25 October, 2006

Minutes of Glasgow Southern Medical Society - Presidential Address on 12 October 2006

Minutes of Glasgow Southern Medical Society
Presidential Address on 12th October 2006

Dr David Ritchie, Consultant in Accident & Emergency Medicine presented his Presidential Address to 31 members of the audience. He described the situation in Glasgow around 1870s when there were various hospitals in Glasgow for Specialist Problems but no general hospital in the South Side and for that reason Ebenezer Duncan and other members of the society worked to establish a hospital in the Victoria Infirmary site. At that time there were 250,000 people living in the area around the hospital. In the 1800s 30% of deaths were due to infectious diseases such as tuberculosis and there were 170 infant deaths per 1,000 births.

In 1900 there were 860 patients admitted to the hospital in its first year. The Victoria Infirmary now has 600 beds when the Mansionhouse Unit is included. Now the infant mortality rate is in single figures per 1,000 live births.
In Dr Ritchie's work in Accident & Emergency he has found that he can do all the good things of medicine as described by his first boss:
He can do the best for his patients
He can educate, train and inspire juniors
He can do research.

Emergency care has always been part of medical training for all doctors at some time. In an emergency you do your best. There is a painting in the waiting room in Glasgow Royal Infirmary's Gate House which shows people in period costume waiting around 1910 to be seen. The only change noted is the change in the costume.
Dr Plant in 1970 perfonrmed a pilot study of how to look after a "Casualty Department". He suggested different levels of departments run by Casualty Surgeons, Senior Doctors or even single handed casualty departments. Casualty was always the poor relation.

Departments have increased in numbers over the years. Originally Medical Students learned to suture in the departments and this clearly did not give patients the best deal. Accident & Emergency does not only deal with trauma. GP, Hospitals and Accident & Emergency Departments often share the same patients. Accident & Emergency is also used for training Paramedics, Nurses and Doctors. Trainees still need to be supervised.

In USA the ATLS system was introduced dealing with advanced trauma and life support. This was started following an air crash in Wyoming where a doctor looked after his family who were passengers in crash and were severely injured. He was concerned about the poor quality at the local hospital and he produced the ATLS system which is now run by the American College of Surgeons. This gives structure to dealing with training in life support courses with training and accreditation.

There is no shortage of people wanting to go into Accident & Emergency Medicine. Dr Ritchie attended a career meeting where the Anaesthetic Department managed to attract two people to their stand and Accident & Emergency attracted forty.
Accident & Emergency is also associated with long hard shifts and there is an early learning curve with structured teaching programmes. Shift work appeals at first and "doing things for people".

Imaging has improved dramatically over the years and thrombolysis if necessary has to be given within 30 mintues and this is only possible in A&E. This may be necessary in the future dealing with strokes. The Victoria A&E already has its blood gas analyser, machines for measuring U+E's and lactate.

In the future there may be a large number of Community Casualty Units for what is described as "minor" cases. Clearly the definition of minor is important and quite difficult.

In the Accident & Emergency Dept 80% of patients are seen by Juniors. In General Practice 80% of patients are seen by fully qualified GP's. The future plan would be for 80% of patients in A&E Departments to be seen by trained doctors.

The Victoria Infirmary looks after 250,000 patients the same number as when the
Victoria Infirmary was started. The Victoria Infirmary is about to to be closed.
The meeting was then laid open to questions. The first question was about how many A&E Depts are needed in Glasgow. In reply Dr Ritchie told us that in USA a trauma centre is based in an area where there are 5,000,000 patients. In Scotland the only area good enough to have a trauma centre is Aberdeen which has all specialites including Surgery, Orthopaedics, Intensive Therapy, Anaesthetics and Accident & Emergency all in the one area. He suggested that three A&E Depts would be necessary in Glasgow, although there are clearly going to be two A&E Depts.

Dr Prakash gave an excellent vote of thanks summarising some of the salient parts of the speech.

The meeting was very well appreciated by the members.

Dr William P McKean