Clinical Governance & Audit Committee of the Scottish Otolaryngological Society (ENT
Scotland) March 2015
Musheer Hussain (Chair) David Baring (Lothian) Angus Cain (Highland) Andrew Clement
(Glasgow & Clyde) John Dempster (Ayrshire) Kerry Haddow (Fife) Stephen Jones (Tayside)
Balaji Natarajan (Lanarkshire) Bhasker Ram (Grampian) Saghir Sheikh (Glasgow & Clyde)
Aileen White (Glasgow & Clyde)
Introduction
All hospitals with an A&E department that receive paediatric emergencies and maternity and neonatal units should have paediatric endoscopes and tracheostomy kit even if airways emergencies are routinely transferred to tertiary paediatric hospitals.
The Clinical Governance and Audit and committee (CGAC) was asked by the Secretary of the
Scottish Otolaryngological Society (ENTS) on behalf of its members to consider the case for availability of airway endoscopy and tracheostomy equipment at all hospitals that receive children.
This report is the result of a consultative process between the members of the CGAC and the wider membership and will be presented to the Council and membership of the society.
Background
There have been issues with the non availability of airway equipment in hospital units in
Scotland that admit children for unscheduled care and have to rely on tertiary referral for paediatric airway problems. The committee is mindful that the equipment is only one aspect of the problem and thought needs to be put into how compromised children can be transferred. Protocols for the extreme circumstances that warrant an extremis attempt on site should be developed. Local teams should discuss this with National Paediatrics Retrieval
Service and Neonatal transport. Non availability of equipment locally, means that staff have to search for equipment and attend their tertiary hospital to collect the equipment before turning up at the local hospital. This delay can be life threatening. This practice is unsafe and will not stand scrutiny.
Results
In the committee’s view the following minimal equipment should be available in all units that receive children and care for neonates:
Paediatric tracheostomy set with a range of tracheostomy tubes
Parsons Laryngoscopes
Rigid bronchoscopes 2.5 - 6.0

1.9mm 0 degree Hopkins telescope (to introduce a 2.5 ETT)
2.7mm 0 degree Hopkins telescope (to introduce a 3.0 ETT)
Paediatrics Oesophagoscopes (to safely get a button battery in a toddler/young child though one would almost certainly need a long fine telescope and optical forceps in tandem with this).
4mm rigid scope, light sources/stack and cables should be available from adult inventory.
Recommendations
The committee therefore recommends:
1.
That all hospitals that with an A&E department that receive paediatric emergencies and maternity and neonatal units should have available equipment for paediatric airway surgery and tracheostomy as listed above.
2.
It is good practice for all consultants to once a year attend a CPD event where ENT surgeons Anaesthetists and theatre nurses get the paediatric bronchoscopes and tracheotomy kits out to check that everything is in place and to know what is available and where it is kept.
3.
In order to maintain consultant skills and confidence colleague may wish to consider attending a paediatric airway refresher course once every 5 years