Preparing to care for paediatric trauma patients

Considerable evidence has discussed the significant workload and advances in clinical care by UK Defence Medical Services (DMS) during recent conflicts in Iraq and Afghanistan. Although the DMS is not doctrinally staffed to deal with children on operations, severely ill and injured paediatric casualties continue to present to military medical facilities; therefore, staff must be competent to deliver the appropriate level of care. This paper reports the paediatric presentations to the emergency department (ED), at the Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan, over a 21-month period. The aim was to provide quantitative, statistical data of paediatric presentations seen by deployed ED nurses, to identify whether the current training was appropriate and to make recommendations for further training requirements for DMS ED nurses.

All paediatric presentations to the MTF ED between January 2011 and September 2012 were analysed. The following aspects of the admission were analysed: date of admission, mechanism of injury, injury sustained, discharge, length of stay in the ED and length of stay in the R3.

There were 159 paediatric presentations to the ED in 2011 of which 56% warranted admission to the intensive treatment unit (ITU). In contrast, over the shorter period in 2012, 79% of 73 paediatric presentations were admitted to the ITU. The most common mechanism of injury was hostile action. 13% of the patients who presented to the ED in 2011 did not survive to discharge, compared with 11% the following year.

Although the exposure to paediatric polytrauma during the conflicts in Afghanistan and Iraq is not replicated in peace time roles, it is likely that wherever emergency nurses are deployed the treatment of children will continue. Analysis of the service evaluation has led to the recommendations for specific skills that emergency nurses could develop during the pre-deployment phase to better prepare for caring for such patients. These include recognition of the sick child/triage, paediatric drug calculations, awareness of the massive transfusion requirements for children and skills to gain intravenous/intraosseous access in a child.