Classification of 3 levels is dependent or both paediatric training time and skills acquired.

After-hours work mainly involves covering the following areas:

. Children's Ward
. Neonatal Unit
. Postnatal Unit
. Delivery Suite
· Family Birth Centre
· Accident & Emergency

plus A&E consultations and transfers from Shellharbour, Bulli and Port Kembla Hospitals and Neonatal transfers (VMO- directed) from lllawarra Private and Shellharbour Hospitals

DESCRIPTION

Training level, Involves intensive period of training and skills acquisition. Implies little or no previous experience in paediatrics:

EXPERIENCE

Insufficient paediatric experience at entry. Needs to complete at least one term (ie 10-12 weeks). Requires close supervision at all times. Can undertake limited after-hours work but require paediatrician on-call to be immediately available, if necessary, for assessments and managements particularly with procedures and neonatal resuscitations.

DIAGNOSTIC

May possess limited diagnostic skills at entry - paediatrician must be consulted immediately with all acute assessments.

MANAGEMENT

Needs to be discussed with paediatricians.

Resuscitation

resuscitation skills as defined in Paediatric Annexure A..

specific neonatal skills

- suctioning (nasopharyngeal)
- laryngoscopy with or without aspiration below vocal cords
- bag and mask ventilation
- use of naloxone
- basic CPR
- endotracheal intubation with or without aspiration
- peripheral venous access.

Procedural Skills

May possess limited skills at entry, but at the end of the term will be able to perform a number of the following:

- neonatal and paediatric peripheral venous cannulations
- suprapubic aspiration (supervised)
- lumbar puncture (supervised)
- venesection
- newborn examinations

General

Possesses only limited knowledge of management of paediatric presentations.

DESCRIPTION

Competently functions in the paediatric field, though still required to consult for the diagnosis and management of some presentations.

EXPERIENCE

>2 years full-time (or its part-time equivalent) paediatric experience at SRMO or Registrar level (equivalent to a FRACP basic trainee in paediatrics - pre exams stage)

-Relevant other experience can be included

For after-hours work, paediatrician on-call may need to be available after a given time for difficulties in assessments and managements, for example, impending preterm delivery.

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, ECG and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a comprehensive range of paediatric presentations, though assistance may be required for the diagnosis of some presentations.

MANAGEMENT

Resuscitation

· resuscitation ski skills as defined in Paediatric Annexure A.

· specific Neonatal skills

- all items in level 1
- intubate and ventilate manually
- use of volume expanders/dextrose
- use of endotracheal resuscitation drugs
- commence mechanical ventilation.

Procedural Skills

Competence in the following skills, this implies not just technical proficiency but where applicable, a knowledge of indications, contraindications plus complications and their management:

- uncomplicated intubation
- manual ventilation
- intraosseus cannula*
- ABG
- use of CPAP
- lumbar puncture
- urethral catheterisation
- nasogastric tube insertion
- suprapubic aspiration

General

Able to initiate management for the majority of Paediatric presentations though assistance may be required for the management of more complex presentations.

Ascertain the safety and stability of peripheral patient transfers prior to transport to Wollongong

DESCRIPTION

Competently functions independently in the paediatric sphere. Able to supervise more junior staff

EXPERIENCE

Advanced trainee

OR

>3 years full-time (or its part-time equivalent) paediatric experience at SRMO or Registrar level.

- Relevant other experience may be included

In after-hours work, paediatrician on-call rarely required to be called in except, for example in critical cases.

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, ECG and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a comprehensive range of paediatric presentations.

MANAGEMENT

Resuscitation

· resuscitation skills as defined in Paediatric Annexure A.
· Specific neonatal skills - all items in Level 1 & Level 2

- umbilical venous/arterial catheterisation
- mechanical ventilation
- intercostal catheter
- peripheral arterial catheterisation
- nasal CPAP
- complicated venous access
- use of inotropes
- administration surfactant via ETT
- exchange transfusion
- newborn emergency transport

Procedural Skills

· Competence in the following skills. This implies not just technical proficiency but where applicable, a knowledge of indications, contraindications plus complications and their management

- all skills specified in Level 2 plus
- use of mechanical ventilation
- intercostal catheter
- central venous access
- arterial line*

General

Able to provide initial and ongoing management for the majority of paediatric presentations.

LEVEL I

basic CPR
bag/mask ventilation
peripheral venous access
ECG interpretation/ recognition of arrhythmias

LEVEL 2

all items specified in level I
establish airway and manually ventilate
intraosseus cannula
simple use of fluid and blood products
large bore venous cannula
emergency cardioversion (unconscious patient)
use of first line anti-arrhythmics
use of endotracheal drugs

LEVEL 3

all items specified in Level I & Level 2
maintenance of the established uncomplicated airway
use of mechanical ventilation
complicated venous access
complicated use of fluid and blood products
intercostal catheter.

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