Emergency medicine: past, present, and future

Emergency medicine in the UK is at a crossroads. Here I review the story so far and discuss the directions it could take in the future, for better or worse. FIRST THERE WAS ‘CASUALTY’ Both before and after the founding of the National Health Service (NHS) in 1948, the majority of hospitals had a ‘casualty department’. This was often located in an uninspiring corner of the hospital and was staffed by casualty officers, usually senior house officers (SHOs) who had been qualified for one or two years. Most of these were hoping to follow a surgical career and six months’ experience in casualty was required before they could sit for a surgical fellowship. These casualty officer posts, widely regarded as an unavoidable interlude between the more useful SHO posts in general surgery or a surgica