Crisis in emergency departments


Sir, – Asking doctors, who are idle because of operating theatre closures, to be reallocated to the emergency department flies in the face of the concept of specialisation that we have embraced for many years (“Enough of the hand-wringing”, Editorial, January 3rd).

Operating-theatre doctors do not have the skills to work in the emergency department, don’t know its policies and procedures, and would get in the way of the regular emergency doctors. I wonder whether you would equally ask emergency doctors to undertake anaesthesia and surgery if the operating theatres were swamped by the volume of their work. – Yours, etc,



Co Wexford.

Sir, – Dr Sara Burke rightly raises the pressing need for consultant (“senior decision-maker”) presence in our hospital emergency departments, as part of the remedy for their perennial congestion (“Trolley crisis is a uniquely Irish experience”, Health + Family, January 3rd), but fails to highlight the pitifully small number of consultants in emergency medicine in this country (fewer than 80, covering 30-odd emergency departments nationally, which collectively cater for 1.2 million new patient attendances annually).

She is also entirely correct to identify the “overreliance” on acute hospital care and the under-resourcing of community facilities, including access to diagnostic testing which might reduce referrals to emergency departments.

And of course the glaring mismatch between supply and demand is set to worsen over the next few years as consultants and general practitioners retire in growing numbers and vacancies proliferate.

However, I take issue with Dr Burke’s suggestion that the problem with patients waiting on trolleys is “uniquely” Irish. One only has to Google “waiting on trolleys in NHS A&E departments” to read about “soaring” and “deeply worrying” trolley waits in British emergency departments, while overcrowding has plagued emergency departments in the US and Australia for many years, prompting huge investment in research and possible solutions. I have only spent a brief period in an African health service but I know that, throughout sub-Saharan Africa, people can wait for days outside acute hospitals for all sorts of care. The point is that it is fundamentally wrong to think that Ireland is alone in having an acute public health service facing an existential threat, due to excessive demand.

Some 3½ decades of working in the emergency departments of these islands has convinced me that global trends are a far better guide to the underlying causes of hospital overcrowding than “local” variations: obesity, increasing lifespan, mass migration, population growth, globalisation and the internet have transformed the health service “burden” far more than any other “indigenous” issues or initiatives (whether it be the bed cutbacks recommended by “experts” in the 1980s or the controversial but necessary “hierarchy” of emergency department/local injury units currently in evolution).

In short, our health service performs remarkably well, considering the tsunami of complex challenges it faces. And those who prescribe simple fixes would do well indeed to “act local, but think global”. – Yours, etc,


Consultant in

Emergency Medicine,

Cork University Hospital,