Volume 2 REPORT OF A MEETING 247 Number 3

REPORT OF A MEETING

A C C I D E N T S E R V I C E S

Round Table Discussion at the Meeting of the British Orthopaedic Association on 25 Sept., 1970, under the Chairmanship of Sir Henry Osmond-Clarke.

Dr. K. Easton described the service that he and 33 other general practitioners in the North Riding of Yorkshire had organized with the police, fire, and ambulance services of the area. When an accident occurred, police headquarters notified the nearest available doctor, by radio if necessary. In many cases this enabled the doctor to arrive some time before the ambulance and those taking part in the scheme had trained and equipped themselves to be able to render medical first aid when it was required. Dr. Easton stressed the importance of early skilled care for saving lives that could otherwise be easily and needlessly lost. Special rescue equipment carried by the fire service enabled persons trapped in distorted vehicles to be released with the least possible delay. High quality care at the roadside should be supported by similar care in hospital.

Mr. P. S. London (Birmingham) dealt with the management of patients on arrival in accident and emergency departments. He distinguished between the vast majority of patients that needed fairly simple treatment and the 1 per cent or so that needed resuscitation, but he emphasized that in each case the diagnostic and therapeutic facilities should be arranged to reduce movement by the ambulant patient and eliminate it for the severely injured. He went on to illustrate some errors and omissions that should be kept in mind and he concluded by expressing the opinion that the details of how the service was organized were perhaps less important than that it should be based on the interest, availability, and good will of its members.

Mr. J. C. Scott (Oxford) spoke of the history of surveys of services for the care of the injured, which had now reached the point of being recognized as something that should be provided for the community of an area that drained conveniently into a suitably equipped and staffed hospital. A service that was capable of dealing with large numbers of patients every day should be able to cope with a disaster without radical changes in the organization. He stressed the great value of accident and emergency cases for teaching and added that they could be utilized fully only if a senior member of the staff was on the spot to supervise and to teach in other ways. He drew a distinction between an accident service, an accident and emergency service, and a casualty department, and urged that this distinction be drawn in all future discussion of the subject.

Dr. ArchibaM (Department of Health and Social Security) acknowledged the unpopularity of accident and emergency work and of the need for suitable

training to support this service. It was an expensive service that required the active participation of senior men. He did not favour putting medical assist- ants in charge of accident and emergency departments. He saw health centres as providing a very useful link between general practice and hospitals.

Mr. F. C. Durbin (Exeter) opened discussion by upholding the need to have a team of specialists to treat the severely injured person and of the need to have a known place to which they could be referred. He blamed much of the trouble on lack of money and called for posts that allowed for a career in accident and emergency work.

Mr. R. G. Pulvertaft (Derby) said that a senior casualty officer (of consultant status) supported by registrars and senior house surgeons and with observation beds enabled first-class primary care to be provided in an accident and emergency unit.

Mr. G. Parker (Middlesbrough) agreed that the senior casualty officer should have consultant status and that if his interest was to be sustained he should also have beds. He wondered whether fractures and dislocations should be separated from other disorders of the locomotor system.

Mr. J. M. Kingsmill Moore (Ashford) pressed for the creation of a career grade, with sufficient time off to study for higher examinations. He would like to see accident and emergency work generally accepted as a portal to both medical and surgical careers.

Mr. H. H. Langston (Southampton) supported the call for a consultant grade and active participation by consultants in accident work. He had not found that general practitioners had been able to give much help to accident services after 5 p.m. He believed that services should be concentrated and rationalized.

Mr. B. T. O'Connor (Oswestry) said that consultants must roll up their sleeves and he asked that a distinc- tion be drawn between fracture surgeons and accident surgeons, who had a ' total concept of trauma '.

Mr. A. M. Naylor (Bradford) spoke of the alarming shortage of staff, which general practitioners could do much to alleviate up to 5 p.m. He advocated a flat rate of pay, irrespective of the status of the person concerned, for all work done after that time. Casual attenders should he turned away but casualty work should be a compulsory part of the training of all specialists.

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