The Paediatric Assessment Triangle (PAT) is a rapid, hands-off tool used by paramedics and emergency clinicians to form an immediate impression of a sick or injured child — often within seconds of first contact. It’s designed to answer one critical question: “Is this child seriously unwell and do they need urgent intervention?”
Paediatric Assessment Triangle
Introduction
The Paediatric Assessment Triangle (PAT) is a rapid, structured observational tool used by paramedics to assess the severity of illness or injury in children. It is endorsed by the College of Paramedics, integrated into JRCALC guidelines, and aligns with NICE recommendations for paediatric emergency care. PAT enables clinicians to form an initial impression within seconds, guiding prioritisation and early intervention.
Components of the Triangle
PAT consists of three interconnected domains:
🔶 Appearance
Assesses neurological status and overall vitality:
- Tone – Is the child floppy or holding themselves up?
- Interactiveness – Do they engage with their surroundings?
- Consolability – Can they be comforted?
- Look/Gaze – Are they alert and tracking?
- Speech/Cry – Is it strong, weak, or absent?
This component reflects central nervous system function and perfusion.
🟩 Work of Breathing
Evaluates respiratory effort and distress:
- Rate and effort – Tachypnoea, laboured breathing
- Positioning – Tripod, head bobbing
- Sounds – Grunting, wheezing, stridor
- Retractions/Nasal flaring – Use of accessory muscles
This helps differentiate respiratory distress from failure.
🔴 Circulation to Skin
Assesses perfusion and shock indicators:
- Colour – Pale, mottled, cyanosed
- Temperature – Cool extremities
- Capillary refill – Delayed >2 seconds
This reflects circulatory compromise and guides urgency.
Clinical Application
PAT is performed hands-off, often from the doorway, and precedes the ABCDE assessment. It helps answer:
- Is the child critically unwell?
- What is the likely physiological problem?
- How urgent is intervention or transport?
Common Patterns:
| PAT Findings | Likely Condition |
|---|---|
| Abnormal breathing only | Respiratory distress |
| Abnormal circulation only | Shock |
| Abnormal appearance only | CNS/metabolic issue |
| Two or more abnormal domains | Critical illness |
Alignment with UK Guidelines
- JRCALC includes PAT as part of the paediatric primary survey.
- College of Paramedics promotes PAT in paediatric life support education.
- NICE supports structured observational tools for early recognition of serious illness in children (NG51, NG143).
PAT complements tools like the Paediatric Observation Priority Score (POPS) and ABCDE, forming a robust framework for prehospital paediatric care.
Summary
PAT is a vital tool for student paramedics:
- Rapid, structured, and intuitive
- Enhances clinical decision-making
- Aligns with national standards
- Improves communication and documentation
Mastering PAT improves confidence and safety when managing paediatric emergencies.
References
- Horeczko T, Gausche-Hill M. The Paediatric Assessment Triangle: A powerful tool for the prehospital provider. Journal of Paramedic Practice, 2011.
- NICE Guidelines NG51: Sepsis recognition, diagnosis and early management.
- NICE Guidelines NG143: Fever in under 5s: assessment and initial management.
- JRCALC Clinical Guidelines 2024.
- College of Paramedics Curriculum Framework.
