FIELD REFERENCE
Full criteria & treatment guidance
First impression
- Use visual and auditory observations. The triangle is particularly useful in children younger than 5.
- Continue assessment and use the applicable pediatric standing order for treatment.
1. Appearance
- Tone: observe movement and posture.
- Interaction: look for alertness and engagement with people or surroundings.
- Consolability: assess response to a caregiver.
- Look/gaze: observe eye contact and tracking.
- Speech/cry: listen to the strength and character of the voice or cry.
2. Work of breathing
- Observe breathing effort and listen for abnormal respiratory sounds.
3. Circulation to skin
- Observe skin color for pallor, mottling, or cyanosis.
Turn the impression into a focused assessment
- Use the triangle as a rapid visual/auditory impression, then assess airway, ventilation, perfusion, and mental status. It does not supply a stand-alone diagnosis or treatment order.
- When documenting depressed consciousness, use the age-appropriate GCS components; PR-002 has separate scoring for age 2 and younger.
Find the next pathway
- For respiratory distress, use SO-P-035 and reassess the response to oxygen, airway support, and the specific treatment. For altered mental status, SO-P-065 includes a glucose check and treatment of poor perfusion.
- 310.00 identifies pediatric respiratory distress and circulatory compromise as base-contact triggers, with a pediatric-capable base preferred. A reassuring momentary appearance does not cancel the BRUE contact criteria.
VISUAL FIELD REFERENCE
Three sides of the first impression
Pediatric · Assessment
Appearance
Tone: observe movement and posture.
Interaction: look for alertness and engagement with people or surroundings.
Consolability: assess response to a caregiver.
Look/gaze: observe eye contact and tracking.
Speech/cry: listen to the strength and character of the voice or cry.
Work of breathing
Observe breathing effort and listen for abnormal respiratory sounds.
Circulation to skin
Observe skin color for pallor, mottling, or cyanosis.
- Use the triangle as a rapid visual/auditory impression, then assess airway, ventilation, perfusion, and mental status. It does not supply a stand-alone diagnosis or treatment order.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. PR-001 · PR-002 · SO-P-035 · SO-P-065 · 310.00
UNDERSTAND THE CARE
How the triangle guides the next examination
The triangle organizes the first impression before a lengthy examination. Appearance includes tone, interaction, consolability, gaze and speech or cry; breathing and skin circulation supply different information. Describe which part looks abnormal so the rest of the team knows what needs immediate attention.
Applying the guidance
The next step is a focused assessment of airway, ventilation, perfusion and mental status. Use the caregiver’s description of normal behavior to interpret the child’s interaction. A reassuring snapshot does not cancel a concerning event history or the local base-contact requirements, particularly for a reported resolved event.
Putting it together
Teaching example: the child’s color appears normal but interaction is markedly reduced and breathing effort is abnormal. Communicate those separate observations and move to the respiratory and mental-status assessment.
Diagram text & teaching checkpoints
- Appearance
- Tone, interaction, consolability, gaze, cry.
- Work of breathing
- Effort and abnormal sounds.
- Circulation to skin
- Pallor, mottling or cyanosis.
- Focused assessment
- Use the findings to choose the next pathway.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Turn caregiver observations into a useful reassessment
Ask the caregiver for a concrete comparison with the child’s usual behavior: how the child normally looks toward them, moves, responds and cries or speaks. Record what was witnessed and when, then describe what the crew sees now. Keeping those accounts separate is especially useful when the child appears better by the time EMS arrives.
A focused handoff can follow the triangle without reducing it to a score: appearance, work of breathing and skin circulation, followed by the vital signs and treatment response. Repeat the same observations so the receiving team can understand the change.
Teaching example: a caregiver describes an episode of limpness and color change, but the child is now interacting. Include both the reported episode and current findings. The reassuring present examination does not remove the historical-event contact provisions in Policy 310.00. The triangle is an entry into the examination, not permission to disregard the history.
OCEMS source: PR-001: Pediatric Assessment Triangle.
Contact requirements: Policy 310.00, pediatric base-contact criteria.