Why do we need to train doctors specifically in Paediatric Emergency Medicine?
Do you like treating kids?
Do you like treating emergency cases?
Do you like the ED environment?
Then maybe this is a career for you!
Do many children come to an ED each year?
Yes - about 5 million attendances each year – which is about 1 in 4 children! The vast majority of Emergency Departments in the UK see adults and children. Children make up 20-25% of attendances. Most Emergency Departments in the UK now have a separate area for children, but this varies from just a separate waiting area to a self-enclosed ED.
Children may present with either injury or illness, and the balance varies widely from department to department – each forming 30-70% of the total. The commonest presenting complaints of children to an ED are limb injury, head injury, difficulty in breathing, fever, rash, abdominal pain, fitting and dehydration.
Who normally treats these children?
Emergency Departments are staffed by Emergency Medicine (EM) trained doctors and nurses. Many departments have a core group of nurses with paediatric training. In at least half of UK EDs one or more of the EM doctors have sub-speciality training in PEM. Sometimes Paediatricians are based in the ED; they are likely to have PEM training.
Core training for doctors in general EM training includes 6 months of PEM, and equips all EM consultants to deal with injuries and illness in children to a reasonable level. Core training for Paediatric training does not usually include specific time in the ED, or cover training in injuries.
Looking at the common presentations it can be seen that there is an overlap of skills needed. There is evidence that an ED which can provide good clinical treatment for both injury and illness, in the right environment for the child and with staff competent and confident in the range of common presentations, children fare better. A study by Geelhoed showed that an increase in PEM consultants coincided with a decrease in the number of children admitted to hospital, in complaints to the department, and in average waiting times, while also being cost effective (Geelhoed G, 2008).
So what does PEM "as a sub-specialty interest" mean?
As well as core (general) training, some trainees opt to undergo additional training in PEM, and are able to qualify on the UK Specialist Register at the end of their training for their base speciality "with sub-specialty recognition for PEM". This is possible for both EM and Paediatric consultants. EM (PEM) consultants can see adult and paediatric patients, but Paediatric (PEM) consultants are only qualified to look after children. A similar system exists in Canada, the USA, Australia and New Zealand.
It is recommended that in EDs seeing more than 16,000 children per year, there should be at least one EM(PEM) consultant. Larger departments should also have a Paediatric (PEM) consultant (RCPCH, 2007). By the end of 2010 over 100 EM consultants had undergone additional training in this way, and there are 248 EDs in the UK.
EM(PEM) consultants tend to work across the adult and paediatric areas of the ED. Some work solely in Paediatric Emergency Departments. Some Paediatric (PEM) consultants work in other areas too, such as the Paediatric Admissions Unit, or in General Paediatric Wards and Clinics. Some sample plans are shown in the following RCPCH document: