A clinical audit of the pre-hospital paediatric respiratory assessment in London

Paediatric assessment is a challenging skill in the pre-hospital setting. Pre-hospital clinicians are generalists and do not have the specialised paediatric training that hospital and primary care clinicians will have. The fact remains, however, that demand for this skill is high. To take London as an example, 5% of all patients attended to by the London Ambulance Service NHS Trust (LAS) last year were under the age of four years (93 626 incidents). To put this in context, LAS clinicians attend more children under the age of four years than the sum of all patients in cardiac arrest, with confirmed myocardial infarctions and fast positive strokes. Paediatric patients are challenging to treat and it is therefore essential that clinicians are making appropriate, safe decisions based on their accurate clinical assessments.

Historically, studies suggest that confidence and aptitude amongst pre-hospital clinicians in assessing and treating paediatrics has been low. Research in the UK is sparse; however, American research has shown that pre-hospital clinicians are not confident treating paediatric patients and have the least confidence treating patients under two years old (Gausche et al, 1990). This lack of confidence may affect paediatric care as is evidenced by a UK study where pre-hospital clinicians have not adequately monitored or treated paediatric patients (Fisher and Vinci, 1995). This has been supported by more recent American research that reports pre-hospital clinicians have the lowest accuracy in assessing infants (Foltin et al, 2002). The research indicates that there is a potential to improve the assessment and treatment of this challenging age group.