Emergencies

Staff are actively encouraged to call the emergency team for any deteriorating patient, any patient in Cardiac Arrest and / or any situation in which they need help (2222). 

• Please identify required team by stating ‘PAEDIATRIC’ or ‘ADULT’ Emergency at the time of the call. 
• We support and encourage all staff to escalate care when they have heightened concerns regarding a patient. Therefore, should you attend an emergency call that turns out not to require full escalation of care, please do not in any way make dismissive comments about the call. 

• Paediatric Emergency Team (PET) consists of six individuals: 

• • Team Leader (either consultant or senior paediatric registrar) 
  • Junior Paediatric Registrar 
  • Paediatric Critical Care Unit (PCCU) doctor 
  • PCCU Nurse 
  • Clinical Co-ordinator 
  • Porter 
  • Anaesthetist 
  • During daytime hours the Clinical Nurse Manager and Resuscitation Officer (RO) will also attend 
  • Additional attendees are not to be encouraged unless specifically requested. 

• If your role involves being a member of the team: 

• • You will be rostered onto the weekly PET training sessions on Thursdays from 2-4pm. 
  • A reminder email will be sent to you on the previous Monday morning 
  • These are mandatory training sessions; in the event of not being able to attend you should swap with one of your colleagues. 

• Adult emergency calls: 

• • Calls for emergency assistance to the PET team are assumed to be of a paediatric nature unless communicated otherwise. In the event of an adult emergency the porters will, in the first instance, collect and bring a defibrillator to the scene. 
  • There are two transfer bags in the Paediatric Emergency Department (ED) which contain both Adult, and Paediatric resuscitation equipment. If required the ED Dr will transport these to the event with a small O2 cylinder. 
  • The patient will be transferred to the Adult ED in RIE for further treatment 

• All clinical areas have access to a red Cardiac Arrest Trolley (except ED) please ensure you are familiar with the location of these trolleys identified by a red triangle on the wall above trolley 

• • Location of closest defibrillator is identified in the red folder on each trolley 
  • To open the trolley break the yellow tag, lift and push back the bottom flap of the trolley in fully to release the drawers. 
• Intraosseous equipment is centralised and is available to be retrieved to each area from ED, Theatres or PCCU. 
• SCRAM bags containing advanced airway equipment will be brought to the event by the PCCU responder. Intubation drugs are centralised and are available to be retrieved form ED, Dalhousie Ward and PCCU.
• Emergency resuscitation equipment in ED is not in a red trolley and has a different layout. Please familiarise yourself with the equipment available in ED and how it is organised 
• Evidence suggests it is safest to intubate patients in controlled environments. Therefore in the event of intubation being required where possible, it will be facilitated within the ED, PCCU or theatre. Should intubation be required out with these areas, optimum communication to ensure appropriate equipment is available is imperative. 

• Indications for activation and the policy document can be found on the Intranet search Major Haemorrhage RHCYP

• 2222 is also the number to activate the Major Haemorrhage protocol 

• The clinical coordinator will be familiar with these please ensure if you activate this policy you communicate with them at the earliest opportunity. 

• There is a copy of the policy within each Resuscitation folder located on the Cardiac Arrest Trolley 

• Red Paediatric EMERGENCY DRUG BOXES and ANAPHYLAXIS boxes are located in the bottom section of the cardiac arrest trolleys. 

• Anaphylaxis boxes are small red top boxes containing an anaphylaxis protocol and the emergency drugs required for this event. 

• If Lorazepam is required and not available in your clinical area it can be sourced from ED & Paediatric Critical Care Unit (Please note this is stored in the fridge) 

• There is a guidance sheet within the Resuscitation folder which is on every cardiac arrest trolley. 

Your feedback is important to us 

• In the event of an emergency, the team leader is responsible for filling out the audit form supplied by the clinical co-ordinator (Yellow PET Form). 
• Audit forms should be returned ASAP to the Resuscitation Officer (RO) 
• Other feedback from participants is encouraged either by completing the event feedback form in the policy folder which is on the trolley or by speaking to the RO in person. 

• We try to facilitate debriefing on any particularly stressful event as routine however should you feel that there is any event you need support with please speak to the RO. 

• NHS Lothian counselling service contact details are available on the Intranet. 

• Mindray Defibrillators are used throughout NHS Lothian. Pads for defibrillation can be found on the top and bottom of the cardiac arrest trolleys and in the ED & PICU grab bags. 

• Pads come in two sizes, <25kgs and >25 kgs (adult). 

• Due to the requirement for defibrillation energy levels (4j/kg) to be calculated according to weight in paediatrics, the manual defibrillation mode should be used. In the event of an ADULT requiring defibrillation the AED function can be used with due regard to individual competency. 

• As there is not a defibrillator in all areas please refer to Resuscitation folder on the cardiac arrest trolley to identify nearest location. 

Under the guidance of the SPSP there are multiple initiatives being undertaken throughout the hospital to steadily improve the safety of our hospital care using Quality Improvement methodologies. The line manager of each area will be happy to discuss relevant projects with you however some are in all areas and include: 

PEWS

National PEWS charts are used throughout RHCYP with the exception of critical care who use CIS, an electronic record system. 

Charts are subdivided into 5 age bands: 

0-11 months / / 12-23months / 2-4 years / 5-11 years / >12years 

Staff are asked to discuss with the medical team any child who is ‘triggering’ an ‘Escalation of PEWS’ (EoP) and to ensure there is a management plan in place. It is therefore important you take the time to familiarise yourself with this process. 

Recording an ‘Eop’ on Trak in progress notes is done by typing in \eop as a shortcode then pressing the spacebar which will reveal prompts to answer. To respond to an escalation of concern or elevated PEWS type in \eopr followed by the spacebar to reveal prompts and enter a management plan/review. 

Watchers – the ‘sick list’

If a patient has the potential to deteriorate and is causing concern then they are declared a ‘watcher’ by staff and discussed at site huddles and handovers. A patient’s status as a watcher and a clinical management plan must be recorded in notes by entering the ‘\watcher’ shortcode then pressing the spacebar to reveal prompts. 

Use of these short codes should be facilitated by all members of staff.

In the event of a systems failure with telecoms there is a supply of pagers and mobile phones for the emergency team and nominated individuals to carry. Should you be made aware of any issue you should make contact with the clinical co-ordinator who will provide you with further instructions. 

• European Paediatric Advanced Life Support Courses (EPALS), run 3-4 times a year, application forms and bookings can be made through the ED secretary and resuscitation@nhslothian.scot.nhs.uk 

• Resuscitation (UK) Paediatric Immediate Life Support courses (PILS) is free to NHS Lothian staff and run weekly. Medical staff can access booking through the SPHERE administration team Ext 51618 or RHCYPSPHERE@nhslothian.scot.nhs.uk 

• Basic Life Support updates are regularly available. Medical staff can access booking through the SPHERE administration team Ext 51618 or RHCYPSPHERE@nhslothian.scot.nhs.uk 

• Consultant staff PILS is facilitated annually and booked thought the RO 

• Parent BLS – All families can be given access to the Paediatric Resuscitation training videos, available in multiple languages on the RHCYP website Parent and Carers page - Training Videos - Royal Hospital for Children and Young People (nhslothian.scot). Face to Face teaching sessions may be provided to parents whose children potentially require support. One of the ward/dept BLS facilitators will facilitate this. Referral is made by completion of the referral form in consultation with the training provider prior to discussion with parents. In order to ensure families receive appropriate ongoing training as necessary, it is mandatory that the consultant responsible for the child’s care countersign’s the referral.