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Brief history of Pre-Hospital Emergency Medicine
  1. Roderick Mackenzie1,2
  1. 1 Department of Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2 Intercollegiate Board for Training in Pre-Hospital Emergency Medicine, Faculty of Pre-hospital Care Royal College of Surgeons of Edinburgh, Edinburgh, Scotland, UK
  1. Correspondence to Dr Roderick Mackenzie, Intercollegiate Board for Training in Pre-hospital Emergency Medicine, Faculty of Pre-hospital Care Royal College of Surgeons of Edinburgh, Edinburgh EH8 9DW, UK; ibtphem{at}rcsed.ac.uk

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Introduction

Pre-Hospital Emergency Medicine (PHEM) often involves provision of critical care in a resource limited and physically challenging setting. Add to this the combination of medical emergency, time pressure and an unfamiliar ‘flash’ team and one wonders why any healthcare professional would seek to immerse themselves in this area of clinical practice. Yet over the last 50 years, a surprising number of doctors have chosen to do so—largely on a voluntary and altruistic basis. In 1994, one of those doctors, an emergency physician who subsequently became a national clinical director for emergency care, challenged those involved in pre-hospital care ‘to progress from a group of enthusiasts of varying qualifications and standards …’.1 The challenge was accepted. PHEM has now been established as a GMC-approved subspecialty. As with emergency medicine (EM), a new generation of consultants are shaping the future.

Historical context

The development of PHEM mirrors the development of UK EM itself. Just as Maurice Ellis, an early postwar EM pioneer, campaigned vigorously for improvements in the organisation and delivery of hospital services in the 1950s,2 so too did PHEM pioneers such as Ken Easton.3 Both doctors were characterised by their drive, passion and personal provision of an exemplar clinical service. Both went on to lead national organisations: Maurice Ellis led the Casualty Surgeons Association and British Association for Accident and Emergency (A&E) Medicine, while Ken Easton joined the Medical Commission on Accident Prevention’s Immediate Care Sub-committee and later led its successor, the British Association of Immediate Care Schemes (BASICS). They were not alone. At the same time as the first 32 A&E consultants were taking up their roles in the early 1970s, enthusiasts from general practice and a range of hospital specialties were organising ‘flying squads’,4–6 mobile coronary care units7 8 and immediate care schemes3 9 to …

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