Do you know how to help a baby who is choking and have you read any other important updates recently?

The Chokeables – featuring the voices of David Walliams, David Mitchell, Johnny Vegas and Sir John Hurt – is a 40 second video that shows people how to help a choking baby.




Parents told St. John Ambulance that over 40% of them have witnessed their own baby choke and when they were quizzed on the first aid, they found that almost four-fifths don’t know what to do in this situation.

In The Chokeables, the celebrities take on the characters of animated objects that could potentially choke babies: a small princess toy, a pen lid, a jelly baby and a peanut. They’ve joined together because they want to show how easy it is to save a choking baby’s life.

There are other first aid resources for parents on the St. John Ambulance website including: dedicated first aid advice videos, a download and keep first aid poster, the St John Ambulance app, and an essential first aid course.



Re-ACT talks

Whilst I’m on the subject of quick and easy updates there are some really good resources on the NHS England Re-ACT website which are a great educational resource and especially good if you haven’t got a huge amount of time and would like an update, with practical tips you can implement immediately, on topics such as:

Deterioration: How to Spot the Sick Child – by Ffion Davies, Consultant in Emergency Medicine, University Hospitals of Leicester NHS Trust.

Batteries, Burns and other Bombs – by Rachel Rowlands, Paediatric Emergency Consultant at University Hospitals of Leicester NHS Trust.

Spotting Sepsis in the Sick Child – by Jeremy Tong, Consultant Paediatric Intensivist, University Hospitals of Leicester NHS Trust.



APLS Changes

Those people who teach on Advanced Paediatric Life Support (APLS) courses will know that there were a number of trauma changes announced earlier in March. In particular:


Cervical spine stabilisation

The approach to spinal immobilisation is a stepwise approach. The method of stabilisation should be considered carefully:


  • Manual in-line stabilisation (MILS)
  • Blocks where necessary if suggested by mechanism of injury (see NIHCE guidance)
  • There is no evidence of the benefit of using collars in children and in many cases they are contraindicated e.g. penetrating trauma and, therefore, their use will no longer be routinely taught on APLS, APLS recertification and PLS courses
  • Spinal board used only for extrication with rapid transfer to a scoop stretcher for transportation and early removal from scoop stretcher in ED
  • Minimal handling with 20o tilt is recommended (rather than log roll) as described in the FPHC consensus guidelines1



Haemorrhage control


  • <C>ABC with assessment for catastrophic haemorrhage and immediate response to this before Airway assessment.
  • Pelvic binders may be applied in the pre-hospital setting or ED for pelvic stabilisation and haemorrhage control. Remember ‘first clot, best clot’ principle and do not remove pelvic binder until cleared by someone with expertise in this area. Proprietary pelvic splints are available for children.  However, there may need to be some innovative approaches to the equipment used depending on the size of the child and the equipment you have available.  For example, an adult BP cuff may be more effective in an infant.



Approach to fluids

  • First fluid bolus of 10ml/kg followed by reassessment
  • If blood not available, then a further fluid bolus of 10ml/kg followed by reassessment
  • Where indicated, implement massive haemorrhage protocol. Examples of massive transfusion policies can be viewed here
  • Early surgical consultation and intervention


Professor Simon Carley has summarised these changes in a really good blog that you should read here:



Mental Health Act 1983 Code of Practice

Finally, the following Mental Health Act Code of Practice comes into force today:



The status of this guidance is as follows:


This Code of Practice provides statutory guidance to registered medical practitioners, approved clinicians, managers and staff of providers, and approved mental health professionals on how they should carry out functions under the Mental Health Act (‘the Act’) in practice. It is statutory guidance for registered medical practitioners and other professionals in relation to the medical treatment of patients suffering from mental disorder.


All those for whom the Code is statutory guidance must ensure that they are familiar with its contents. Others for whom the Code is helpful in carrying out their duties should also be familiar with its requirements. The Code has been revised following extensive consultation, collaboration and engagement with service users, carers, professionals, the voluntary sector, providers, commissioners and statutory bodies.



From an Emergency Department point of view there are four chapters that are, in particular, relevant to our work:


Chapter 16 about police powers and s135/s136 (particularly section 16.20 relating to when Section 136 of the Mental Health Act can be used in an Emergency Department)


Chapter 17 dealing with how patients should be transported under the Act


Chapter 19 dealing with Children and Young People


Chapter 20 dealing with those patients with Learning Disabilities or Autistic Spectrum Disorders


It is worthwhile reviewing the above updates – they don’t take long to read and are great CPD for anyone working with children and families – especially those in an Emergency Department.


Enjoy your weekends!