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Drs MacKenzie and Bevan are to be congratulated for producing a thoughtful and thought provoking article. They present a very strong case for further strengthening training and quality assurance of training in pre-hospital and retrieval medicine.
The Faculty of Accident and Emergency Medicine fully accepts the need for ongoing improvement in this area and would be very glad of the opportunity to work together with other relevant bodies to this end.
We are in a time of substantial change in the provision of healthcare in the UK. The paper accurately identifies the importance of the new Postgraduate Medical Education Training Board and the supervision of a new style of medical education with competencies at its centre.
The paper is inaccurate, however, in stating that license to practise will be specialty specific. This is not the case. The license to practise will be a license to practise as a doctor, not as a specialist.
The changes in supervision of medical education occur at the same time as changes in the provision of healthcare. Reconfiguration of hospital services seems inevitable. Implicit in this will be an extra burden of patient transfer from one hospital to another. The burden of providing this service is likely to fall on anaesthetic, critical care, and emergency medical services. The implications of the proposals in this paper for these services need further exploration.
The scale of pre-hospital care is enormous. Almost every day, an ambulance service somewhere in the country will ask for a doctor’s help. We should also remember that pre-hospital care will include work with voluntary aid societies, care at equestrian, sporting, and motoring events, and membership of mountain and cave rescue teams.
Voluntary immediate care schemes offer invaluable support to ambulance services, but provision of cover for the whole country is not available, and in the absence of such comprehensive cover, any emergency department may be asked to provide analgesia, anaesthesia, or a variety of other treatments for a single casualty or major incident. It is difficult to see how this situation will change in the short to medium term. Pre-hospital care must remain an integral part of specialist training in emergency medicine.
This paper clearly identifies the need for rigorous standards, clear curricula, and robust assessment processes in ensuring the necessary competencies for practice in this area. It seems to me to make a better case for strengthening existing curricula and structures than it does for the establishment of a new specialty.
The Faculty of Accident and Emergency Medicine would, however, be very pleased to enter into dialogue with the Faculty of Pre-Hospital Care and other relevant bodies in further exploring this important issue.
Competing interests: none declared
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