Sunday, June 3, 2012

The Beginnings of Emergency Medicine in the United Kingdom

The specialty of Emergency Medicine developed in the United Kingdom out of a recognition of the need for injured people to receive better care. Over the years its scope has broadened to include serious illnesses, disease, infections and other more medically related problems.

The First World War provided the catalyst needed to kick-start the process of specialism within overstretched hospitals. A pioneering surgeon named Robert Jones was appalled by the lack of provision for those suffering gunshot wounds in the First World War. This led him to establish the British Orthopedic Association in 1918 with Robert Osgood, which became one of the most important developments in the care of the injured, and led to increased cooperation among orthopedic surgeons.

An early example of specialism for fracture patients was the establishment of separate fracture clinics in Manchester by Harry Platt in 1913-14. It was he who, many years later, as the chairman of the Accident and Emergency Services Sub-Committee of the Standing Medical Advisory Committee, produced the famous Platt report in 1962. This report highlighted major concerns over the level of care provided for the seriously ill and injured patients.

Though many of the report's recommendations were taken on board, there was no provision for the creation of senior career posts for the newly named accident and emergency departments. An exception was Maurice Ellis, who had been appointed 10 years before the report in 1952, as the first consultant in Emergency Medicine in the United Kingdom at Leeds General Infirmary. He, among others, noted that a different skill set was required of doctors running accident and emergency departments to those responsible for orthopedic surgery. This was one of the main driving forces behind the formation of the Casualty Surgeons Association in 1967, of which Maurice Ellis was its first president. The main aim of the association was to form a professional body to further the standard of accident and emergency care in the United Kingdom, but accident and emergency departments remained understaffed and poorly led.

In 1971, therefore, the Joint Consultants Committee investigated the problem. The main recommendation of this report was the appointment of 32 consultants in "Accident and Emergency" to work full-time in major departments. This led to immediate improvements in the quality of critical care, and by 1976 there were 105 consultants in post. By the middle of the 1970s it was evident that there was a need to formalise training of consultants, and the Specialist Advisory Committee in accident and emergency medicine was established and a training programme designed. The first senior registrar appointment was in 1977. The number of consultants continued to increase until, by 1997, there were almost 400 consultants in post.

The Casualty Surgeons Association was changed in 2004, to the British Association for Emergency Medicine, reflecting a more holistic approach to the specialism. Then in 2005, this was merged with the Faculty of Accident and Emergency Medicine (formed in 1993) to form the College of Emergency Medicine, which today stands as the authoritative body for emergency medicine in the UK. The College publishes guidelines and standards for the practise of emergency medicine, and its fellowship and membership exams, are the standard by which emergency medicine doctors are measured.