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James Tooley discusses the sheer terror that comes with the challenge of managing children in the pre-hospital environment. As James explains, although many clinicians may think that they do not need to (or may not want to) think about the paediatric population, it is something that every clinician would do well to mentally prepare for. James shows a video clip of a large-scale paediatric trauma and challenges you to consider being dispatched to the scene. How do you prepare for that? Simulation, as usual, is key. Through simulation one can discover knowledge gaps, limitations of equipment and guidelines, and coping strategies. James takes you through some specific pointers regarding equipment that one should carry when anticipating dealing with pre-hospital paediatric emergencies. Next, James discusses pressure and how it degrades performance. A clinician should be aware of where their pressure limit is. The importance lies in recognising when you reach your cognitive overload. Once you recognise this point