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Paediatric education for prehospital professionals
  1. F E Jewkes

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    Edited by R Dieckman, D Brownstein, and M Gausche-Hill. Published by Jones and Bartlett, 2000, pp 344. ISBN 0-7637-1219-1

    This book from the USA is a companion to the course of the same name.

    The book is crammed with gems that have clearly come from years of paediatric experience and the photography and drawings are outstanding. The chapters are fairly uniformly constructed and most of them contain a section on when to transport. The text is comprehensive and some of our paediatric and emergency medicine trainees would learn much from it. I personally found the “Tips” and “Blips” in the margins irritating but they may appeal to some. The highlighted “Controversy” points were a different matter—an excellent way of emphasising the confusion and ignorance surrounding the prehospital care of children, they were topical and up to date.

    I totally agree one should analyse the overall severity of illness of the child on arrival, but I was very disappointed in the patient assessment triangle or “PAT”, which receives much emphasis throughout the book. It seems to be nothing more than a rapid initial assessment of ABCD, which is certainly taught as part of the approach to any child on most of the major resuscitation courses in the UK. To give it a special new name left me mystified.

    Treatment is divided into basic life support (BLS) and advanced life support (ALS). The BLS was clear and well presented at ambulance technician level, but some of the ALS interventions would be in the realm of the paediatric intensivist in the UK. I can only assume American paramedics have good “on line” medical support if they are really giving inotropes and adenosine to children and babies in the field! I was disappointed that a number of less high powered problems I have trouble dealing with in practice (like when to move in cardiopulmonary arrest when there are only two of you and how to best protect the neck of a hysterical head injured toddler) were neatly avoided. Maybe they don’t know either!

    I was worried from the start that the text might confuse rather than clarify matters for British readers because the UK and North American EMS systems are so different. Generally this was not the case, but there were certainly some glaring discrepancies as well as a lot of minor ones. For example, we would almost never use neat 50% dextrose in any child to treat hypoglycaemia—neither would we usually head straight for adrenaline if nebulised salbutamol failed to improve asthma.

    In conclusion, I thought the book beautifully presented (except for the paper, which was poor quality) and the BLS sections good value for all. I would recommend that UK paramedics follow the ALS sections only under the guidance of a doctor experienced in UK prehospital paediatrics who could “pick out the wood from the trees” for them—defeating the object of using it for personal study. Prehospital doctors, however, would, I’m sure, find it a useful read providing they had enough paediatric background knowledge to recognise the transatlantic differences.

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