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5 Assessment and identification of paediatric primary survey positive patients
  1. M Woollard1,
  2. F Jewkes2
  1. 1Pre-hospital Care Research Unit, Department of Academic Emergency Medicine, The James Cook University Hospital/University of Teesside, Middlesbrough, UK
  2. 2Wiltshire Ambulance Service NHS Trust, UK
  1. Correspondence to:
 Mr M Woollard
 The James Cook University Hospital, Department of Academic Emergency Medicine, Education Centre, Marton Road, Middlesbrough TS4 3BW, UK;

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Unwell children present particular challenges to the prehospital practitioner. The anatomy of children is different to that of adults, and this can result in differences in the presentation and severity of a range of conditions. Paediatric physiology also differs from that of adults, and although this means children often compensate very well to significant clinical illness it also carries the risk that a severe problem will be overlooked or underestimated. When compensatory mechanisms fail in children, they often do so rapidly, catastrophically, and irreversibly. The index of suspicion of the prehospital practitioner must therefore be higher when assessing the unwell child, and the threshold for hospital admission will consequently be lower than for an adult patient with similar findings. The emphasis should be on detecting and treating the seriously ill child at an early stage to prevent deterioration rather than attempting to cope with a decompensated, critically ill patient.

The paediatric section of the ABC of Community Emergency Care series will be divided into two articles. The objectives of this first paper are outlined in box 1.

Box 1 Article objectives


  • To describe the anatomical and physiological differences between children and adults

  • To describe the range of normal behaviours in children of different ages

  • To discuss approaches to assessing children to minimise the effects of distress

  • To identify the findings associated with primary survey positive patients

  • To differentiate between compensating and decompensating primary survey positive patients

  • To discuss where treatment should be started in primary survey positive patients

  • To identify consent issues in caring for children

  • To discuss child protection issues

While this first article concentrates on identifying or ruling out potentially time critical problems, it should be remembered that many children have problems that are not immediately life threatening. Common illnesses effecting children will be covered in a …

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