Emergency medicine is no accidental procedure

THERE are two words that must be expunged from the emergency medicine lexicon; one is “casualty” and the other is “accident” (“Hospital A& E crisis looms as GPs take Christmas off”, The Herald, December 8). My erstwhile colleagues in Australia and New Zealand realised this, and acted on it, literally 30 years ago. In Britain, “Casualty” remains the title of TV’s longest running medical soap, and “A& E” remains the preferred title for hospital departments of emergency medicine amongst the public, medical managers, politicians and, it pains me to say, some emergency physicians.

If you want to know why British emergency medicine remains a Cinderella speciality, look up the word “casual” in Chambers Dictionary: “Casual (adj.) accidental: unforeseen: occasional: off-hand: negligent... casualty... an accident: a misfortune: loss by wounds, death, desertion ... casualty department... a hospital department, ward, in which accidents are treated; casual ward formerly, a workhouse department for labourers, paupers etc”.

William Hadden, the father of injury prevention in the United States, had a swear box in his office and fined anybody who used the A-word, “accident”. He realised that there is no such thing as an accident. If you truly think the insult that befell your patient was a bolt from the blue you will never attenuate it, for you will never predict it. If you truly think your patient is a pauper he will doubtless remain such. If the department in which he is seen resembles a Dickensian workhouse then its facilities and available expertise are liable to be of similar vintage. How can we possibly improve acute medical care if we continue to use the terminology of a dressing station on the Somme?

I wonder if The Herald, in its admirable NHS: Time for Action campaign, would take a lead and stop using these archaic words which cause the emergency medicine fraternity throughout the world to squirm with embarrassment. Remember this: he who controls the language sets the agenda. Dr Hamish Maclaren, Fellow of the Australasian College for Emergency Medicine, 1 Grays Loan, Thornhill, Stirling. This cave near Whithorn is reputed to be where St Ninian came to pray in the 6th century. It is a peaceful place and I imagine not much has changed through the centuries. The December day was grey and overcast so the picture almost looks like it’s in black and white. I shot it using my Canon Power Shot. We welcome submissions for Picture of the Day. Please email photographs to picoftheday@herald.co.uk