It found that less than a third of UK hospitals include children's needs in their major incident plans. Four to five major incidents occur in the UK every year, many of which involve children.

A major incident is defined as: "An event that owing to the number, severity, type or location of live casualties requires special arrangements by the health services."

Many hospitals are preparing major incident plans for the millennium celebrations.

The authors of the study want planners to take the needs of children into consideration in any future preparations.

Consensus opinion

The research involved a Delphi study, where a panel of specialists "investigate a complex or imprecise issue using a series of structured statements".

The study's findings are published in the Archives of Disease in Childhood journal.

The Oklahoma bomb injured 61 children

The authors said children have particular needs in an emergency incident setting, from staff sufficiently experienced and trained in managing children to obtaining adequate equipment.

They said: "The common theme is not that planning for children has failed, but rather that planning for children does not exist."

Prominent examples of major incidents involving significant numbers of children include The Manchester and Oklahoma bombings in 1996.

In Manchester, out of 217 casualties, 30 were in children. In Oklahoma the figure was 61 out of 759.

Failings at all stages

Yet, the authors said, few UK hospitals are equipped to deal with more than a few seriously injured children, and few centres recognise it as a priority.

They said: "Difficulties in the management of children during a major incident have been documented at all stages of the incident response.

"In the pre-hospital stage, problems have been identified in determining triage and transport priorities.

"In the hospital reception phase, difficulties have arisen in mobilising staff experienced in managing children and in obtaining adequate amounts of paediatric equipment.

"In the surgical phase, concern has been expressed at the standard and choice of procedures performed by non-paediatric surgeons."

They have devised a set of guidelines for medical staff from on site care to recovery and support.

Developing a strategy

The guidance claims to offer "a practical approach" to providing emergency care to children in the event of a major incident.

The three key elements of the guidelines are:

• Planning - regional planners should ensure that every hospital receiving casualties is prepared for children
• Equipment - planners should assume that at least 10-15% of major incident casualties will require paediatric attention
• Training - all clinicians involved in paediatric care during a major incident should be trained to advanced paediatric life support level

Dr Barbara Phillips, a consultant in paediatric A&E at the Alder Hey Hospital in Liverpool, took part in the Delphi study.

She said the report should have a huge impact because it draws attention to deficiencies in current planning and makes recommendations to improve practice.