First of all, it does not lead to us being called every few hours. As we all
know a true big emergency between Midnight and 8am even in large departments
does not happen every night. Secondly, we are not doing this to let other
specialties and our mangers off the hook, we do this because we are in A&E
medicine and not dermatology or urology - proper emergencies are what we are
supposed to exist for. Even if I do not go in for things, at least I know
about them and I dont hear that someone was in Resus for two hours getting
an ex-fix on followed by a laparotomy from my consultant colleagues the next
day.
For single or double consultant departments (as during my consultant
colleagues holidays) we simply raise our threshold for going in but NOT for
being informed of what is going on. After all, telephone advice is hardly a
big problem is it? I remember all these people telling me " being on call
from home is no picnic either!" - they have obviously never worked as an A&E
Spr overnight somewhere like Glasgow Royal or Liverpool.
We will need a minimum of 6 consultants to provide increased on-site
consultant cover out of hours. At present we have 3. We do not attend for
standard cardiac arrests during the night as by the time we get there it
would be pointless but for complex blunt trauma and situations where there
are multiple sick patients in the department we DO make a big difference and
we SHOULD be there.
Coming in from home is a compromise I agree, but I would rather have that
than the situation at one "centre of excellence" where the on-call A&E
consultant didnt attend when they were told that a train had crashed nearby
and an unknown number of casualties were expected!
Phil Munro
A&E Glasgow
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