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We read with interest the article and accompanying editorial by Lecky et al in the Emergency Medicine Journal.1 Of note, between 1989 and 1994 there was an increase in the proportion of trauma patients (ISS>15) in whom a consultant was involved in their care: at the same time, trauma related mortality fell. Since then, both the level of documented consultant involvement and the mortality have plateaued. Documented middle grade involvement is unchanged from 1989.
This lack of improvement in the involvement of consultants and middle grades is of concern, and there is great pressure from many sides to increase senior cover on the shop floor. This includes BAEM’s 1995 recommendations for increasing the levels of senior staff in A&E departments.2 Many of these recommendations were repeated in the Workforce Planning Document from BAEM and FAEM3: one of the main recommendations of this paper is that shop floor consultant cover should be available 12 hours a day, 7 days a week. This is to achieve the objective of allowing all patients to have an experienced clinician (specialist registrar, non-consultant career grade, consultant) either care …