“A few days into the fighting we started to receive civilian casualties. The kids were the worst and hardest to deal with. I would have given a lot to have had a paediatrician alongside me, or access to specialist advice.”
Combat Medic, Mosul 2017
Up to 80% of children presenting to hospitals in conflict areas are suffering from penetrating trauma to the head due to shelling, shrapnel injuries and gunshot wounds. Medical care focuses on preventing further damage from swelling of the brain or bleeding and monitoring of the brain activity, which only a team with knowledge of specialised paediatric care can provide.
Children have a unique anatomy and physiology which, if not acknowledged by the medical team, can lead to life threatening pitfalls in their treatment. For example a child's ribcage is still flexible (made of cartilage instead of adult bone) which allows any sudden impacting forces to be transmitted to the chest organs (heart, lungs, major vessels). Following a blast injury and even in the absence of any rib fractures, the child could have sustained severe damage to their heart and lungs, requiring acute and life saving procedures such as placements of tubes directly through the ribcage to drain any blood or air.
When a child has suffered a burn injury or loss of blood, it is crucial to give intravenous fluids, however too much or too little can be fatal. Estimating the amount of fluid that is needed has to be done immediately, based on the child's weight, without using scales and by a doctor trained in these calculations. Placing intravenous access (drips, lines) to give fluids and medications is much more difficult in children then in adults due to their smaller size and differences in anatomy so guidance to find appropriate sites is needed. Shock can be difficult to recognise in children due to their ability to compensate for fluid loss. This can create a false illusion of stability, which, if not recognised and treated appropriately, will be followed by a precipitous deterioration and death.
In areas where the health infrastructure has been damaged, more fatalities occur due to disease and other factors than to battle. Children require treatment for all kinds of acute or chronic illnesses but without an effective healthcare system and dedicated paediatric care, common paediatric conditions can't be treated and children die from preventable diseases like respiratory tract infections, diarrhoea, malaria and vaccine preventable diseases. A paediatrician can also advise on children suffering from dehydration or severe acute malnutrition and can suggest alternative treatments when supplies are not available/sufficient.
COVID-19 highlights the need for projects like Save A Child. The pandemic and measures taken to control its spread are putting additional strain on often already overstretched healthcare systems, leading to increased problems of provision and disruptions of essential services. Now more than ever, the world requires solutions that can use remote medical technologies to increase safety for healthcare professionals by delivering direct access to expert paediatric care.
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