In the Prehospital Care section of this edition of the Journal McKenzie & Bevan propose the formation of a subspecialty of prehospital and retrieval medicine. They argue that the standards and varying provision of prehospital medical care compare poorly with the more uniform consultant led Accident & Emergency services and suggest that the new GP contract, development of GP’s with special interests, licensing and re-validation and the reform of postgraduate medical education all make this the appropriate time to form a new subspeciality.

This article is accompanied by responses from:

• The Faculty of Pre-Hospital Care

• The Royal College of Anaesthetists

• The Royal College of General Practitioners

• The Faculty of Accident & Emergency Medicine

• BASMeD

• BASICS Scotland

All respondents wish to see a dialogue on this topic taken forward. The formation of the new Postgraduate Medical Education Training Board and the supervision of a new style of medical education with competencies at its centre makes this an appropriate time for such debate to take place. The lack of robust scientific evidence and the need to develop audit and research in this area is highlighted. The responses indicate a divergence of opinion as to what interventions are appropriate in prehospital care and as a consequence the type and length of training that is required to practice prehospital care.

It is clear that a number of organisations have concerns that the development of accreditation, particularly where it is examination based, would result in a considerable number of doctors currently providing prehospital care becoming non-operational. Many of the replies mention the importance of competency based training and it would seem achievable to design a competency based graded system of training that would allow practitioners in immediate care to practice safely at the level to which they have the time and experience to develop.

Only one reply mentions the work of prehospital care practitioners at mass gathering and sporting events. This is, however, an area which frequently involves prehospital care practitioners who would also benefit from the development of recognised levels of training.

As to who should take the lead role in this – there is a suggestion that The Faculty of Pre-Hospital Care of The Royal College of Surgeons of Edinburgh should do this. None of the replies opposed this suggestion. Many of the replies suggest the need for widespread consultation should this proposal be taken further and BASMeD points out the need for the academic support for this initiative not to be “narrow” and to be intercollegiate. Indeed many of the respondents refer to the multi disciplinary nature of this work. Some of the respondents have worries about the best title for this speciality and it seems likely that further discussion on this topic will be required.

It seems that there is much support for the proposal to closely examine medical prehospital care education, standard setting and regulation. This article has started the debate and the momentum should not be lost. A meeting of all interested parties seems to be called for?