Paediatric Intensive Care

The Joint Faculty of Intensive Care Medicine in Ireland (JFICMI) has offered ongoing support to the development of Paediatric Intensive Care Medicine (PICM) in Ireland and there will always be Paediatric representation on the Board either by election or if not co-option. The Faculty continues to support the concept of Adult and Paediatric Intensive Care Medicine acting cooperatively and in parallel in its dealings with the HSE and the CCP.

The National Standards document for Paediatric Critical Care Services in Ireland is operative and future documents (in collaboration with the Paediatric Critical care Group (PCCG), JFICMI and ICSI) will delineate the entire pathway for critically ill children in need of Critical Care.

Consultant Paediatric Intensivists have completed the requisite 2 years of Paediatric Intensive Care Specialisation in addition to completion of specialist training in their base speciality of Anaesthesia, Paediatrics, Neonatology, Emergency Medicine or Paediatric Surgery. (1). In the future it is hoped that Paediatric Intensivists will be certified as registered specialists in their base speciality and in Intensive Care.

The PCCG are working with the Examinations and Training Committee of the JFICMI in evolving work based competency assessment and accreditation processes to ensure and sustain the quality standards of the JFICMI. Like Adult Critical Care, the PCCG envisages that a written exam will be a key component of accreditation in the future and are currently actively involved with the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) in preparing a European Diploma in Paediatric Critical Care to achieve a reliable and consistent exam throughout Europe. The PCCG are engaging with the constituent Colleges to also explore how Paediatric Critical Care Medicine can be incorporated into the Specialist Registrar Programmes.

Training in Paediatric ICM (SI and Fellowship years) will involve rotations through Our Lady’s Hospital for Sick Children (OLCHC), and in the future, modular training in the Children’s University Hospital Temple Street. A modular training programme is outlined within the paediatrics document, publications section, it incorporates rotations through general paediatric medical-surgical ICU, cardiac ICU and also specialist modules such as retrieval medicine, airway, vascular access, ECHO, paediatric dialysis and ECLS rotations. Standardisation of logbooks and the determination of competencies for paediatric ICM in Ireland is an evolving process in continued development. In-training assessments (ITA) and workplace-based assessments (WBA) are complementary and administered by the supervisors of training for later review by the Joint Faculty. It is also worth noting that OLCHC is recognised for training in ICM since the accreditation process started in 1995, and that at present, up to four months of ICM may be attained in OLCHC (adult or paeds).

The Paediatric Critical Care Group (PCCG) is instrumental in organising training and running courses directed towards paediatric ICM trainees. While many courses such as BASIC cater for both paediatric and adult ICU trainees, certain courses are specifically directed toward the paediatric ICM trainee, examples include APLS and Paediatric Tracheostomy, Paediatric ECLS, Paeds BASIC and a paediatric retrieval course. (2)
The Irish Paediatric Acute Transport Service (IPATS) has recently been established and is funded by the National Transport Medicine Programme. Presently it provides daily cover and is working to become a 24 hour service in the future.
A PICU bed can be accessed Nationwide via the PICU website (PICU.ie) and dedicated National Referral Line. The website provides users with a single referral point for all Paediatric ICU beds in Dublin but also valuable information on clinical guidelines, resuscitation measures, drug doses and essential equipment.

For further information and useful resources the reader is referred to the publication section. (4,5)

 

References:

  1. Criteria for inclusion of Paediatric/Neonatal Specialists on JFICMI – Memorandum and Articles of Association
  1. Association of Paediatric Anaesthetists of Great Britain and Ireland
  1. The Irish Paediatric Critical Care Network
  1. European Society of Paediatric and Neonatal Intensive Care
  1. National-Standards-Paediatric-Critical-Care-Medicine 2020.