The greatest mortality in children occurs before the first birthday. The highest rate of all is in the first month of life and is related mainly to perinatal events. From 1 month to 1 year of age the commonest cause of death is cot death and between 1 and 4 years congenital abnormality and trauma are about equal. After that age children die predominantly because of trauma.1 It can be seen therefore that most life threatening events leading to cardiac arrest are likely to commence outside hospital. The provision of an effective prehospital emergency service is an important element in reducing childhood mortality.

Most cardiac arrests are secondary to hypoxia or less commonly circulatory failure (shock), rather than primary cardiac arrest.2 Early attention to adequate oxygenation and correcting shock may therefore be life saving if instituted early enough. Children who arrive at the hospital pulseless and apnoeic have a poor chance of survival and if they do survive, a high chance of neurological deficit.3 ,4

Only about 10% of the emergency calls made to the ambulance service are for children and only about 5% of these will require rescuscitation.5 ,6 The need for paediatric emergency care in the community is therefore rare, but when it is required, the response must be prompt and effective.

Prehospital health care professionals have an unrivalled opportunity to improve the outcome for a seriously ill or injured child. They are present during the critical initial time following an accident or the onset of severe illness (the so called “golden hour” of resuscitation) before the child reaches hospital. This is time in which simple lifesaving measures can halt and reverse the otherwise inevitable progression to cardiac arrest. In addition, they have the opportunity to assess the child's surroundings at the …