Recognising children with surgical problems in the pre-hospital setting

The child with abdominal pain and/or vomiting is a common presentation to the emergency department (Marin and Alpern, 2011). Most have self-limiting conditions that can be managed with reassurance, fluids and pain relief. It is however estimated that approximately 25 % of patients (adults and children) calling ‘999’ for abdominal pain do have a serious underlying condition requiring intervention (UK Ambulance Service Clinical Practice Guidelines, 2006; Paul and Heaton, 2013). In children, surgical problems are relatively uncommon; however the cause and presentation of such a problem may differ from that commonly seen in adult practice.

Paramedic teams are often the first-line health professionals who will come across children with a suspected surgical problem and early recognition and appropriate initial management is the key to a good outcome. This article aims to give an overview of the common surgical problems encountered in children, along with some simple guidance to aid a quick assessment and transfer to the emergency department/ specialist services. While the specific surgical aetiology is rarely identified with certainty in the pre-hospital setting, it is important to remember that most of these conditions will need urgent identification and management, and time is of the essence. After reading this article readers should be able to: