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We have people called emergency physicians in our hospital, they are trained to deal with emergency situations. Paul, if we follow your reasoning , why not to call the orthopaedic surgeons to do the manipulation? and then we can get on with other things...(on the other hand we should call somebody else to do the "other things" too). In our department, we do haematoma blocks, Biers blocks, femoral blocks, sedation etc depending on the patients needs and surrounding circumstances and I believe that is good for our patients and they are treated by somebody with experience in these procedures (which they seen to do quite well). I know you also meant that we do not have enough staff in our departments, but I cannot see how we are going to make a good case for more, if we keep delegating responsibilities. Andres I. Martin Consultant in Accident and Emergency Royal Free Hospital -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]]On Behalf Of Howarth, Paul - RCHT Sent: 01 October 2002 10:25 To: [log in to unmask] Subject: Re: Bier's Block We have people called anaesthetists in our hospital, they outnumber us by about 20 to 1. They seem to like to come down to the department to ply their trade (which they seem to do quite well), they also bring down an ODP with them so who checks the equipment and drugs, so all our nurses have to do is assist us in putting on the plaster. It means that we are free to concentrate on doing the manipulation and then getting on with other things. Paul --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.391 / Virus Database: 222 - Release Date: 19/09/2002