Accident and emergency departments still lacking in essential services for children

Five years after accident and emergency departments were found to be lacking in essential services for children, many still fail to meet the minimum standards, says a study on bmj.com this week.

In 1999 a comprehensive review of A&E services for children made 32 essential recommendations to be implemented by 2004. Children require specialised treatment, said the review, particularly in emergency cases, including assessment on arrival (triage) by appropriately trained nurses. A&E staff should also be trained to provide specialist paediatric emergency care while awaiting children's intensive care units to become available.

The new study looked at 139 emergency departments, seeing more than 18,000 children per year. It showed that a quarter of departments do not have separate triage facilities for children, and 36% of A&E consultants have not had specialist training in paediatric emergency care. Of those with paediatric triage facilities, 23% do not use an appropriately trained nurse to carry out the assessment.

In addition, A&E staff should undertake courses and refresher training in paediatric life support, but almost half (47%) of nurses had no such training.

Researchers also found that the number of hospitals providing for children in major incident plans had fallen to just over 10% of those surveyed in 2004.

Though the Government has recognised unacceptable variations in standards of emergency care for children, many A&E departments are still running with few if any appropriately trained staff. Many of the minimum, essential standards recommended five years ago are yet to be met, say the researchers. More structured investment is vital if we are to provide our children with proper emergency care, they conclude.

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