Paediatric First Aid

Andrew Gwynne Excerpts

Monday 15th December 2014 Westminster Hall

[Mark Hunter]

I thank the hon. Gentleman for his intervention. Again, I could not agree more. I think that everybody, once they have focused on the issue, starts to appreciate that there is a significant difference between having a general qualification in first aid and having a qualification in paediatric first aid, which by the very nature of the fact that it involves dealing with small children—in this case, Millie was only nine months old—is rather more specialist. However, parents would naturally assume—I think we all would—that if they are placing their child in a nursery, the nursery would be covered.

The hon. Gentleman is also right to say that tribute must be paid to the Thompsons; after such a terribly tragic experience, they have made something positive through Millie’s Trust, which is creating a legacy in Millie’s memory. I will say more about that legacy later.

I will go back to the point I was making about the CCTV coverage. Millie’s parents have stated that it was obvious from that footage that when Millie was being taken out to the ambulance she was “like a rag doll” and they believe that at that point she should have been receiving CPR.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I am grateful to the hon. Gentleman for giving way, and of course he is right to highlight these issues here in the Palace of Westminster today. However, this tragic incident not only highlights the failures in the nursery system—that is, the lack of paediatric first aid training—but the fact that until recently the ambulance services were not compelled to have the appropriate paediatric equipment in their ambulances. If one good thing has come out of the Millie’s Trust campaign, it is that the North West Ambulance Service has now pledged to ensure that all its ambulances have the appropriate paediatric equipment.

[Mark Hunter]

Again, I thank the hon. Gentleman for his intervention and he is absolutely right. I will come on to the point about how the North West Ambulance Service has responded to this case in the positive way that he has indicated.

On the day in question, Millie was being fed by the supervisor of the nursery, who had worked in child care for some 20 years; she was an experienced person. Yet, when this tragic incident happened, Millie received no treatment from the supervisor, because she was not trained in paediatric first aid. Instead, she handed Millie to another member of staff.

After Millie had received the slaps to her back, she was left in the arms of someone who was trained in first aid at work, not paediatric first aid. That should not have been the case. Sadly, of the two paediatric first-aiders at the nursery, one chose not to be involved and went to look after the other children while the second administered the back slaps and then left the building, through the nursery grounds, and went to the main road to wait for the ambulance. This should never have happened. The paediatric-trained first-aider should not have left Millie’s side until the paramedics arrived.

I will outline the treatment that Millie should have received and what should have happened at that point in time. Millie, as I said, received a few back slaps and was then held in a non-paediatric-trained first aider’s arms for around 10 minutes. On arrival, the paramedics immediately began standard choking treatment for a baby. By this point, it was tragically too late and Millie’s heart had stopped beating.

In a statement from the nursery, it was stated that one of the untrained staff members finger-swept Millie’s mouth, which all guidelines and all paediatric first aid courses state is the wrong thing to do. The treatment for a choking baby, as outlined on the NHS Choices website, is as follows:

“A baby who is choking will be distressed and may be unable to cry, cough or breathe.

Lie the baby face down along your forearm or thigh, with their head low. Support their head.

Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)

Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.

If the airway is still blocked, give up to five chest thrusts.

Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should: dial 999 for an ambulance immediately. Do not leave the baby—take him or her with you to the phone; continue with the cycles of back slaps and chest thrusts until help arrives.

In babies under one year old”—

remember that Millie was under one year old—

“chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

Lie the baby along your forearm on their back, with their head low. Support their back and head.

Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger’s breadth below the nipple line.

Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage.”

Again,

“Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in.”

This is standard choking advice and every paediatric first aid course teaches these guidelines, which means that the staff involved that day should have given a statement as I just stated it.