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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams acknowledges the court system's natural conservatism, but points out the Family Court's ability to innovate. Family Drug and Alcohol Court (FDAC) has changed abuse proceedings involving substances and produced significant success. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams cites Richard Susskind's view that AI will soon have the capability to complete replace the role of judge. As more advanced technology makes its way into our practice as paediatricians, the evidence base for this will doubtless find its way into court and be tested in that forum. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams very interested in the concept of 'cross-fertilisation' and about to expand on this, although immediately at pains to point out that these are his personal views and he'll be retiring soon! #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: support processes improving, given the vicarious trauma that working around injured and murdered children can produce in professionals. Schwartz round held in January, with a judge, a barrister and a paediatrician sharing their stories on a common theme. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: lots of work done within the court system about the difference between disagreeing with an expert and criticising an expert - he can think of one judgement he has produced where an expert was gently criticised, as experts work to very high standards. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: Baby P's death produced significant anxiety in society and a subsequent rise in family court cases. This rise required more expert reports - roughly 30,000 expert reports per year. More demand requires more expert witnesses. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: we are getting better at sharing information between agencies, but still operate too much within our own silos. As well as sharing information, shared decision-making is essential in child protection. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: not all witnesses are allowed to offer their opinion on what may have happened. In his experience, most paediatricians would have sufficient knowledge and experience to be able to provide this as an expert witness in most cases. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: a large level of the judiciary's understanding of the impact of trauma has come from the testimony of paediatricians, alongside radiologists, neurologists and other partner specialties. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Williams: a long list of children murdered by their parents and carers have led to our statutory frameworks, specific organisational roles and models of best practice in child protection. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Final plenary of the day at #RCPCH26. Delivering the Illingworth-Rees lecture, reflecting on the last 40 years of family justice, is Mr Justice Williams, chair of the Family Justice Council's Committee on Experts.

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Sepsis screening tools all a bit crap, points out @damianroland.bsky.social - illness recognition tools (such as NPEWS) probably better - before confessing to once swallowing a Lego figure. I think my brain is starting to lose track of events 😂 #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Aligning NPEWS with Manchester (or non-subscriber alternative) acuity levels key to standardise response, reports @damianroland.bsky.social. Reassessment can obviously upgrade acuity level. "1 or 2? Bring them through! 3 or 4? Wait some more! Clearly a 5? They'll survive!" #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

I thought we were done! I was wrong! @damianroland.bsky.social is here with a Lego-themed National PEWS update! Crux of the issue: PEWS designed to detect deterioration and we know a single set of obs less helpful than a trend. Can this model apply to triaging undifferentiated kids? #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Gamble: however, positives - ongoing departmental and organisational buzz and excitement even months later, with obvious directions for improvement in pathways and processes. We practice resuscitating one patient. Time to practice resuscitating twelve. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Gamble: missed opportunity for other depts in Trust. Whole hospital engagement, even as tabletop exercise, would have tested other departmental responses. For example, 4 patients simultaneously being transferred to theatre, but only one paeds theatre normally - response remains untested. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Gamble: what went wrong? Admin - patients should have been pre-registered with trauma designations, but attempts to book patients in on arrival caused large delays - some patients had been in dept for 30 minutes and received blood products despite not being registered! #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Staged incident - knife attack at local primary school. First 'casualty' arrived 10 minutes after call. 15 patients including adults. One patient transferred to theatre to continue 'resuscitation'. Standard running of dept continued alongside. 60 staff included. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Vital to perform live exercise in realistic venue as goal is to test system - how does pt A get to location B and C? Not realistic sim patients, nobody acting as distressed parents etc - goals was to test systemic response, not traumatise staff. Observers from specialties & other Trusts. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Gamble's key players: Blood bank - Leeds have 15 units O neg with 8 units suitable for kids. Previous tabletop used 18 units PRCs and 18 units FFP - would exhaust supply. Blood bank happy to make up mock shock packs to test systems. Theatres and anaesthetics - likely limited paeds cover. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Gamble: Trust audit day so theatre lists and clinics cancelled - worked really well, would recommend again. Liaised with other specialties to ensure people around and mimic calling in from home. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Gamble: not very rare - 5 incidents in 6 years in Leeds. Legal duty to run tabletop exercise annually and live exercise every 3 years. If it feels busy now, how will it feel during a mass casualty event? "Timing is everything" - aimed for July as quieter but pre-holidays. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Edwina Gamble now discusses preparing a major incident plan. Emotional impact of paediatric mass casualty events not to be underestimated, but running simulated live event is difficult when every shift feels like a major incident! Unfounded, and perceived as rare events. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Children often minimised in orgs that also look after adults, and local major incident planning reflected this, @babydrclaire.bsky.social points out. Major incident plan currently being rewritten, but quick reference guides being written reflecting learning from incident, with sim planned. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

However, accident of timing. @babydrclaire.bsky.social discussed with resilience lead - "we were going to sim a paeds incident, but we didn't want to make people feel uncomfortable" - but children are involved in mass casualty events and most paeds clinicians aren't trauma-trained. PLAN! #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

When impact on hospital clearly minimal after acute flurry of activity, major incident state stepped down to release resources. What went well? Teamwork, communication, timing it with the monthly ED consultant meeting(!), flexibility of paeds response, separate bereavement stream. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

@babydrclaire.bsky.social: 4 patients admitted - 3 needed theatre the next day. Fatality 10 years old - died at scene. Kept at scene until survivors evacuated. Separate paeds medics/nurses used to managing bereavement led response, and brought to cordoned off separate area of ward. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Additional cannulation equipment fetched from wards. Rapid discharge round on paeds assessment unit and wards, whilst medical presentations to ED all pulled to PAU to free up ED resources. First patient arrived at 17:20; final patient at 21:05. Ambulance transfers had to self-ID. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

First response on receiving the major trauma bleep - "I hear it's a school coach crash, it MUST be a sim". Team members had children on school coaches - rapidly establishing safety of their kids necessary for focus. Paeds consultants excluded from initial planning and decision calls. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Last talk of the session - @babydrclaire.bsky.social and Edwina Gamble share learning from managing a mass casualty incident - coach crash with 21 injured children - in a DGH (50 min from crash site) with one PEM consultant, no paeds surgery on site and no guaranteed paeds radiology cover #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Finally, Ricky Odedra from @imperial-ighi.bsky.social discusses the impact of language discordance on safe care in CED. No prior UK studies. Rapid ethnography study: preferred language not identified in 69% of triage, whilst professional interpretation in only 9% of discharge encounters. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Next, David Kung examines the impact of ⬆️ staffing during IA on CED performance. Unsurprisingly, disposal within 4 hours improved despite no change in admissions, but very expensive, no data on precise staffing, and I DUNNO MAYBE TRAINING RESIDENTS IS A CORE PART OF OUR JOB. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Time for the Joan Robson Prize presentations! First up, @headsmartfellow.bsky.social. Children are more likely than adults to present as emergencies with their malignancy. Older children present later, as do bone tumours. What's our follow up pathway for acute limp? How/when do we reimage? #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Host of upcoming PERUKI-sponsored studies almost ready to launch, including research examining management of supracondylar fractures, periorbital cellulitis and detection of sentinel injuries in the emergency department. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

FORCE's success has influenced other orthopaedic study setup in ED, with patient information leaflets ready to quickly adapt - CRAFFT took advantage of this, demonstrating non-inferiority with casting of displaced distal radius fractures compared to manipulation. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Recently closed studies include the Frog study (feasibility study examining urine collection methods in ED) and COWS (examining calcium levels in trauma and association with haemodynamic instability). Meanwhile, survey of practice following FORCE has shown a change in practice. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

CRESCENT: standard care + Carbogen (95-98% O2, 2-5% CO2) vs standard care in status epilepticus - recruitment nearly complete. Belly POCUS - observational (POCUS on patients without abdo trauma), aiming to define mesenteric adenitis diagnostic criteria in children #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

BACHb - Non-blinded RCT comparing HFNC vs CPAP in severe bronchiolitis Bronchstart - observational bronchiolitis study, paused at present, but restarting in the autumn - impact of RSV vaccine will be interesting... CURLY - comparing course lengths of oral cefalexin in febrile UTIs - CUTE! #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Current open studies... EVITA - Evaluation of Intravenous Therapy in Asthma - three arm open label RCT comparing IV salbutamol vs aminophylline vs MgSO4 HOPSA - unblinded RCT comparing HFNC to standard care in acute severe wheeze classed as non-responders to burst inhaler therapy #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

NEXT: it's the PERUKI update, from @alderhey.nhs.uk's Shrouk Messahel! The PERUKI x APEM Conference is happening in Southampton in September and there are only 200 tickets available, so please hold off booking your place until I've booked mine plskthx #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Audience question: it's great having so many follow-up options in an Ivory Tower, but what do we do in our DGH? Mulvaney: our respiratory nurses have done a lot of outreach work with primary care and general paediatrics, both of which would be no different to a DGH. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Audience question: is it practical to commence/alter maintenance therapy in the emergency department? Mulvaney: "initial thoughts [after practical session with different devices] were 'OMG what the hell' but you get used to it, and regular rotations mean regular training." #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: life-threatening asthma guidelines remain unchanged, whilst dosing of MART varies depending on precise formulation selected, so care needed in communicating correct dose/regime to patients/parents. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: specific guidance for inpatient teams for changing from acute asthma algorithm to planned maintenance therapy, with versions for SABA/ICS and MART #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: FAQs from patients/parents circulated in regular newsletter from respiratory specialist nurses. Staff lists on departmental wall - very clear who had completed their asthma training and who had not! #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: intensive staff education to become more used to managing MART/AIR as concepts, including weekly sim and easy visual guides. Patient/parent information leaflets for all treatment regimes and devices updated. Personal asthma plans unchanged. Direct resp referral pathway from ED. #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: AIR/MART devices come as both dry powder/breath-activated devices and MDI, so inability to use breath-activated device should not preclude their use - MDI and spacer always appropriate for any age/developmental ability #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: >12? MART default choice for treatment, whilst AIR is now default choice for newly diagnosed mild disease, replacing SABA #RCPCH26

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Sean Monaghan @drseanmon.bsky.social · 11/05/2026

Mulvaney: 1 puff of MART every 2-3 minutes until ambulance arrives in emergency. MART side of 5-12 algorithm via @alderhey.nhs.uk #RCPCH26

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