One argument that can be made against having EDs without surgeons on site is that a significant number of emergency medical admissions have an emergency surgical problem either as the main diagnosis which has been misdiagnosed, as a cause of the medical problem, as a result of the medical problem or as a coincidence particularly if the two problems have an association other than cause and effect (e.g. the ?MI that turns out to be ischaemic bowel- which rather neatly fits into any one of the four categories). The RCSEng has issued a statement (which I can't remember the reference for, and may have been part of the consultation document on acute care) saying that you shouldn't have acute medical admissions in a hospital without surgeons.
Matt Dunn
Warwick
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