Continuing Professional Development: The challenges of pre-hospital paediatric trauma

After completing this module the paramedic will be able to:

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The challenges paediatric trauma presents to pre-hospital and emergency clinicians have remained constant over the years. There has been a nationally increased focus to improve the quality of trauma care in the UK, leading to the development of regional trauma networks in 2012. This focus includes children. This module will discuss the challenges and issues of dealing with paediatric trauma and how some of the problems encountered might be mitigated.

Who are the paediatric trauma experts? Prior to establishing trauma networks, the entire burden of paediatric trauma divided amongst receiving units led to an average of just over one case of major trauma (ISS>15) per year presenting to each single unit (NHS Clinical Advisory Group, 2011). Figures from the Department of Transport show that in 2000 there were 5 011 seriously injured children and 191 deaths as a result of motor vehicle accidents; by 2011 this had fallen to 2 211 seriously injured and 61 killed (Department for Transport, 2013). Paediatric Intensive Care Audit Network (PICANet) data shows that trauma accounts for around just 2.8% of Paediatric Intensive Care Unit (PICU) admissions (Draper et al, 2012). These are happy numbers but the chances of any individual practitioner having regular exposure to significant paediatric trauma are slim. The fact remains that most primary responders will not have paediatric expertise and may only have very limited experience. This deficiency has the unwanted and probably entirely unnecessary effect of heightened anxiety when presented with a seriously injured child. This can lead to further impairment of clinical performance and decision making. There is very little confidence in dealing with seriously injured or unwell children.