Paediatric emergency medicine – the new frontier

Welcome to the special issue of Paediatrics & Child Health dedicated to paediatric emergency medicine (PEM). This issue provides succinct updates on a number of common clinical problems seen in the paediatric emergency department (PED) (head injuries, fever, respiratory distress and, toxic syndromes or ‘toxidromes’), and focuses on areas of concern (overcrowding, teaching resuscitation skills and reducing errors). We also review the history of PEM in Canada, discuss recent articles in PEM and offer ideas for pre- and postemergency care. We hope many readers will use this issue to improve urgent child and youth care in their region, leading to better health outcomes. The young subspecialty of PEM has undergone tremendous and exciting changes over the past two decades. From a service that was provided by other specialists such as surgeons, general practitioners and community paediatricians, PEM has evolved into a service provided by paediatric emergentologists, with a unique set of skills, knowledge and aptitude. While in the past emergency rooms served as a triage and a referral system for children and their families, they have evolved into EDs providing acute care; saving children's lives 24 h a day, seven days a week and 365 days a year; and in academic centres, providing teaching and research. Clinically, PEM in Canada has moved rapidly to provide evidence-based practices, including the use of clinical practice guidelines, up-to-date therapeutic options and procedures appropriate for children and youth. Advances in the management of common acute illnesses such as fever, respiratory distress and abdominal pain have led to more efficient and proficient care, the use of drugs previously ‘prohibited’ for children following careful research in the field, and improved analgesia and procedural sedation. Canadian PEM practitioners were pioneers in the area of teaching in the PED setting, and at an early stage understood the importance and impact of knowledge translation. From bedside teaching to PEM-specific workshops and conferences, and from Web-based learning to high-fidelity simulation, Canadian PEM physicians have made PEM learning an interesting and enriching experience, enhancing paediatricians' knowledge and skills. Research in PEM has grown tremendously over the past decade, despite the need to diagnose and treat almost immediately, challenges in obtaining consent and the crowded nature of the ED. Networking between Canadian centres has paved the way for quality collaborative research in PEM. The importance of PEM in child and youth care was recognized by the Canadian Paediatric Society supporting the formation of the PEM Section. Our work has only just begun. We need to advocate for better and more timely access to high-quality urgent care for children and youth across Canada, regardless of where they live. We need more research to refine and improve care in the ED, better transport and triage protocols, and more work with colleagues to prevent urgent acute health care problems. Working together, we can make an even bigger difference in the health and lives of acutely ill children and youth.

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