Seniors for minors, juniors for majors: an unbalanced and dangerous equation

M Sakr, Specialist Registrar,
July 03, 2001
Dear Editor,

I read the article titled "The management of minor injuries- a personal view" and while I agree with the author on the title, I believe that the contents are very biased and unrealistic. Of course the author is entitled to give his views but in the era of evidence-based medicine nobody can deny the evidence and antagonise all the research results because simply he "does not like it".

Throughout the article the author states that "recently a number of some influential groups have suggested that minor injuries can be managed entirely by nurses and do not need to be seen in an A&E department, the purpose of his article was to question this proposal". The author moves on without providing any evidence from his or anybody else's research to contradict the success of the Emergency Nurse Practitioners in providing a high standard care for patients presenting with minor Injuries [1-7].

Research on the ENPs in the UK has indicated that the care provided by these trained nurses is equal and in some aspects better than typical SHOs during their normal six months post in A&E . Certainly this is the standard care for patients with minor injuries through the UK as most of these patients are cared for by SHOs. The ENPs in Minor Injuries Unit were also compared with the medical staff in the A&E department; the results indicated that the standard of care was the same in both groups (details of this study will be published soon).

The author states that a new generation of A&E specialist, characterised by many registrars in training see themselves as emergency physicians who are not interested in minor injuries. He also adds that those interested in intensive care should become intensivists. The correct state is that most, if not all, the registrars in training have chosen their speciality rationally, they are not in the wrong speciality but they are all aware of the balance between what is life threatening and what is common, between what is triage category 1, and what is triage category 4 or 5. It is worrying to see that seniors in some departments have no interest in multiple trauma and believe that minor trauma is more important, such departments might be better declared as Minor Injuries Units.

He also adds that "some older A&E consultants are not interested in minor injuries, and their position has weakened with the decline in major trauma". There is strong evidence that the work of these "older A&E consultants" has improved trauma care in this country and reduced mortality [8], these "older A&E consultants" are probably the ones who established our speciality and are the ones who plan ahead for the development of a speciality that care for all patients not just minor injuries patients.

M Sakr ( FRCS, FRCS A&E, MD) SpR


(1)Sakr M. Angus J. Perrin J. Nixon C. Nicholl J. Wardrope J. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial Lancet. 354:1321-6,1999 Oct 16.
(2) Geolot D, Alongi S, And Richard E, Charlottesville V. Emergency nurse practitioner: an answer to an emergency care crisis in rural hospitals. JACEP 6:8 (Aug) 1977,354-357.
(3) Freij RM, Duffy T, Hackett D, Cunningham D, Fothergill J. Radiographic interpretation by nurse practitioners in a minor injuries unit. J Accid Emer Med 1996; 13:41-3
(4) Meek S, Kendall J, Porter J, Freij R. Can accident and emergency nurse practitioners interpret radiographs? A mu1ticentre study. J Accid Emerg Med 1998 Mar;15(2):105-7.
(5) Mabrook AF, Dale B. Can nurse practitioners offer a quality service? an evaluation of a year's work of a nurse led minor injury unit. J Accid Emerg Med 1998; 15:266-268.
(6) Powers M, Jalowiec A, Reichelt P. Nurse practitioner and physician care compared for non-urgent emergency room atients. Nurse Practitioner 1984; 9:39-52.
(7) Rhee K, Dermyer A. Patient satisfaction with a nurse practitioner in a university emergency service. Ann Emerg Med 1995; 26: 130-2.
(8) Lecky F. Woodford M. YatesDW. Trends in trauma care in England and Wales 1989-97. UK Trauma Audit and Research Network Lancet. 355(9217):1771-5, 2000 May 20.

Conflict of Interest

None declared