency.

If you think about

Matt: 64 percent are missed, how many go unreported, you can guarantee that number is over a million. [00:24:30] Yeah. You know, which is just terrible.

Erik: Yeah. And there's, there's so much more, even the emotional abuse side of it. The kids are, uh, it's just tough. It's just, the world could be a tough place and, uh, for kids who are so vulnerable and dependent upon mom and dad, who three quarters of the time are the abusers and, you know, I don't know what goes, I don't know what the next most common one would be, but maybe extended family too, right?

Yeah. Or caregivers, depending on, yeah. [00:25:00]

Matt: Brothers, sisters, siblings. I'm sure it was probably huge.

Erik: I think to sum things up, if you, if, um, you know, we've gone, I mean, you've gone through that lecture, if you haven't watched it, watch it. I mean, it's a good lecture to review some of these pattern recognition. Um, I learned something new just in reading, uh, sobering.

It's horrific what's going on. Um, but, but to sum things up though, uh, the obviously got the 10, uh, 10, four faces B. [00:25:30] Um, acronym, which is a good tool you can use. Um, but, uh, if you were gonna, if you were gonna say something, to, to our, uh, to a new paramedic who's learning, who's gonna see thousands of patients in his or her career, what advice would you give them about child abuse?

Matt: It's, you know, that it's not going to be, it might not be obvious. Again, you might be in a million dollar house and the kid might look fine, but there'll be [00:26:00] signs, you know? Okay, how's the kid interacting with the parents? You know, are they being vague about what's going on? Oh, no, I'm fine. I'm fine. Like we talked about in our lecture.

So I would just say it's a bigger problem than people think until you really start looking into the statistics and you're like, Wow, this is a bigger problem than I thought it was, you know, where this happens in my town, you know, I didn't think this happened here. We live in a nice area. Um, always, anytime you're dealing with a kid, just always have that [00:26:30] element of, and you can even take this to elder abuse too, like you go into nursing.

Oh,

Erik: ATS too.

Matt: Yeah. It's the same thing. So, you know, you can, we're the front lines being out there in the field. We're the front lines, just always have your radar up. For something that seems off, and don't be afraid to call and report something.

Erik: That's really good. I would say, let the physical exam talk to you.

These kids don't know that what's happening is bad. They wouldn't know to verbalize. That's right. [00:27:00] You ask, hey Johnny, do you feel safe? If you did ask that question, Johnny Oh yeah, report. Doesn't know any difference. This is what he knows, right? Exactly. It's normal to be chained to your bedroom. The only way to get the truth, the only way to let that kiddo talk to you, might be that physical exam.

Just behooves us to do a thorough, meticulous, systematic physical exam. And if you see any red flags, you just pull up the sleeve, you see some bruises, and some more bruises. [00:27:30] Check the frenulum.

Matt: Lift up the back of the shirt,

Erik: look at their back. This is not looking good.

Matt: Yeah.

Erik: And then you start seeing more and then you, the 10, four faces pee.

Oh, wow. This is, you know, let the physical exam talk. Be thorough, meticulous, and systematic. And document it. And document it. Heavily. Be strategic in your communication too. These are, well, we got more than one point, but yeah, there's lots

Matt: of stuff. Lots of levels to it. Yep. Well, it's not a fun conversation, but it's an important one.[00:28:00]

Erik: So. This is a, uh, I guess, uh, it's worth, it's worth even mentioning too, that as we talk about this sobering subject is that this is part of the reason why burnout, these calls are tough on the

Matt: responders too. Yeah, for sure. Yeah, this

Erik: is not easy. So, um, um, there's a moral injury with these types of things.

And then even to think about, in my career. The how many times have I missed it? Right. And there's a moral injury there too. So [00:28:30] we got to do the best we can with every patient. You can't do better than your best, but just be faithful. Treat that kiddo like it's your own family. Really, you may be the one saving their life next week.

They could be in the morgue. You never know. So anyway, good, good lecture. We did watch it. If you haven't child abuse lecture, um, important to watch and then great, great, great podcast.

Matt: See you in the next one. See you.[00:29:00]

Narrator: Thank you for listening to EMS, the Erik and Matt Show.