In the Republic of Ireland, the schedule of state-funded immunisation for children is comprehensive and includes diphtheria, pertussis, tetanus, pneumococcus, hepatitis B, meningococcus C, haemophilus B, polio, measles, rubella and mumps. Varicella and meningococcal B vaccines are commercially available but are not currently funded by the government. Each of the illnesses preventable by these vaccines can cause substantial morbidity, and rarely mortality, in infants and children. Our PICU continues to see serious illness due to avoidable infection. There were 39 admissions in a 4 year period, with 34 children surviving to discharge. Nine children were infected with pneumococcus, with 4 deaths. There was one case of pertussis, causing death. Most infections occurred in previously healthy children. These preventable conditions represent a significant burden on children, families, and on social and healthcare resources.

Extra corporeal membrane oxygenation (ECMO) is a form of life support, which facilitates gas exchange outside the body via an oxygenator and a centrifugal pumping system. A paediatric cardiac ECMO programme was established in 2005 at Our Lady's Children's Hospital, Crumlin (OLCHC) and to date 75 patients have received ECMO, the majority being post operative cardiac patients. The outcome data compares favourably with international figures. ECMO has been most successful in the treatment of newborn infants with life threatening respiratory failure from conditions such as meconium aspiration, respiratory distress syndrome and respiratory infections. There is no formal paediatric respiratory ECMO programme at OLCHC, or anywhere else in Ireland. Currently, neonates requiring respiratory ECMO are transferred to centres in Sweden or the UK at an average cost of 133,000 Euros/infant, funded by the Health Service Executive E112 treatment abroad scheme. There is considerable morbidity associated with the transfer of critically ill infants, as well as significant psycho-social impact on families. OLCHC is not funded to provide respiratory ECMO, although the equipment and expertise required are similar to cardiac ECMO and are currently in place. The average cost of an ECMO run at OLCHC is 65,000 Euros. There is now a strong argument for a fully funded single national cardiac and respiratory paediatric ECMO centre, similar to that for adult patients.

The development of employee assistance programmes (EAPs) has significant implications for doctors, especially general practitioners and psychiatrists. This paper discusses the importance of training counsellors to detect serious psychological disorders among people who use an EAP service and the need for clinicians to accept referrals of those users who are identified as being in need of further medical treatment.

Health gain is a term describing an improvement in health status, arising from defined inputs. The focus on outcome is a welcome change from the traditional emphasis in the health sector on structures and process of care. Inputs include the spectrum of health care from primary prevention through to rehabilitation. The health gained from such interventions depends on the effectiveness of care and the willingness particularly of doctors to change practice to aspects of care of known benefit to patients. Relatively modest inputs in health care can lead to considerable health gain. This has economic implications in a climate of reducing resources for health care internationally. However at a population level, better health may result from inputs in sectors other than health, particularly education, housing and higher employment rates. The public also need a mechanism for becoming involved in the debate about improving their health. The developments to support health gain in the UK have opened up a challenging new era for the health services there.

Farms in Ireland remain a dangerous environment for children despite increasing publicity about farming hazards based on international research. A one year prospective study on farm accidents was carried out in four Irish accident and emergency departments. During this time, four deaths and 62 cases of injury aged 15 years and under were seen. Half the cases required admission to hospital; tractor accidents were common and serious. Most injuries occurred to the extremities but 13 (21 per cent) had multiple injuries. Forty-three (69 per cent) of the children required outpatient follow-up and twenty-seven of these (63 per cent) had more than one outpatient re-visit. The Irish farming community is still unappreciative of the risks to their children on the farm, and urgent attention needs to be directed towards educational and legislative measures to improve the safety profile of Irish farms.

A one-year prospective survey of farming accidents in three Irish counties recruited 37 general practitioners in a wide geographical sample. The response rate to the survey was 84%. There were 319 accident cases seen by the general practitioners in the survey period, and 175 (55%) of these were farmers. Children accounted for 52 (16%) of all accident cases. The majority of cases (256, 80%) were treated by the general practitioner, and the spectrum of injuries treated was very broad. Many injuries required extensive suturing and follow-up of soft-tissue injuries. General practitioner coroners were involved with five fatal farm accident cases. It is concluded that the Irish rural general practitioner is providing a significant trauma service to farm accident victims, and is a valuable source of information on these incidents. The general practitioner would be a local source of expertise in a health education campaign directed at increasing the awareness among the farming community on the extent of farm accident morbidity and mortality. Continuing education for rural general practitioners should be directed towards regular updates on trauma management.

Doyle, Y. and Conroy, R., 1988. A one year survey of accidents on Irish farms and their medical outcome. Journal of Occupational Accidents, 10: 199–208.