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Mark , I hear what you're saying but I think Robbie was simply pointing out the "real" world situation. Sometimes you have to be pragmatic and realise that the prehospital situation has a bearing on outcome and the total level of discomfort suffered. If any improvements have to be made then it is essential that they include a more streamlined system from Primary care straight through to the definitive end point. It is desirable for A/E depts to continue to improve on their performance but from a patients point of veiw they just want to get things sorted from the minute the injury happens. In my dept.in HMP Kilmarnock the majority of referals to A/E have been given oxygen, analgesia , are cannulated , have their bloods taken and the appropriate xray cards etc. filled in. All prior to attending the dept. I used to do this for most of my emergency admissions when I was a GP. It doesn't take long and saves a lot of faffing about and duplication of work at the other end, ie A/E. Shouldn't we be doing this for all our patients? Shouldn't we be looking at ways to reduce the time between call out and attendance of GP's. It's easy enough to target in house systems but when you're faced with the coordination difficulties of the prehospital setting then you can easily see how significant delays happen. Cheers Iain Jamieson --------------------------------- Do You Yahoo!? Thousands of Stores. Millions of Products. All in one place. Yahoo! Shopping.