The high preva­lence of pae­di­atric emer­gen­cies in rur­al and remote Aus­tralia neces­si­tates that health pro­fes­sion­als pri­ori­tise exper­tise in both pae­di­atrics and emer­gency management.

In Fitzroy Cross­ing, WA, a study by Dos­se­tor et al¹ revealed that a stag­ger­ing 82% of chil­dren in the com­mu­ni­ty vis­it­ed the emer­gency depart­ment (ED) at least once, with 32% expe­ri­enc­ing more than 11 pre­sen­ta­tions over a five-year period.

The chal­lenges inher­ent in deliv­er­ing emer­gency care to chil­dren in low-resource set­tings are often com­pound­ed by the pres­ence of chron­ic con­di­tions, com­plex needs, bar­ri­ers to ser­vice deliv­ery, poor infra­struc­ture, and cross-cul­tur­al considerations. 

Inter­ven­tions in these set­tings must also be tai­lored to the spe­cif­ic emer­gency con­text and align with the poli­cies of the employ­ing health service.

Pae­di­atric Assess­ment Tri­an­gle (PAT)

The Pae­di­atric Assess­ment Tri­an­gle (PAT)², used along­side the pri­ma­ry sur­vey, provides 

a struc­tured approach to quick­ly iden­ti­fy poten­tial­ly life-threat­en­ing con­di­tions in chil­dren, ensur­ing time­ly and appro­pri­ate interventions. 

It is a visu­al and hands-off tool that helps health work­ers assess a child’s con­di­tion with­in seconds.

PAT focus­es on three crit­i­cal components:

1. Appear­ance: This includes the child’s tone, inter­ac­tive­ness, con­sola­bil­i­ty, look/​gaze, and speech/​cry. A child who is alert, inter­ac­tive, and has a nor­mal cry or speech is gen­er­al­ly sta­ble. Con­verse­ly, a child who is lethar­gic, irri­ta­ble, or has an abnor­mal cry may be in distress.
2. Work of breath­ing: Observ­ing the effort a child makes to breathe can reveal res­pi­ra­to­ry dis­tress. Signs include nasal flar­ing, retrac­tions, grunt­ing, or abnor­mal breath sounds. Nor­mal, effort­less breath­ing indi­cates stability.
3. Cir­cu­la­tion to skin: This involves check­ing the child’s skin colour and tem­per­a­ture. Nor­mal skin colour and warmth sug­gest good cir­cu­la­tion, while pal­lor, mot­tling, or cyanosis can indi­cate poor per­fu­sion and poten­tial shock.

By com­bin­ing the PAT with the pri­ma­ry sur­vey, health pro­fes­sion­als can rapid­ly and effec­tive­ly assess pae­di­atric patients.

This struc­tured approach ensures that poten­tial­ly life-threat­en­ing con­di­tions are iden­ti­fied and man­aged prompt­ly, improv­ing out­comes for chil­dren in rur­al and remote settings.

What is your lev­el of con­fi­dence in assess­ing and respond­ing to ill or injured pae­di­atric patients? If you have some gaps in your knowl­edge or could do with an update, a CRANAplus Pae­di­atric Emer­gency Care & Pae­di­atric Advanced Life Sup­port (PEC+PALS) course could be for you!

Ref­er­ences

1. Dos­se­tor PJ, Fitz­patrick EFM, Glass K, et al. Emer­gency depart­ment pre­sen­ta­tions by chil­dren in remote Aus­tralia: a pop­u­la­tion- based study. Glob. Pedi­atr. Health. 2021;8. doi:10.1177/2333794X21991006
2. Horeczko T, Enriquez B, McGrath NE, Gausche-Hill M, Lewis RJ. The Pedi­atric Assess­ment Tri­an­gle: accu­ra­cy of its appli­ca­tion by nurs­es in the triage of chil­dren. J. Emerg. Nurs. 2013; 39(2):182 – 189. doi: 10.1016/j.jen.2011.12.020