Children account for nearly one-fourth of all care provided in emergency departments (EDs) in the UK and the USA.1^–6 Two issues highlight the differences between children and adults who seek care in ED: first, there are physiological differences between adults and children; and second, the variety of disease and injury patterns seen in children are different from those in adults.7 8 In the USA, it is estimated that children receive their emergency medical care from paediatric emergency medicine physicians (PEMPs) only 23% of the time4 8 and in separate paediatric EDs (PEDs) only 7% of the time.2 8 With children receiving the majority of their care in general emergency departments (GEDs), and the minority in PEDs, it is possible that the variability of physician training and types of EDs may impact quality of care.

Recognition of the need for specialised emergency care for children formally began in the US in 1985 with the development of the Emergency Medical Services for Children (EMSC) programme.6 Since that time, educational tools, medication and equipment standards, protocols, practice guidelines and facility preparedness standards have been developed.7 Paediatric emergency medicine (PEM) training programmes have been established, and the last decade has seen a 64% increase in PEM fellows in training.9 Currently there are 46 accredited PEM fellowships in the US10 and 1450 PEM providers nationwide.11

In the UK, the Specialist Training Authority officially recognised PEM as a subspecialty in 2003, and in 2007 the first RCPCH National Grid trainee completed formal training in PEM; however, employment in senior medical staff positions does not currently mandate accredited PEM training.12 13 The 2007 “Services for Children in Emergency Departments” document recommends that a consultant with subspecialty training in paediatric EM be appointed for each emergency …