The Introduction of Paediatric Cases to Pre-Hospital Grand Rounds

Background: Paediatric emergencies can be challenging and intimidating for providers in the pre-hospital setting. Pre-hospital practitioners require a skill set very different to interventions performed in the adult population. These include challenging intravenous access, medication calculation, potential external stressors and a variety of clinical conditions seen less frequently.

Methodology: Pre-hospital Grand Rounds (PHGR) is a relatively new concept. It was introduced in St Vincent’s University Hospital Dublin with the programme in University Hospital Limerick (UHL) commencing in October 2018. Following discussion with pre-hospital colleagues in the midwest region the coordinators of PHGR UHL acknowledged the importance and potential benefit of inclusion of paediatric cases at each session. A survey was conducted to gauge pre-hospital provider views on PHGR UHL as a source of paediatric emergency education.

Discussion: At each meeting a case is presented by a paramedic or advanced paramedic. This includes assessments, interventions on scene and subsequent handover in the Emergency Department. An Emergency Department doctor subsequently discusses the management of the child and outcome. A brief teaching session related to the primary diagnosis follows in an open forum with the audience, consisting of pre-hospital providers, nursing and medical staff. The meeting is supervised by a Consultant in Emergency Medicine with input from the Department of Paediatrics and National Ambulance Service training officers.

When surveyed, participants considered PHGR UHL as an educational resource for paediatric emergencies, considered the meeting to add to their practice and found paediatric emergencies posed different challenges to the adult population.

Conclusion: The introduction of paediatric cases at PHGR UHL has been met with enthusiasm and in its infancy is being considered a beneficial resource. It creates a link of communication between pre-hospital clinicians and hospital providers. The meetings do not follow a template but are developed through feedback and communication between all parties.