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Planning for major incidents involving children by implementing a Delphi study
  1. IAN MACONOCHIE
  1. Department of Academic Paediatrics
  2. St Mary's Hospital, London W2 1NY, UK
  3. Accident and Emergency Medicine
  4. Frimley Park Hospital
  5. Camberley, Surrey GU16 5UL, UK
  6. Bromsgrove, Worcestershire, UK
    1. LT COL TIM HODGETTS
    1. Department of Academic Paediatrics
    2. St Mary's Hospital, London W2 1NY, UK
    3. Accident and Emergency Medicine
    4. Frimley Park Hospital
    5. Camberley, Surrey GU16 5UL, UK
    6. Bromsgrove, Worcestershire, UK
      1. JOHN HALL
      1. Department of Academic Paediatrics
      2. St Mary's Hospital, London W2 1NY, UK
      3. Accident and Emergency Medicine
      4. Frimley Park Hospital
      5. Camberley, Surrey GU16 5UL, UK
      6. Bromsgrove, Worcestershire, UK

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        Editor,—The proposed paediatric triage algorithm in Mackway-Jones et al's study1has a number of important flaws:

        (1) 
        few children younger than 10 months are ambulatory
        (2) 
        there is no airway opening manoeuvre
        (3) 
        capillary refill time is affected by the ambient temperature; refill time measured at the sternum and forehead only have a Gaussian distribution.2 To rely solely on the capillary refill time increases the number of priority 1 (immediate) children especially in cold surroundings
        (4) 
        the paediatric trauma score (even with the Eichelberger modification) is inappropriate as the systolic blood pressure is required. The ability to measure it at the incident, the need for different cuff sizes, and the time it takes when faced by a large number of casualties rule this score out
        (5) 
        there is no account made for the change in physiological parameters with age.

         We have devised a triage system (on a waterproof tape) that overcomes these problems.3 The changes in normal physiological values with age are shown by dividing the tape into 4 compartments based on body length or weight (50–80 cm or 3–10 kg; 80–100 cm or 11–18 kg; 100–140 cm or 19–32 kg; and > 140 cm or > 32 kg). A child > 140 cm is triaged as an adult.

        Each compartment has a triage sieve algorithm corrected for age with the 5th and 95th centiles for respiratory rate and heart rate from all available published literature stated. Figure 1 shows the values for the 50–80 cm compartment.

        Figure 1

        Paediatric triage tape 50–80 cm.

        Triage is a dynamic process and starts in the prehospital setting. Appropriate prioritisation allows limited resources to be diverted to needy children.

        References

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