SUPPLEMENT
May 2008
Emergency Medicine Journal
Medical Services at the 2012 Is there any guidance on numbers of
patients likely to be seen?
RB: There were just over 10 000 medical
Olympic Games and Paralympic encounters in Athens; 7000 of these were
at the polyclinic and 3000 were at venues
Games: an interview with Richard (both competition and training venues).
Just fewer than half the medical problems
Budgett were musculoskeletal and approximately
half the patients were athletes, the rest
being made up of support staff, Olympic
family and spectators.
The London 2012 Olympic Games will bring the athlete and ensuring there is a level
thousands of athletes and visitors to London, playing field (anti-doping) at Game times.
and will create opportunities for doctors who The Chief Medical Officer is the channel What kind of medical problems/conditions
want to contribute to the success of the Games for all information to and from the IOC are you anticipating?
rather than just watching it all on television. on health services and anti-doping. RB: The acute orthopaedic injuries will be
Richard Budgett is the Chief Medical related to the sport and event. Overuse
Officer London 2012 and he talked to Alison injuries will be even more specific.
Sanders (SpR Emergency Medicine/HEMS How will the services be organised? Thereafter, musculoskeletal and phy-
and Sydney Olympics 2000). RB: There is a polyclinic in the main siotherapy services, dental and ophthal-
Olympic village (and smaller ones in the mology services are the busiest in the
other two Olympic villages) which is polyclinic.
What is your role?
RB: The Chief Medical Officer is respon- similar to a small hospital. There is a
sible for medical services. The IOC 24 hour emergency service and 70% of Will lots of visitors come to emergency
(International Olympic Committee) con- health care is delivered through the departments?
siders medical services as both health care polyclinic. The polyclinic provides pri- RB: Statistics from previous large events
and anti-doping. Health care includes care mary care, sports and exercise medicine, show that the use of emergency medicine
for all athletes, their support staff, the physiotherapy, emergency services (a departments is usually less during the
IOC and other staff who are the so-called small A&E), ophthalmology, dental ser- event. This is probably due to the services
‘‘Olympic family’’. It also covers all vices, imaging, pharmacy, podiatry and provided on site. Spectators will be triaged
members of the public while within other medical specialities. The medical and dealt with by the venue medical
ticketed areas. We also have to ensure services at venues depend on the need for teams so that the burden on any depart-
that public health measures are in place the field of play. There will be paramedics ment is unlikely to be significant.
within the village and venues. with a combination of sports and exercise
At this stage the Chief Medical Officer medicine doctors and emergency medicine Will there be any jobs for emergency
is very part time and not involved in doctors. The level of emergency cover will medicine doctors?
detailed planning but overviews strategy depend on the risk of the event. For RB: In April 2009 we will appoint a
and liaises with stakeholders. There is a instance, it may be appropriate to have an medical volunteer coordinator. There will
medical manager and an anti-doping HEMS standard land-based team at the be opportunities to volunteer for all
manager who are putting together a equestrian and the BMX events. Spectator specialities but emergency medicine doc-
detailed plan with timelines and budgets. care will follow the green guide as a tors will be in demand both to man the
I see the Chief Medical Officer as primar- minimum and a large number of other polyclinic and appropriate venues.
ily responsible for protecting the health of doctors will be needed. Doctors will be at an advantage if they
emj.bmj.com
EMJ Supplement
have experience of sport and working on national Olympic committees without a There will be a total of 3000 volunteers
the field of play or of spectator care at team doctor will rely on the polyclinic, and the exact distribution is not yet
major events. particularly accessing primary care, sports decided. If you are interested in being
and exercise medicine and physiotherapy. involved then you can put your name
In the vast majority of events, team down as a volunteer on the website, but
What type of doctors will treat the medical staff are not permitted in the opportunities will be advertised next year
athletes and what qualifications will they field of play at the Olympics so, in the and it is not necessary to register or take
need? event of an accident on the field of play, it any action now.
RB: Many athletes will be treated by will be the team of medical staff at the
their own medical support team of venue (paramedics, SEM/EM doctors) Alison Sanders
doctor and physiotherapist. Smaller who will deal with the injury. SpR HEMS, Royal London Hospital, London, UK
Consultant appointments March 2008
The information for the consultant appointments is provided by the College and any errors should be notified to them and not the journal
Name Hospital Previous post
Mr David KIRBY Addenbrooke’s Hospital SpR
Mr Matthew E CADAMY Newcastle General Hospital Locum consultant
Dr David Charles ROBINSON Bradford General Hospital
Dr Iain BEARDSELL Southampton General Hospital SpR
Dr Sarah J ROBINSON Southampton General Hospital SpR
Dr Lisa CLARK Queen Alexandra Hospital, Portsmouth
Dr Sophie GOUGH Queen Alexandra Hospital, Portsmouth
Dr Brian LOCKEY Salisbury District Hospital
Dr Sarah ASSHETON Salisbury District Hospital
Spot the difference
These two pictures look the same, but there are a few subtle differences. How many can you spot?
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EMJ Supplement
Correction: William Rutherford
Obituary
Unfortunately the following paragraphs were contacts and friendships, William fostered three identities—Irish, British and Indian.
omitted from the end of Jonathan Marrow’s healing between the communities in He truly saw beyond borders and was one
sensitive obituary of William Rutherford Northern Ireland. During the years when of the group who inspired the establish-
published in the April supplement. he worked in the hospital service in ment of the International Federation for
We very much regret this and apologise to Belfast he was delighted to see attitudes Emergency Medicine in 1989.
Jonathan and our readers. change, from the era when the religious Towards the end of the time when he
affiliation of a medical or nursing job was able to take an active part in the
In 1982, during William’s term of office, applicant was seen as something which activities of the BAEM, William quoted a
the annual scientific meeting of the CSA might be relevant to a committee’s traditional Irish blessing at the end of a
was based in Dublin, with a day of decision to the point where it no longer Gala Dinner. He added one word to the
presentations in Belfast as well. For many seems their concern at all. familiar version to make it acceptable to
delegates from Great Britain this was the William was born just before the Irish all faiths:
first time they had ventured into the Free State was established, in what is now May the road rise to meet you
troubled north of Ireland and, indeed, part of Northern Ireland. When he was May the wind be always at your back
perceptions were such that some stayed in aged 6 the family moved down to Dun May the sun shine warm upon your face
Dublin rather than risk the trip. Laoghaire, near Dublin. He went to board- The rain fall soft upon your fields
Throughout his time at the Royal ing school in Belfast, then back to Trinity And until we meet again
Victoria and after his retirement too, by College, Dublin for medical school. William May your God hold you
means particularly of many personal was proud to regard himself as a man with In the hollow of his hand
The photograph of William Rutherford published in the April supplement was supplied courtesy of the Irish News.
News from FASSGEM
The news ‘‘hot off the press’’ is that the regrade to the AS grade you should do so opportunities for e-learning, membership
SAS committee decided on 18 March to as soon as possible. This is the time to of FASSGEM, the receipt of the ever
accept the new SAS contract; 40% (5139) support FASSGEM as we are going to improving and recognised EMJ, revalida-
of the ballot papers were returned with work with CEM on introducing aspects of tion and registration of CPD.
60.4% supporting the new contract. The the new contract on your behalf. CEM Further information on the contract
new contract will be offered on an has allowed FASSGEM to play a vital part including a ready reckoner to gauge how
optional basis from 1 April 2008 to in its own future by contributing to the your salary is affected is available at
doctors/dentists in the following grades: ‘‘Way Ahead’’ document. Please come to http://www.bma.org.uk/ap.nsf/Content/
staff grades, associate specialists, senior the FASSGEM Spring conference and SASvote or http://www.bma.org.uk/ap.
clinical medical officers, clinical medical contribute to these discussions. This year nsf/Content/SASdocumentation1007.
officers, clinical assistants and hospital the Spring meeting will be held at For further details on FASSGEM and
practitioners. Frenchay Hospital on 9 May 2008 with meetings please see the CEM website
Doctors will have 12 weeks from receipt our annual conference and AGM to be at http://www.collemergencymed.ac.uk/
of a letter from their trust to express an held in Scarborough. FASSGEM/Our%20Meetings/ or contact
interest in the new contract, which does All SAS doctors should also take Caroline Shaw at caroline.shaw@nnuh.
not commit them to accepting it but advantage of the grandfather clause nhs.uk.
guarantees back pay to 1 April 2008 if offered to obtain membership of CEM.
they do. Remember that this will only extend for
It is vital that diary planning occurs 6 months from 1 March and will not be Meng Aw-Yong
now, but if you are eligible to apply to repeated. Membership will confer great Chair-elect of FASSGEM
emj.bmj.com 3
EMJ Supplement
Saving mothers’ lives
Are we missing something? Are these avoid- The writing process is complex and
able deaths in the ED? exhaustive and uses a number of important
definitions of maternal death. Maternal
A woman attended the ED 3 weeks after
It all comes down to vital signs and the
death up to 42 days is direct when it results
a mid-trimester termination of pregnancy;
recognition of the sick patient, pregnant,
from obstetric complications of the preg-
she had chest pain and was tachycardic
post-partum or not.
nant state from interventions, omissions,
at 120 bpm. A diagnosis of urinary tract
The Confidential Enquiry into Maternal
incorrect treatment or from a chain of
infection or pelvic inflammatory disease
and Child Health (CEMACH) published its
events resulting from any of these. An
was made and she was referred to the
seventh report in December 2007. This gynaecological on-call team before being
report, entitled ‘‘Saving Mothers’ Lives: indirect death up to 42 days results from
previous existing disease or disease that
sent home. She died a few days later and
reviewing maternal deaths to make a post-mortem examination revealed a
motherhood safer’’, covers the years 2003– developed during the pregnancy which was
not due to direct obstetric cause but was
pulmonary embolism.
5 and is the first report to have emergency
medicine and general practice represented. aggravated by the physiological effects of
The work of CEMACH is funded by the pregnancy. A late death occurs between time in an ED is rather depressing.
National Patient Safety Agency Centre, 42 days and 1 year after abortion, miscar- Clinicians miss the signs of the acutely ill,
the Scottish Programme for Clinical riage or delivery due to direct or indirect worrying signs and symptoms are over-
causes. Coincidental deaths arise from looked or given little significance and
Effectiveness in Reproductive Health and
unrelated causes which happen to occur communication can lack precision, particu-
by the Department of Health, Social
in pregnancy or the puerperium (eg, road larly around the severity of the illness. Even
Services and Public Safety of Northern
traffic accidents). in these days of a more consultant-led
Ireland. The report requires a huge
There were 132 direct deaths, 163 indirect service both in emergency medicine and
amount of work and a significant time
deaths, 11 late direct deaths and 71 indirect obstetrics, senior help is often sought late—
commitment from all the assessors,
late deaths during the triennium under if at all. As a consultant it is impossible to
authors and contributors which—as you
investigation. These numbers may seem salvage a situation if you know nothing
might expect—is not remunerated.
small, but the report makes the excellent about it, and my impression is that senior
The Director and Editor Dr Gwyneth
point that each of them represents a young obstetricians are keen to be involved early
Lewis (the maternity ‘‘tsar’’) has the unenvi- when a pregnant or recently pregnant
woman who died which led to the prema-
able task of collating the relevant data, patient is seriously unwell.
ture loss of a mother, partner and member of
preparing the report and directing the On a positive note, it is reassuring to
a family and the community, so the social
inquiry. Not least, she has to corral a number read that resuscitation of mothers in
costs of these deaths is immense.
of healthcare professionals into writing their One of the most useful outcomes of cardiac arrest tends to be run well
chapters on time and mould all the disparate this report is the list of recommendations. (although outcomes tend to be poor); this
writing styles into a composite whole. There is a pithy list of the top 10 should perhaps be expected!
recommendations at the front of the Rather than print out the recommenda-
report which draws on common themes tions, I commend you to find your
A woman was seen three times in the ED seen in most cases of substandard care. department’s copy of the report, grab a
with abdominal pain and diarrhoea; she Each of the clinical chapters also makes coffee and read. The size is manageable,
had a heart rate of 130 bpm the first time specific recommendations. Although a the style readable with interesting vign-
and 140 bpm on the second occasion. fatal outcome is rare, near misses happen ettes and your CPD will be enhanced.
She was discharged with a diagnosis of often and many of these can be avoided Maternal death may not happen in your
gastroenteritis. During her third presenta- by judicious use of this section. department every day but, when it
tion she arrested and died and was found As is often the case, the emergency threatens, wouldn’t you like to be ready?
to have a ruptured ectopic pregnancy at medicine top tips are not surprising or
post-mortem examination. obscure. Rather the reverse. Reading the
case notes where deaths occur in or after Diana Hulbert
College News
The time is rapidly approaching when you, the College of Emergency Medicine, can have your say
about the future direction of our specialty:
c In early May there will be a request for nominations for the President, Chairs of national committees
and regional representatives.
c Voting will commence in mid-June and continue until the beginning of August.
c The results will be announced in mid-August.
c On 18 September 2008 the first Council meeting with new members will take place.
PLEASE USE YOUR VOTE—have your say, get involved and shape your specialty. If you do not exercise
your democratic rights, you cannot complain about the future.
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