Services for Children in Emergency Departments


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“Around 3.5 million children per year attend Emergency Departments (EDs) in the UK. This equates to around 28% of the child population each year. Children usually constitute 25-30% of all ED attendances. For any hospital, this represents three times the number of children attending paediatric outpatient clinics. About 90% of the children attending an ED will be seen and discharged without involvement of any in-patient team. Accident and Emergency Services for Children was a document written in 1999 by representatives of several Royal Colleges and national organisations, that made recommendations on the services and skills which EDs should provide in order to safeguard the care of children.

The original “red book”, as it became known, was widely used in the UK to improve the care of children in emergency settings. Since 1999, improvements have been achieved in the majority of EDs, particularly in terms of facilities. The Intercollegiate Committee for Services for Children in Emergency Departments has remained active since its inception in 1999. It sits within the committee structure of the Royal College of Paediatrics and Child Health (RCPCH). It has published two further documents since 1999, Children’s Attendance at a Minor Injury/Illness ServiceThe Designated Liaison Paediatrician.

Despite improvement in many areas, some of the standards recommended for implementation by 2004 have failed to be fully implemented in many EDs. Particular difficulties have been experienced in recruiting sufficient numbers of medical and nursing staff with paediatric training. A recent Healthcare Commission review, Improvement Review into Services for Children in Hospital

This second edition of the 1999 guidance brings the recommendations up to date with current practice, taking account of an evolving political climate and an inexorable rise in children’s attendances to EDs. It has been renamed Services for Children in Emergency Departments in accordance with the change in name of the speciality of Emergency Medicine (EM). The committee hopes that readers find these recommendations practical, helpful and realistic.

Dr Ffion Davies FRCPCH FCEM
Intercollegiate Committee for Services for Children in Emergency Departments