Dr Valarie Astle and Dr Simon Chu

In Australia, the evolution of Pediatric Emergency Medicine (PEM) as a licensed subspecialty arose from the advocacy of a core group of pediatricians working in our children’s hospital emergency departments in the 1980’s (1) to where it is now listed by the Medical Board of Australia under both paediatric medicine (1996) and emergency medicine (2018) (2).

To become a paediatric emergency specialist, one completes a subspecialist training program, which is governed equally by the Australasian College for Emergency Medicine (ACEM) and the Royal Australasian College of Physicians (RACP). This is in addition to the ACEM training program’s compulsory paediatric emergency requirement, and the RACP program’s compulsory acute paediatrics requirement. This program initially started only under the RACP in the mid 1990’s, and with time and consultation became a two-college partnership (4,5). Initially, it was mainly RACP trainees, but now the tide has swung and 80% of subspecialist PEM trainees are ACEM trainees. As of 2024, there are 18 accredited paediatric emergency departments in Australia and New Zealand where PEM subspecialist training is allowed (6).

PEM Research has a key role in national PEM recognition as a stand-alone subspecialty. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) grew out of a passion for PEM research, initiated by Prof Franz Babl in Melbourne (7). PREDICT is now highly respected internationally and is a full member of the international Paediatric Emergency Research Network (PERN).

Standards of PEM need constant advocacy. In the past, ACEM had a PEM special interest group, but due to governance requirements this moved to an independent PEM Society to ensure equal respect of doctors trained under either RACP or ACEM. Changes to governance process within both colleges allowed the ACEM PEM Network to form in 2023 with equal rights for members trained under RACP or ACEM, and also welcomes doctors who did not complete the full PEM subspecialty training program but have a strong passion for PEM (8). This is important to advocate for the majority of children in Australia who still seek emergency care at their local general emergency department, rather than travel the distance to PEDs found in dedicated paediatric hospitals in the city.

The challenges that currently face PEM in our region are the same and yet are also different from other regions in the world. The Australian healthcare system faces growing pressure due to a rising population and shifting patient expectations. More individuals now seek urgent care in emergency departments when overstretched general practices and outpatient services cannot meet this demand. Not all patients present with acute illnesses or injuries—many involve complications from chronic or non-urgent conditions. There is a need to continually monitor patterns of patient presentations so that models of care can be advocated and a workforce constructed so that core paediatric emergency medicine is delivered, whist not disadvantaging patients with more complex problems who come to the emergency department as a last resort.

In addition, whilst there is a compulsory paediatric emergency requirement in ACEM specialist training and a compulsory acute paediatrics requirement in RACP specialist training, this may not be enough training for consultants working in mixed EDs which see a large cohort of children. Models of care suitable in standalone paediatric EDs may not be a perfect fit for mixed EDs. It is this middle area where a collaborative effort between specialist emergency physicians, specialist paediatricians, and specialist paediatric emergency physicians is required to ensure that the needs of children presenting for emergency care remain in line with contemporary hospital systems and what they can deliver, as well as embracing new models of care discovered through innovation and research. It is here where advocacy bodies can build communities of practice to support each other to delivery optimal care.

References:

1. Starr M, Babl F, Isaccs D. Editorial: Paediatric emergency medicine. Journal of Paediatrics and Child Health 52 (2016) 103–104
2. https://www.medicalboard.gov.au/Registration/Types/Specialist-Registration/Medical-Specialties-and-Specialty-Fields.aspx
3. https://www.mcnz.org.nz/registration/scopes-of-practice/vocational-and-provisional-vocational/types-of-vocational-scope/
4. https://acem.org.au/Content-Sources/Training/Paediatric-Emergency-Medicine-Training/FACEM-Trainees-commenced-from-2022
5. https://www.racp.edu.au/trainees/advanced-training/advanced-training-programs/paediatric-emergency-medicine
6. https://acem.org.au/Content-Sources/Training/How-the-FACEM-Training-Program-works/FACEM-Trainees-enrolling-from-2022/Where-can-I-do-my-training
7. https://www.predict.org.au/
8. https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Networks/Paediatric-Emergency-Medicine-Network

Acknowledgements:

Dr Jeremy Raftos and Dr Ron Clark, retired PEM consultants who were one of our mentors and founders of PEM in Australia.