Background The purpose of this national survey of UK ambulance services was to provide an up-to-date assessment of service provision for children in the prehospital setting and to identify the challenges faced in providing optimal services to this group.

Methods Questionnaires were sent to clinical directors of the 16 UK NHS ambulance services in April 2009.

Results Questionnaires were returned by 13 (81%) respondents. Paramedics and most emergency medical technicians receive a limited amount of paediatric training. An increasing amount of equipment suitable for children is becoming available, but services for children vary depending on location. For example, paediatric airway adjuncts (short of intubation) were often lacking, and only 62% reported having pulse oximetry suitable for use in children. Four or the 13 respondents (31%) considered it ‘possible or highly likely’ that someone with no specific training could be the first to respond to a child in an emergency, and seven (54%) indicated that the likelihood that the first response to a child could be someone with no current qualification specific to paediatrics was ‘high’. There are large areas of the country where no formal medical support is available at any time of day.

Conclusions Despite improvements, paediatric care by front-line personnel is limited by resource and availability of staff with key skills. Accepted standards are often lacking. Collaborative audit, research and training initiatives should be carried out between services and acute trusts to meet local service requirements. This will reduce variation and maintain the safety of patients and quality of care.