Major incidents involving children -to what extent are we prepared?
Background:
A major incident is “an event that owing to the number, severity, type or location of live casualties requires special arrangements by the health services”. It is well-recognised that a protocol to deal with a major incident should be included in every hospital’s management plan and that specific arrangements should be in place for the management of the unique needs of paediatric patients.
Current literature however clearly demonstrates deficiencies with respect to paediatric major incident planning. Determining health care workers’ perceptions, capabilities and training for a major incident involving children is crucial in both identifying and understanding gaps in our own paediatric major incident response.
The aim of this study therefore is to identify current deficiencies regarding paediatric major incident protocols by examining front-line staff opinions.
Methods:
A quantitative, cross-sectional study using an anonymised online questionnaire was performed over a 4 week period in two mixed (i.e. both children and adults treated) emergency departments. Doctors and nurses working in the areas of emergency medicine, paediatrics, orthopaedics and anaesthesia were surveyed.
Outcome measures:
- Major incident protocol awareness
- Self –reported readiness to deal with a paediatric major incident
- Self-reported education and training needs.
Results:
A total of 51 responses were recorded. 30 participants (58.8%) worked in emergency medicine; 10 (19.6%) in paediatrics and 8 (15.7%) in anaesthesia. Overall 41 participants (80.4%) reported working in a mixed adult and paediatric department.
Protocol awareness:
26 participants (60.5%) reported that they had never read the major incident protocol and 44 participants (86.3%) reported that they had never been involved in a paediatric major incident.
Readiness to deal with a paediatric major incident:
Qualitative data was collected. Personal concerns listed by participants included: lack of personal experience, lack of experienced staff, equipment, training, limited resources, overcrowded department and heightened emotions.
Education and training:
48 respondents (94.1%) reported that they would benefit from receiving training in paediatric major incidents. They considered that they would benefit from increased training in the following areas: equipment -19(37%), triage -16 (31%) and communication – 11(21%). The remainder did not specify their exact learning needs.
35 respondents (68.6%) reported that structured teaching sessions regarding paediatric major incidents would be “very useful”. No participants reported that structured teaching sessions would be “not at all useful”.
Discussion and Conclusions:
This small, local study demonstrates a need for increased awareness of major incident protocols in this setting and confirms deficiencies in the level of preparedness of front line staff regarding paediatric major incidents. The vast majority of participants in this study had never read the major incident protocol of their hospital and were unaware of the specific paediatric provisions in place.
Specific concerns identified were a lack of personal experience, lack of and familiarity with paediatric appropriate equipment and inadequate training for paediatric major incidents. These concerns identified may provide an opportunity for future education and training.
