TY - JOUR T1 - Rural peer support: a reflection JF - Emergency Medicine Journal JO - Emerg Med J SP - 650 LP - 650 DO - 10.1136/emermed-2018-208073 VL - 35 IS - 10 AU - James Alexander Keitley Y1 - 2018/10/01 UR - http://emj.bmj.com/content/35/10/650.abstract N2 - The call came innocently enough. A young child had fallen, reportedly suffered some bruising and potentially needed some pain relief. This brief did not prepare me for a child periarrest following major trauma. They had multiple fractures, widespread internal haemorrhage and several other injuries. Tragically, the story of motor vehicle accident was thought to be a concealment of non-accidental injury. This, on the night following my last official day of medical school.In a rural island hospital, the out-of-hours staffing composed of one nurse, up to two medical students and two generalist junior doctors on-call 24/7. No surgery; no specialists; no scans.It felt unreal—like another simulation. Yet this one was messy, chaotic and traumatic. Afterwards I sat on the floor and cried. The next day it felt wrong to leave the hospital, wrong to see people continuing on with life as normal, wrong to hear jokes and laughing on the ward. I could not face consultations with patients with minor health complaints, yet as an NHS doctor I would have needed to do so almost immediately following the event. I had been in … ER -