Ambulance alerting of paediatric emergencies to a general hospital

There are at present only a small number of dedicated paediatric emergency departments in the UK. Severely ill and injured children are often taken by ambulance to the nearest general hospital. Efforts have been made to provide better care for these sickest children pending the establishment of dedicated paediatric emergency services within general emergency departments by 2004 [Royal College of Paediatrics and Child Health; Accident and Emergency Services for Children-Report of a Multidisciplinary Working Party, June 1999]. To learn more of the staffing implications for the establishment of dedicated paediatric emergency units within the general hospital, 30 months of paediatric alert call data are presented.

A prospective review of paediatric alert calls over 30 months, (from January 1999 until June 2001). All alert calls from the ambulance service to a large urban emergency department were recorded on a specific form. Data from these forms is presented.

There were 1754 alert calls of all types during this 30-month period, of which 153 (9%) were for patients under the age of 16 (mean 1.2 each week). Of these, 102 (66%) were for medical conditions and 51 (34%) were for trauma. The mean estimated time of arrival from the time of the alert call was 6 min. The majority of both medical and trauma paediatric alert calls occur in the afternoon and progress well into the night. The 51.6% of paediatric medical alert calls and 64.4% of paediatric trauma alert calls occur 'out of normal hours'. There was little reduction in the frequency of alert calls at the weekend. There were no paediatric trauma alert calls between 2 a.m. and 10 a.m., although medical paediatric alert calls continued throughout the night.

Resident senior trauma personnel to manage injured children should be provided until at least midnight. Hospitals that maintain a facility for the reception of sick children must be able to provide a rapid response to paediatric medical emergencies on a 24 h basis. Guidelines for alert calls for ambulance crews are required.