The UK has strived in recent years (resources and training) to establish separate Paediatric Emergency Departments staffed by dedicated Paediatric Emergency and Paediatric Consultants. This has many benefits including a setting more appropriate to small children, less noisy and disruptive adult patients, less alcohol-related problems. It means that children are treated by specialists with sufficient knowledge and experience to treat them appropriately. In contrast in many adult or mixed departments, particularly junior staff are often very anxious about treating young children.
As we strive for Utopia are we beginning to see any drawbacks?
Adult Emergency Physicians tend to have much more day-to-day experience of difficult wound management both in numbers, and the prevalence of sedation/anaesthesia in younger children.
In mixed departments there are regular serious trauma cases (which thankfully none of the UK centres experience in children), and regular resuscitation scenarios such as cardiac arrests (which again are thankfully very rare in children). This is increasingly being addressed in scenario training becoming part of day-to-day practice. But for example, despite training on defibrillator use Paediatric teams often find it difficult to use in an emergency situation - where an adult department would find this second nature.
Finally pathology changes with age. Paediatricians tend to overlook the dissecting aortic aneurysm or pulmonary embolus, or to have little experience reducing shoulder dislocations. This depends on where the cut-off for age is drawn, but illustrates that Paediatric Emergency Departments still require physicians regularly practicing in Adult Departments rather than becoming insular stand-alone departments.