The impact of emergency medicine on surgical care in the emergency ward.

The Committee on Issues of the Association for Academic Surgery surveyed the Association’s membership, surgical department chairmen, and university hospital emergency department directors as to their attitudes about the role of surgeons and emergency medicine specialists in emergency care. Major differences in attitudes exist between surgeons and nonsurgeons regarding the surgeon’s role in the emergency department. Although surgeons want to preserve a dominant role in emergency care, they have little interest in being in charge of emergency wards on a day to day basis. Emergency medicine specialists have a tendency to function independently, even to the point of independently performing emergency surgical procedures. In emergency departments led by nonsurgeons there is decreased participation of surgical house staff in the resuscitation of the critically injured patients. This may result in inadequate training of surgical residents in acute trauma care and ultimately result in lowered overall standards of care in critically ill patients. An important question is whether surgeons can continue to abdicate their present reponsibilities in the emergency ward and yet maintain their essential role in the preoperative care of the emergency patient.