Marking 50 years of organised emergency medicine

While hospitals have many problems, the care given by emergency medicine specialists has brought great benefits to society, writes Fergal Hickey

THIS day 50 years ago, the inaugural meeting of the Casualty Surgeons Association took place at BMA House in London.

This meeting, chaired by Maurice Ellis (regarded as the father of emergency medicine in these islands) was attended by 10 senior doctors convinced of the need to improve the services provided in casualty departments in the UK and Ireland.

Up to then, these departments were typically staffed by very experienced nurses but generally inexperienced doctors at an early stage of their training or not in training. Indeed the term casualty department reflects the historical reality that these departments were for “casual attendees”.

As a result of this initiative, those relatively few senior doctors working in these departments began the process of revolutionising the care provided in what are now known worldwide as emergency departments (EDs).

What started as the CSA may have changed its name through the decades to become the Royal College of Emergency Medicine but it has certainly not changed its aspiration.

The forefathers of our specialty of emergency medicine (EM) recognised that acutely unwell or injured patients deserved the services of experienced doctors trained to deal with undifferentiated medical presentations, with the capability to resuscitate and stabilise the ill and injured of any age group, with any type of emergency.

Up to this point the preoccupation of hospital services and existing medical specialities was the delivery of scheduled care and the care of patients admitted to a hospital bed rather than those attending with unscheduled care needs.

Within a short few years, similar organisations had sprung up in the US (American College of Emergency Physicians), Australia and New Zealand (Australasian College of Emergency Medicine) and in Canada (Canadian Association of Emergency Physicians).

They shared the common goals of improving the care provided in their countries’ emergency departments. Such has been the success of emergency medicine internationally that there are now very few countries in the developed world where emergency medicine has yet to be established as a medical specialty or the seeds of this development are germinating.

The development of emergency medicine in Ireland has closely mirrored that of Britain and the same milestones have occurred on our journey. The first consultant appointments in the
specialty in the UK were in 1972. The first appointment on the island of Ireland was that of William Rutherford to the Royal Victoria Hospital in Belfast, who was among the first group of 32 appointed in 1972.

This was followed two years later by the appointment of the late Leo Vella to the Charitable Infirmary in Dublin, a hospital best known to many as Jervis St.

The creation of well-respected national training schemes; the development of a postgraduate examination structure; the creation of more than 80 consultant posts and the recruitment of many of the best and brightest of graduating medical classes into emergency medicine has resulted in extraordinary progress in the development of emergency medicine in Ireland.

While, in the eyes of many, emergency departments are associated with crowding and patients on trolleys, it is well-established that the causes of these problems are outside of the emergency department and the solution requires a significant investment in bed capacity by the Department of Health and the HSE.

Notwithstanding these significant challenges, the quality of care provided in Ireland’s emergency departments has improved significantly during recent decades and Ireland “punches above its weight” in emergency medicine internationally.

The majority of Ireland’s initial consultant appointees did some, if not all, of their postgraduate medical training in the UK and were members of CSA and its successors.

This close bond with UK emergency medicine continues to this day with Irish EM trainees taking the fellowship examination of the Royal College of Emergency Medicine (FRCEM) at the end of their training. Indeed many Irish consultants in emergency medicine examine in RCEM’s Membership and Fellowship exams.

In 1989, at a time when there were fewer than a dozen consultants in emergency medicine in here, a decision was made that there needed to be an Irish organisation to promote the specialty of emergency medicine and represent the doctors working in the area.

This organisation became the Irish Association for Emergency Medicine (IAEM) and in addition to its many educational and advocacy roles, IAEM acts on behalf of RCEM in Ireland.

The association intends to mark this important event by joining in the simultaneous illumination of famous landmarks in London, Belfast, Edinburgh, Cardiff, Australia, India (and even Antarctica), by illuminating three famous Dublin landmarks in the RCEM colours of purple and white which represent night and day and reflect the 24/7 nature of emergency medicine.

Dublin’s City Hall, the Mansion House and the Civic Offices, Wood Quay, will be illuminated today and president of Irish Association for Emergency Medicine Dr Emily O’Conor will join colleagues at the City Hall event in Dublin at 7.15pm to mark the occasion. It is worth marking the development of the specialty of emergency medicine, which has so greatly benefitted millions of Irish patients over the last half-century.

Dr Fergal Hickey is a consultant in emergency medicine at Sligo University Hospital and communications officer for the Irish Association for Emergency Medicine

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