The care of minor injuries
I write in support of the article by Alan Leaman in the EMJ Supplement January 2001
I agree with him completely that the care of minor injuries is one of the skills of the A&E department and one in which Consultants should and do have a considerable expertise. The focus has for a long time been on improving the care of the major injuries which present to our department. Although obviously of great importance these are small in number and the majority of our work revolves around the less critical cases. I feel that those who enter our department, our specialty, with an interest only in the major trauma cases must spend a large proportion of their time feeling frustrated.
Conversely, I have always enjoyed the care of the less critical injuries (I feel the term "minor" conveys the wrong image of these patients). I see them as a group who require a care beyond the expertise of general practice but not requiring inpatient or other specialist care in the hospitals.
The A&E department deals with a greater number of soft tissue injuries than any other department and consequently develops its own expertise. For the patient these injuries are painful, troublesome and indeed can lead to as prolonged an absence from work with a crushed finger as would be experienced with a limb fracture or after abdominal surgery. It is a matter of pride to treat these injuries effectively producing the best possible result in the shortest possible time and certainly I have had as much in the way of letters of thanks and compliments from people for treating their so-called minor injuries as from the care of patients with major problems.
I hope we will continue to see this as a large part of our work and to teach it to our trainees. I agree also that the routine handing over of so-called minor problems to other members of staff, whether they be Nurse Practitioners, Paramedics or others, is likely to result in a decrease in quality of care for these patients. As in any other situation there is no problem until something goes wrong and it is the recognition of a potential problem and its avoidance that is the skill. We all know that the plumber or electrician who comes to our home can perform a task in a few minutes leaving us with the opinion that "I could do that". However, it is their very training and expertise that makes the task appear so easy that others feel they could take it over. This is our current problem that we have done the tasks so well that we have convinced anyone that they are equally able to take over the task. With full training and appropriate on- going supervision Nurse Practitioners can of course contribute valuably to the care of our less critical patients but I feel to give up the practice entirely from A&E would be a serious move and a loss of quality care to the patients.
Dr S C Brooks Consultant
Accident and Emergency
Yeovil District Hospital