Accident and emergency services.

A CONFERENCE of this nature is most valuable in bringing together people who are interested and involved in the accident and emergency services, to discuss the problems and to look at possible solutions. Increasingly over the last few years it has become more difficult to staff accident and emergency departments. This situation has caused eminent bodies such as the Royal College of Physicians, and the Royal College of Surgeons and the British Ortho-paedic Association to set up subcommittees to investigate the problem and to make recommendations. The Joint Consultants Committee has also been considering it. In addition, in September 1970 the Department of Health and Social Security carried out a survey, which included all accident and emergency departments, to try and establish the facts relating to the number of major departments in England and Wales, their study and the adequacy of the premises. It is common ground that junior posts in accident and emergency departments are unpopular because there is no career structure and very little training and supervision by consultants. The lack of full participation by consultants may also result in the department not receiving its fair share of available resources because the case is not advanced effectively. Yet another commonly quoted reason for the unpopularity of work in accident and emergency departments is the proportion of 'trivia' which gravitates to them, but it is the misdiagnosis of these cases that forms the basis of most of the litigation which arises from these departments, therefore the degree of consultant participation in them is critical in all these factors. The Platt report on accident and emergency services in 1962 recommended that the medical staffing of major accident and emergency departments should be increased to allow each unit to have three consultant surgeons, each devoting a substantial part of his time to this work, supported by three officers of intermediate grade and an adequate number of junior medical staff. In the Department of Health and Social Security survey of 279 major departments, less than 80% of them had a consultant in charge and only 50% had a consultant who worked at least one session regularly in the department. Twenty percent had no consultant working regular sessions or on call. Obviously there have been departments where individuals, usually orthopaedic surgeons, but in some cases general surgeons and physicians have taken a very great interest in the accident and emergency department and they …