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Emergency staff must be properly trained to treat children, royal college says

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39205.690069.DB (Published 10 May 2007) Cite this as: BMJ 2007;334:974
  1. Kirsten Patrick
  1. BMJ

    Children should get emergency treatment from professionals who are specifically trained in delivering paediatric emergency care, a report from the Royal College of Paediatrics and Child Health says.

    All frontline staff in the United Kingdom who deliver urgent care to children, including ambulance technicians and paramedics, must be competent in the basic skills required for safe practice.

    Attendances of children at UK accident and emergency departments have increased since the new general medical services contract for GPs was introduced in April 2004, which reduced the availability of out of hours care.

    A survey of emergency departments conducted across the UK showed that only 30% of emergency departments that saw more than 18 000 patients a year had a consultant trained in paediatric emergency medicine on duty at all times of the day (BMJ 2005;330:73-4, doi: 10.1136/bmj.38313.580324.F7). It also found that only 32% of departments had at least one trained children's nurse on duty at all times and that only 11% would have adequate paediatric care in the event of a major incident.

    Patricia Hamilton, the college's president, said, “Deficiencies in emergency services for children were recently highlighted by the Healthcare Commission. The RCPCH [Royal College of Paediatrics and Child Health] is now calling for these new standards to be implemented in line with the national service framework, to give children safe, high quality care.

    “We must think about these services from the position of the child or young person, and we are actively encouraging local services to engage with children and young people about their needs.”

    Referring children to larger, dedicated centres and establishing cross site or community hospital arrangements for the care of children is crucial to providing an acceptable service, the report says.

    It acknowledges that not all centres can provide 24 hour specialist emergency paediatric care, because of the limited availability of trained staff. The report recommends better links between acute trusts and smaller centres, including managed clinical networks with shared protocols, shared training, programmes to improve quality, and rotating specialist staff.

    Commissioners and providers should work together to establish geographical networks, it says.

    GPs will have less contact with sick children as urgent care is increasingly provided by other groups of staff, says the report. Therefore GPs need to take steps to ensure that they maintain their competence in managing acutely ill children.

    Community based delivery of health care for all, including children, is now being increasingly emphasised, the report says. Emergency care practitioners may attend to children without bringing them to hospital, in line with the national service framework for children. The report says that a system must be in place to notify the primary care team of a home consultation, in the same way as for attendances at emergency departments.

    The report's purpose is to improve the experience of children in emergency departments and their outcomes. However, it says that its guidelines should be extended to the entire network of pre-hospital services that provide urgent care to ensure an adequate standard of care.

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