Fourteen-twenty

68 children a year were killed in the UK in 2019. In 21 cases the suspects were the parents or step-parents ( ref ). The same year saw 650,900 referrals to social services ( ref ). If we assume that each of those 21 children had been referred to social services (a big assumption; it may well be that children who are murdered are less likely to be referred), that would mean that social services were unable to prevent a child murder in 0.003% of referred cases (about 1 in 31,000). For comparison, the risk of being killed by a motor vehicle in one year is 1 in 20,000, and in a lifetime is 1 in 240 ( ref ).

It was a busy shift, fighting fires, physically and psychologically tiring. I was dealing with two unwell patients in A&E when a house officer from the surgical ward called. He was worried about Mr X’s blood pressure. The numbers didn’t sound too worrisome to me, at least not compared to the patients in front of me. ‘Give him some fluids,’ I said, ‘I’ll be there when I can’. I thought but didn’t say ‘Not for several hours mate’. I continued seeing the patients in A&E. He called again. I tried to buy time with more fluids. Even in hindsight, I don’t know if on the basis of the information available I made the right prioritisation. The crash bleep went off, rudely monopolising attention and trivialising all previously-prioritised thoughts. I raced to the surgical ward, to find an ashen-faced Mr X, in the throes of CPR, and an equally ashen-faced house officer. Pink froth was bubbling from Mr X’s mouth. Pulmonary oedema. He had had too much fluids. The blood gas came back. Lactate...