Bronchiolitis, a lower respiratory tract infection which causes inflammation of the small airways in infants, imposes the largest health care burden on hospital admissions worldwide, with up to 15 % of admissions to intensive care.

Nasal High Flow (NHF) therapy has emerged as a new method to support the breathing of these infants avoiding intensive care admission. We have shown in a previous large study that NHF therapy can be used in regional and metropolitan hospitals and reduces the need to transfer infants to a specialised children’s hospital. This new project entails working with six of the regional Queensland hospitals from the previous study to explore the optimal way to translate the new knowledge into practice.

We will compare three sites provided with structured educational support to three sites with no additional educational support. We suspect that the centres receiving the additional support will retain the knowledge and skill level to maintain and sustain optimal improved outcomes and have better uptake and adherence to evidence based NHF therapy guidelines for admitted infants with bronchiolitis.

Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. This trial will assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.

Children present to emergency departments on a daily basis where sedation is required in order to conduct painful or distressing medically necessary procedures. Ketamine has been widely accepted as the preferred medication in which to achieve this sedation, however ongoing debate revolves around the best method of administration. Historically, intravenous ketamine has been the preferred method and this requires a cannula to be inserted into the vein. This procedure can be difficult to achieve with just one cannulation attempt and often takes multiple efforts to achieve intravenous access. Restraint of the child is necessary, often for a prolonged period of time - this can be significantly distressing for both the child and parent and can have long term psychological impacts. Delivering ketamine via the intramuscular route is significantly easier and quicker to achieve as a first pass success and has the potential to be much less distressful for the child. The hypothesis is that ketamine via one needle only, as an injection into the muscle, can provide adequate sedation for children – this proposed research trial will investigate this. This study will also look at the adverse effects, length of stay in the emergency department and length of sedation of intramuscular ketamine, when compared to intravenous ketamine.