> -----Original Message-----
> From: Accident and Emergency Academic List 
> [mailto:[log in to unmask]] On Behalf Of Paul Bailey
> Sent: 06 December 2006 12:22
> To: [log in to unmask]
> Subject: Re: Emergency access - Clinical case for change: 
> Report by Sir George Alberti
> 
> 
> It's got a certain attraction to it.
> 
> Get critically unwell patients to roam around the countryside 
> for a couple of hours in the back of an ambulance having a 
> trial of viability.  Those that respond favourably to a bit 
> of bouncing around, normal saline and morphine survive their 
> 'trial of viability' and are admitted to hospital after the 
> window of opportunity for any meaningful intervention has passed.
> 
> Those that require more serious and / or time urgent 
> intervention who fail their trial of viability can just go 
> straight to the morgue, thereby saving everyone a whole lot 
> of hassle and expense.  
> 
> Sure, a few people who might have survived with rapid high 
> quality care will not make it, but I'm sure this will be 
> viewed as some sort of Darwinian natural attrition and the 
> cost savings by not having to treat them all will more than 
> make up for it.
> 
> Surely.
> 
> Paul Bailey
> Western Australia

Has Dr. John Crippen of blog fame invaded  Paul's Email account?

A little too much of the  debate has  surrounded   the maintainance of
the system as  is and the the continued throwing of money at that
system.

For much of the urban Uk there is an overwhelming choice of Emergency
Departments 

From where I sit at home now  in a  former Metropolitan County I have a
choice of a good number of Emergency Departments, - the one i currently
work in is 25- 30 minutes walk away ( and 5 -10 minutes in the car)
beyond that within 10 miles  I have 6 other major Emergency Departments,
3 of which are in reasonably sized DGHs and 3 of which are part of
'large' hospitals ...

Sat in my old house in a considerably more rural area I had a Major
Emergency Department a couple of miles a away ( where I used to work)
and a choice of 4 major Emergency departments and a Medically staffed
MIU/A+E within 30 miles...

 Many of the existing areas with limited provision will not see  that
provision get a deal worse  and  assuming the changes aren't made in
splendid isolation  there is a great  deal of potential to see  fit for
purpose services  of a different model provided...

 From the point of view of the bean counters  why  pay for ECPs   when
you have the choice of half a dozen  major Emergency Departments within
10 miles   - lowest common denominator ambulance care is all that is
needed ( van drivers with first aid certificates to quote ken clarke)...
Why expand  walk in centre provision when there is a major emergency
department which has  swallowed the  rising attendance figures and
hasn't  yet  reached total saturation despite the comprehensive
'realignment' of the  Nursing and ENP service in that department ..

 I think there is validity to questioning  would such radical change
damage the speciality , it does however assume that consolidation of
the resuscitation service  would  reduce the number of Senior posts in
A+E -  despite the fact  that  changing provision may change  the role
but not the need for Emergency medicine doctors -  consider the
increased need for 'flying squad' type services if scoop and run is no
longer a 'safe enough' option for difficult to manage patients - who is
going to provide that service  and/or support, clinically manage and
educate non -physician providers in that  role... - Emergency Medicine
doctors ... 

If more and more  work is pushed to the Ambulance service and the PCTs
won't those organistions need more  Emergency medicicne docs on their
payroll?

There are two options for all the staff involved in Emergency medicine -
try and make the changes work for us or "do a Gilchrist" and  be faced
with the changes imposed by government and  our employers without
consultation as the fire service have seen

Martyn
A+E Nurse 
The grim industrial North

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