999 Club aims to reduce children's fears of the emergency department

A recently-launched initiative gives children a flavour of what goes on in emergency departments – so if they should ever have to visit as patients, they will know what to expect

A recently-launched initiative gives children a flavour of what goes on in emergency departments – so if they should ever have to visit as patients, they will know what to expect

Inviting small children to ‘guess the bones’ and to learn what goes on in the back of ambulances sounds guaranteed to appeal to the sometimes-lurid curiosity of young minds.

The 999 Club
Southampton Children's Hospital's 999 Club

In fact, interactive experiences like these are proving a huge hit with five to nine year olds who visit Southampton Children’s Hospital as part of a local initiative to reduce children’s fears of emergency treatment and get them thinking about accident prevention.

The 999 Club began as a pilot project last year but proved such a success with schools in the area that it was recently given the green light and officially launched.

Knowing what to expect

The aim, says Suzie Knight, the hospital’s lead nurse for paediatric emergency care, is to show children what happens in emergency departments (EDs) so that if they should ever have to visit as patients, they will know what to expect.

‘We felt there was no preparation for a child who comes into the ED,’ she says. ‘For children coming for an operation, there’s pre-planning: they come into the hospital, have a trip to theatre and meet the staff. But for the ED, there was nothing whatsoever, and yet children come at a time when they’re scared and in pain, or very unwell, and it can be a frightening place.’


of 2015-16 attendances at urgent and emergency care services in England were children aged 5 to 15 years

University Hospital Southampton NHS Foundation Trust youth and play services manager Joyce Stebbings agrees that a first visit to an ED can be alarming for children and young people. ‘This initiative gives pupils the opportunity to participate in activities related to emergency care and what they may see, hear or experience if they come into hospital via ambulance or with their parents as an emergency,’ she says.

Fun and informative

‘By having the opportunity to look around the department, in a fun and informative way, we hope to reduce the fears and associated anxieties that children experience when attending the ED.’

Despite that laudable aim some might suggest that inviting so many healthy, energetic children into a busy emergency care setting simply adds to workplace pressures experienced by staff. But Ms Knight says the benefits outweigh any concerns people might have.


ED attendances in England for every 1,000 children and young people in 2015-16

‘It’s important that children know a bit about accident prevention and safety, and about coming into the ED. If a child then does have to come in for treatment and feels more relaxed, it’s so much easier to look after them,’ she says.

‘It is time well invested. You can get them in and out much quicker, therefore saving nursing time, saving time the children spend in the department and improving flow.’

Lessons learned

For any paediatric emergency department considering a similar scheme to the 999 Club at Southampton Children’s Hospital, Ms Knight says ‘it’s well worth doing’ because the children who attend remember what they have learned.

‘We sat down at the start and went through what, fundamentally, we wanted to get across during the two-hour session.

‘I would say you must make sure you’ve got everyone on board. Something like this takes a lot of organising and you have to be committed to it. You’ve got 15 young children coming in so make sure everything is in place beforehand so that it runs smoothly.’


Trauma scenario

Working with South Central Ambulance Service, the hospital invites visits from schoolchildren from reception year and above. They come from across the south of England to tour the paediatric ED and meet staff.

As well as handling equipment and learning about observations such as pulse and blood pressure, the children find out about nursing, medical and paramedic roles, and take part in a trauma scenario where a young boy has run into the road and been hit by a vehicle.


year olds’ most common presentations are upper limb fractures, viral infections and abdominal pain

Part of the aim is to enable them to experience what it might be like to be a nurse or doctor having to treat the boy. A realistic mannequin is used in the scenario.

A recent local television news report captured pupils from a junior school completely absorbed in attending to the injured ‘child’ – stabilising him with a neck brace, listening to his chest with a stethoscope and bandaging his injured limbs.

‘But we also teach them about road safety and when it’s appropriate to call an ambulance,’ Ms Knight says. ‘It’s all interactive and it’s all fun.’

Positive feedback

The two-hour sessions include a drink and a snack, a quiz designed to test what the children have learned, a goodie bag for each child and a feedback game where they attach stickers to a target to rate their enjoyment of the different activities.

‘We’ve always had overwhelmingly positive feedback,’ Ms Knight says. ‘I remember the first session we did, at the end of it this little boy was leaving and I heard him say: “That was the best day out ever!” They absolute love it.’

She adds: ‘We also get feedback from teachers – emails saying how much the children enjoyed it.’

Given the scheme’s success, are there plans to extend it to older children? ‘At the moment, we’re so overwhelmed with this age group that we can’t manage any more,’ Ms Knight says.

‘Realistically, I can only run the session once a month. I do it in my work time as it’s part of developing the department, but the ambulance crews and my helpers come in their own time. There’s so much more we could do. But what we’ve got at the moment works well.’

She adds: ‘I’m more exhausted after two hours running the 999 Club than I am after a whole day in the ED because you’ve got 15 inquisitive children and they want to learn. But it’s so worth investing in them. They will remember it because it’s fun.’

Children in emergency departments

Latest figures published by NHS Digital for England show that in 2015-2016, 2,096,128 children, aged 5 to 15 years, attended emergency departments (EDs), including walk-in centres and minor injury units, accounting for 10.2% of total attendances.

View full statistics here

Children and young people are more frequent users of EDs than adults, according to Quality Watch, a report published last year by the Health Foundation and the Nuffield Trust. It said that in 2015-2016 in England, there were 425 ED attendances for every 1,000 children and young people, compared with 345 attendances for every 1,000 adults aged 25 and above. The report argued that improving the health literacy and education of families was among the key principles for reducing high activity in paediatric emergency care settings.

Among the ten most common conditions diagnosed on emergency admission for 0 to 24 year olds were viral infections, abdominal pain and fractures to the upper limbs.

Report available here 


Daniel Allen is a freelance health writer

This article is for subscribers only