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Emergency medicine is maturing as a specialty in the United Kingdom. Consequently, areas of sub-specialisation are emerging, such as critical care, academic emergency medicine, pre-hospital care, sports medicine and acute general medicine. Paediatric emergency care has received the biggest surge of interest, which is no surprise because children form 25% to 30% of patients in most of our departments. This equates to three to four million accident and emergency (A&E) attendances per year, which is more than are seen in paediatric outpatient clinics. This large paediatric workload means that all A&E consultants and specialist registrars must possess basic paediatric skills. However, with (slowly) increasing numbers of consultants, larger A&E departments will in future have a consultant with some additional training in paediatric emergency care.
Over the past decade we have seen significant improvements in paediatric care, for example the mortality from trauma, adjusted for injury severity score, has shown a steady decline.1 Paediatric life support courses have proliferated and their basic principles incorporated in teaching at all levels: medical students, doctors and nurses. It is acknowledged, however, that current standards of care for children vary widely across the country and often fall below those taught on paediatric life support courses, or those outlined in the multidisciplinary Working Party Report convened by the Royal College of Paediatrics and Child Health (RCPCH), “Accident and Emergency Services for Children”.2
The UK government has invested some capital through the A&E Modernisation Fund, into improvements in facilities, particularly protected waiting and treatment areas. However, it has not invested in the doctors and nurses to staff these areas. The lack of this type of funding means that some of these developments have become “white elephants”, and are unsustainable because of dilution of resources. More recently, the UK government has announced ambitious promises in its …