A response to ‘Anaesthetists and care of the critically ill child’, Tomlinson A, Anaesthesia 2003; 58: 309–11.

I read with great interest the views of Dr Tomlinson as I view enhancing my skills in care of the critically ill child as an essential part of my preparation for a consultant post. The majority of my exposure to critically ill children has been undertaken in a district general setting where the anaesthetist is regarded as key in the management and preparation for transfer. Now as a paediatric intensive care unit (PICU) registrar, I find myself in a good position to bridge the gap in understanding the limitations and needs of each setting. The PICU is often regarded as a rarely encountered place exclusive to those attempting to conquer the world of paediatric anaesthesia. My experience is that it is a resource more than happy to be tapped by those who value its existence. Its advice can promote better understanding and therefore improved, more confident, management. A shared emergency experience helps to educate for a future crisis situation, where unfamiliarity rather than lack of basic skills is usually the concern to most anaesthetists. Each setting has provided me with an insight into the many resources we simply do not appreciate we have at our disposal, in particular the neonatologists, paediatricians and adult intensivists, for help with diagnosis, fluid management and difficult venous access. Both experiences have demonstrated the importance of resuscitation skills but equally the value of local team work complemented by good communication with retrieval teams and paediatric intensivists. I would agree with the emphasis placed on stabilisation of children for transfer as an important skill in the Competency Based Training for SpRs and encourage schools of anaesthesia to address this when assisting trainees with their preparation for CCST. Perhaps a 6-month dedicated post would be impossible to acheive for the majority, but the offer of on-call commitment during more general placements would go some way to addressing a recognised concern in departments.