Yes Robbie, your recommendations sound eminently sensible! Such units always
struggle to survive on the "fringes" of what we consider safe practice back
in civilisation, yet to remove such units would be even more dangerous for
the local populace. But can you just clarify something to help put me in the
picture, Robbie? The 30,000 figure refers to catchment population I suspect,
rather than patient numbers, so can I presume that the unit sees less than,
say, 5000 patients per annum? And if so, can I also presume that such a unit
would only see a handful of paediatric cases each day, with only one or two
paeds medical cases each day?
Adrian Fogarty
----- Original Message -----
From: "Robbie Coull" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 10, 2003 8:48 AM
Subject: Paediatric emergency cover in A&E dept
> Having sorted out the OOH nurse call handling (to some extent - thanks for
> the replies), I'm now making recommendations about the handling of
> paediatric emergencies locally and would like opinions on the following:
>
> -Accident and Emergency Department
> -30,000 patient catchment area
> -Consultant in charge in one of the local Surgeons (not A&E trained)
> -No middle grade cover
> -No external A&E input from other departments
> -Dedicated A&E nurses with some PALS trained
> -No dedicated SHOs - dept covered by surgical SHOs on 1:4 rota
> -Most SHOs have little or no A&E experience
> -No paediatric services on site
> -Nearest other A&E/paeds unit is 3 hour drive from dept (roads closed for
> 1-2/52 per year due to adverse weather)
> -Physicians on site have issued statement that they do not provide paeds
> cover under any circumstances.
> -Dept has no formal policy of paeds emergencies
> -Recent critical incidents involving nurses 'phoning round' for GP and/or
> anaesthetist to help stabilise seriously ill paeds cases brought by 999.
> -Maternity unit threatened with closure recently due to lack of paeds
cover
> but reprieved after vociferous local opposition to closure
>
>
> My recommendations are:
>
> 1. Local GP on call should cover medical paeds emergencies and should
have
> one week per year paid paeds training (PHPLS/PALS minimum)
> 2. SHOs should receive APLS training minimum to cover trauma cases
> 3. Anaesthetists should be formally involved in all resuscitations and
> should be APLS certified.
> 4. GPs should have integrated access to A&E facilities without need to
seek
> authority from physicians (eg: xray, vitals, written rx plans)
> 5. Cover for maternity unit should be included in the plan
> 6. Appropriate remuneration for the GPs and funding for
training/equipment
> must be provided by the trusts concerned.
>
> In the mean time I'm concerned about the use of the term 'Accident and
> Emergency' to describe the dept.
>
> (It is my view that if you tell patients that you are an A&E, then you
need
> to be able to provide a proper A&E service).
>
> Could I ask for the following advice:
>
> 1. Are my recommendations for paediatric cover sensible?
>
> 2. In view of the lack of formal medical A&E input what steps should be
> taken to ensure the safe running of the dept?
>
>
> Thanks in advance for your help.
>
> --
> Dr Robbie Coull
>
> R.K. Coull Ltd MB ChB, DipIMC RCSEd
> Locum Doctor Service BASICS Immediate Care Doctor
> INVERNESS - SCOTLAND ALS / PHPLS Instructor
>
> email [log in to unmask] telephone 0777 492 7757
> website http://www.coull.net fax 0704 407 3033
>
>
>
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