HOW DO YOU MAKE AN EMERGENCY DEPARTMENT QUIET? HAVE A EPIDEMIC OF A FATAL ILLNESS IN YOUR CITY

Papers in this issue from Australia and the United States are comforting to those of us in the UK who sometimes feel that long waits for hospital admission are a problem of the National Health Service, especially when other health systems are held up as examples of how it could be better. Equally stunning is the experience from Toronto during the severe acute respiratory syndrome (SARS) epidemic. Paradoxically the ED seemed to be quiet. On reflection it is perhaps not such a surprise. Patients are often very astute assessing risks and benefits and if the hospital appears more dangerous than their symptoms, they will seek help from other sources. Equally when a health system focuses all its resources on emergency demand and reduces routine elective work it can cope with most disasters in the short term.

Unfortunately quick fixes do not work in the long term. The papers on this subject make gloomy reading but do spotlight some of the root …