Summary Applying human factors principles to the design of clinical emergency guidelines is important. The UK Civil Aviation Authority uses a Checklist Assessment Tool for evaluating the content and usability of emergency drills before introduction into service on aircraft. We hypothesised that this model could be used to develop a generic medical tool. A three‐stage modified Delphi process was used to adapt the above tool for use in designing medical emergency guidelines. The resulting Cognitive aids in Medicine Assessment Tool was then used to score and rank seven published difficult airway guidelines; the scores were used to assess its validity and reliability. Pearson's rank coefficient between these scores and scores from independent assessors was 0.89 (p = 0.007). Internal consistency, as assessed by Cronbach's alpha, was 0.74, 0.96 and 0.72 for the tool's three constituent domains of physical characteristics, content and layout/format, respectively. Inter‐rater reliability, as assessed by Cohen's kappa, ranged from 0.33 to 0.72. The adoption of our tool has the potential to improve the usability of medical emergency guidelines.

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Aims-To assess the eVect on health visitor action of providing community health visitors with information on all injury attendances in children under 5 attending an accident and emergency (A&E) department and of providing additional information about each injury. Methods-Children under 5 years attending the A&E department at Queen's Medical Centre, Nottingham between October 1998 and April 1999 were studied, using a randomised controlled trial with a 2×2 factorial design. All attendances or selected attendances (all children under 1, burns and scalds, poisonings, head injuries, and repeat attendances in preceding six months) were notified. Provision of standard (diagnosis, circumstances surrounding injury, and disposal) or additional information (standard information plus place of injury, number of A&E attendances for injury in previous year, and any information recorded about safety equipment) was noted. Results-Many notifications (56%) do not result in any action. Health visitors were nearly twice as likely to take action of some kind and three times as likely to undertake a home visit on receipt of notifications for selected attendances than on those for all attendances. A greater number of actions per notification were taken on receipt of information about selected attendances. Providing additional information had little eVect on the action taken. Conclusions-A selective policy for notifying community health visitors of child injury attendances at A&E results in a greater proportion of attendances in which the health visitor takes action and in a greater number of actions per attendance being taken. The utility of notifying all injury attendances is questionable, as many do not result in any action. (Arch Dis Child 2001;85:366-370) Keywords: health visitor; injury; A&E Unintentional injuries are common and result in one in five children attending an accident and emergency (A&E) department each year. 1In 1994 more than 400 liaison health visitors or nurses were in post in the UK.2 One of their responsibilities is to notify community health visitors about children who have attended A&E departments as a result of an unintentional injury, in order that the community health visitor can fulfil their role in terms of injury prevention.2 3 It has been recommended that all children attending the A&E department should be notified to community health visitors, 3 4 but this is not routine practice in all A&E departments. We have been unable to find any evidence suggesting that notifying all attendances produces better outcomes than notifying selected attendances.The information provided within the notification varies between A&E departments 2 and has been found to be inadequate, mainly in terms of insuYcient information on the circumstances surrounding the injury and previous injury attendances. Previous work suggests that knowledge of how the injury happened, severity of the injury, and occurrence of previous injuries is important for health visitors in deciding what action to take on receipt of a notificati...

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