All children on end-of-life care should be referred for potential organ donation. Organ donation needs to be seen as a priority for hospitals as a part of routine end-of-life care to help increase referral rates and give families the opportunity to donate. Many paediatric deaths are not referred for consideration of organ donation, despite guidelines stating that this process should be standard of care. Further optimization of referral rates may aid in increasing the number of organs available for donation. What is Known: • Shortage of organs continues to be a national problem. • NICE guidelines state that all patients who are on end-of-life care should have the option of organ donation explored. • Required referral both increases the number of donors and organs donated. What is New: • The process of identifying and referring children for paediatric organ donation. • Identifies that children are still not being referred for organ donation. • Organ donation is still not a priority for hospitals.

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Introduction Horse riding and horse handling are risk prone activities and can cause fatal injuries. Horse related injuries are not uncommon in children and could account for significant morbidity. Objectives To review the incidence and mechanism of horse related injuries in children and characterise the severity of injuries in paediatric patients needing intensive care. Methods Data was analysed from the Paediatric Injury Database of the Emergency Department and the Paediatric Intensive Care Unit at a major trauma centre covering a period from January 2012-November2013. Results A total of 275 children attended the emergency department with injuries related to horse riding and horse handling. Mechanism of injuries 81% were due to a fall or being thrown from the horse, 9.4% were due to being trodden,and 8% were due to being kicked by the horse. A small proportion of injuries (1.4%) were related to being bitten by horse. Severity of injuries Majority of injuries involved head and neck and extremities. 5 patients sustained serious injuries needing intensive care management out of which 1 died. Injury characteristics in children who needed intensive care Three patients had serious head injury and required neuroprotection. Their neurosurgical findings were as follows: (Case1: haemorrhagic contusion and intraventricular bleed, Case2: acute subdural haemorrhage and diffuse axonal injury, Case 3: multiple parenchymal haemorrhages and tight brain with midline shift). Two patients had severe abdominal injuries (Case 1: renal laceration in upper pole of left kidney, Case 2: Fractured spleen with subphrenic hematoma and fractured left kidney with trauma to left renal artery.) Outcome Two patients with head injury survived but required prolonged neurorehabilitation. One patient with severe head injury was diagnosed as brainstem dead and care was withdrawn. Both children with abdominal injuries survived and made good progress. Conclusions Improved awareness among paediatric horse riders and handlers is required. Although majority of horse related injuries are non fatal, serious incidents can occur and the importance of vigilance, adequate supervision and safe protective measures cannot be over emphasised.

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Conclusion Despite early resistance to the M&M process, it has sparked culture change around shared learning across the region rather than individual trusts. The next steps include widening the group to include other regional ODNS, consideration of a governance lead within the TVW ODN and most importantly continuing to work with all providers to encourage the open learning culture and shared learning across the ODN.