Over a relatively short period in the evolution of hospital practice, some 45 years, cardiopulmonary resuscitation (CPR) has moved from its historical position as a new experimental technique in adults¹ to its current, clinically pervasive status where we expect all hospital based paediatricians to be proficient and competent in life saving procedures.^2,3 In this issue, Tibballs et al from the Royal Children’s Hospital (RCH), Melbourne, present a new development in this story.⁴ That is, the introduction of a specialist paediatric emergency team charged with improving in-patient safety and providing urgent assistance whenever it is requested—not just for cardiac arrest. On initial reading you may wonder, “isn’t that what we did when we were residents on-call?”. In the following commentary we will explore the arguments and observations that indicate the importance of this Australian development.

Unexpected cardiac arrest is a rare event in paediatric in-patients. Tibballs et al observed 20 instances in almost 105 000 admissions over a period of 41 months—that is, ∼1 per 5000 admissions. If we translate this figure to a typical UK district general hospital paediatric unit (and set aside issues such as potential differences in patient acuity and case mix) then we should have no more than one or two unexpected in-patient cardiac arrests a year. This estimate does raise an important question that will warrant local audit and investigation: if we see much more than 1 cardiac arrest per 5000 admissions, then we should be asking ourselves why.⁵ The answer could lie in a change in pattern of disease or practice, unappreciated severity of illness, or unusual circumstances—sometimes even criminal. In regard to the issue of whether we can do better with CPR there is a more pertinent …