This presentation provides Emergency Medical Technicians (EMTs), first responders, and allied professionals with essential tools to identify, respond to, and report suspected child physical abuse. The primary objective is to improve early recognition of abuse in the prehospital setting, where subtle signs are often first encountered.

The course begins with a case study of a six-week-old infant presenting with respiratory failure and a history of unexplained bruising, illustrating how sentinel injuries, minor, poorly explained injuries in pre-cruising infants, frequently precede severe abuse. Research indicates that 27.5% of severe abuse cases are preceded by a sentinel injury, and in 42% of those cases, the injury was known to a medical provider but no protective action was taken. This highlights a critical missed opportunity for prevention.

Participants will learn to identify at least three historical or physical red flags for abuse, including bruises in the TEN-4-FACESp distribution (Torso, Ears, Neck; Frenulum, Angle of jaw, Cheeks, Eyelids, Subconjunctiva; in children under 4 months, or any patterned bruising). The presentation emphasizes that bruising in pre-mobile infants is rare and should raise suspicion. Additional red flags include inconsistent histories, delayed care-seeking, and injuries incompatible with developmental stage.

A significant portion of the training focuses on trauma-informed care. EMTs are taught to interact with children and caregivers in a non-judgmental, calm manner, using open-ended questions, avoiding leading language, and refraining from confronting caregivers. The “report, don’t investigate” principle is stressed. Documentation of exact statements, preservation of evidence, and photographing injuries with scale are reviewed.

The presentation also covers Wisconsin mandated reporter requirements under statute 48.981(2), detailing who must report, how to report to county CPS or law enforcement, and legal protections for good-faith reporters. Penalties for failure to report are outlined.

Finally, the course addresses implicit bias, noting that race does not change abuse risk, but clinician bias contributes to disparities in reporting. Poverty, not race, is the strongest associated factor. EMTs are urged to recognize how fatigue, high workload, and uncertainty can exacerbate bias.

By the end of this session, participants will be equipped to recognize sentinel injuries, apply the TEN-4-FACESp screening tool, respond with trauma-informed care, and fulfill their legal duty to report suspected abuse, ultimately preventing repeat injuries and saving lives.