PEER REVIEW – INSIGHT INTO THE DARK ART

Writing a paper for a journal can mean a lot of dedication and hard work only to find that all goes quiet as the journal asks your “peers” to review your work. The reports can, on occasion, be less than enthusiastic! Who are these people? Where do they come from? What do they know!?!
 See page 454

ESCAPEING SAFE PRACTICE?

The multi-centre UK Chest Pain Unit trial, ESCAPE, has finished its data collection and the analysis is starting to come through. CPUs can turn patients around rapidly and make decisions quickly and safely using standardised protocols and exercise treadmill testing for low-risk patients. They work … but how do they match up to conventional care? We need to wait for the next instalment!
 See page 462

TIMI – WATCH OUT CHAPS!

Risk stratification for acute coronary syndrome is a tricky business. Differences in clinical presentation and the significance of risk factors between the genders raise the question of whether stratification models are both equal and effective between the sexes. The news is not good chaps.
 See page 471

EMERGENCY MEDICINE DOCTORS AND THAT TUBE

As our speciality comes properly of age and with the development of the College of Emergency Medicine curriculum, trainees are being challenged to demonstrate competencies in areas that have traditionally been the domain of other specialities. Ultrasound has led the way, but the issue of RSI and emergency department airway management has been a topic producing a great deal of heated debate and opinion in the literature over the years. The authors of this paper show that while there has been some development of emergency medicine leadership in emergency airway management, there is still a long way to go. This is an area of urgent challenge if we are going to evolve further and deliver the necessary training and experience to our trainees.
 See page 480

FORGETTING THE FIRST RULE OF EMERGENCY CARE?

Look after your own safety first! Ask any clinician to describe the personal protective equipment that should be worn to minimise the risk of occupationally acquired infection and there is likely to be a range of answers. Observe real practice and few of us comply with the guidance issued, but this is usually our choice; employers provide and we choose not to use.

We are all familiar with mandatory training to address needs regarded as essential to the running of a system and aimed at dealing with the “reasonably foreseeable”. In this worrying paper, a healthcare system clearly has some work to do to minimise the risk to its staff and raise awareness about the importance of infection control. An occupationally acquired infection similar to those described is a low frequency but high impact event for both the employee and the system in which they work.

Resources may be scarce, but not all system changes cost money. Neglecting the issue of staff safety is a dangerous course. Rather than being complacent, how confident can we be that our departments will meet their obligations to protect staff? Our colleagues may be putting themselves at risk in the name of patient care. Are we meeting our duty of care to them?
 See page 497

GADGETS AND TOYS

The Spanish have a wide experience in the use of a novel piece of intubating equipment but it is only now travelling north to UK shores. This case report is a gadget story but it illustrates a sequence of prehospital airway management issues and challenges prehospital providers to think how they might have managed the case within their scope of practice. “Toys” are an important part of prehospital emergency medicine and this device may have potential. The challenge has been made, can we determine if it has a place in our kit bags?
 See page 504

FIERCE AGREEMENT

Planning for controversy and stimulating debate is good editorial practice for a journal. Prehospital emergency medicine has a very weak evidence base and, as the letters here show, there is a fierce agreement that the issue of doctors versus paramedics at scene is riddled with confounding factors and anecdotes in both directions are available in abundance. We all agree on the problem, can we come together and create the critical mass of evidence to provide an answer to the issue?
 See page 521