History of Australasian Emergency Medicine

I was privileged to be in the company of Dr Edward Brentnall one of the Grandfathers of Australasian Emergency Medicine, and one of the founders of the Australasian College for Emergency Medicine (ACEM).

Dr Edward Brentnall (MBE, OAM, MBBS, FRACGP, FACEM, DObstRCOG)

Dr Edward Brentnall (MBE, OAM, MBBS, FRACGP, FACEM, DObstRCOG)

Dr Brentnall qualified in London (UCH) in 1952 prior to serving in the Royal Army Medical Corps in Singapore for 3 years. He was then a rural GP in Kent in England for seven years before he migrated to Australia in 1965. In 1975, after ten years of being a GP he took over as Director in the Emergency Department at Box Hill Hospital in Melbourne, where he played a pivotal part in developing Emergency Department Triage, as well as being one of the original founders of ACEM.

In 2010 he was awarded a Medal of the Order of Australia for service to acute and emergency medicine. 

 

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Edward Brentnall on Forming a College

In the old Casualty Departments, the senior nurse was a powerful and influential figure.  When I was a junior resident (I am talking of the 1950s now!) there was no senior doctor routinely in the Department. We had a couple of senior residents, the RMO and RSO, who came to look at medical or surgical admissions, but they were on the wards for much of the time.

In 1972 the Hospital and Charities Commission in Victoria started to encourage hospitals to appoint doctors as Directors of “Accident and Emergency Departments” (a British imported name). So, in 1973 the “Association of Casualty Supervisors of Victorian Hospitals” was formed in Melbourne. Naturally the word “Supervisors” applied to the senior nurses as well as the newly arrived doctors. 

The striking thing about the minutes of the Association of Casualty Supervisors of Victorian Hospitals is that the subjects for discussion have changed very little in the past 35 years.   Shortage of inpatient beds, statistics, computerisation and data collection, training, staffing issues, overloading with patients, blood alcohol issues, education, association with other states - all of these were early starters.

Over the next few years the organisation grew. Ministers for Health in Victoria recognised that it represented both professions and hence the patients.  There was a close similarity in the need for education and the establishment of ‘protocols’ for the management of common presenting conditions.

In 1979 we formed the embryo “Australian Casualty Association”. We had discussions with colleagues in other states, and the eminent orthopaedic surgeon Tom Claffey was chosen to be the President. He was a Sydney surgeon, and we did not want the organisation to be heavily Melbourne based. Colleagues in South Australia and Tasmania were happy with the idea.

However, there was fierce opposition from doctors in New South Wales and Western Australia. In July 1981 we had a meeting at the Danish Club in Melbourne, and the Australian Society for Emergency Medicine was formed, but there was still emphatic opposition to including nurses in any organisation. We in Victoria were disappointed but kept talking.

In December 1981 we had a meeting at the Camperdown Travelodge in Sydney. We continued to try to persuade the doubters that we should follow the Victorian example, and I proposed the formation of an Australia-wide society along the lines of the ‘Victorian Emergency Department Association’ - VEDA. This was debated, but as the ED Directors from NSW and WA had already made clear, they would not accept any organisation with nurses as members. So, in a fit of bad temper, I proposed that if they would not accept that, we should go straight ahead and form a College. The motion was seconded, put to the vote, and passed!

It was accepted that the senior members of the State organisations should take office.  There was some private discussion, but it was agreed that we should aim to have an organisation and examination structure along the lines of the College of Surgeons. This was particularly a political decision, as it was felt that this was the best way of gaining the support of the RACS in our eventual bid to achieve ‘Specialist’ status. As part of the same train of reasoning, we wanted a Surgeon with a high profile as our first College President.  There was only one who filled the requirement; Tom Hamilton had been an internationally known surgeon, with expertise in breast surgery, in Edinburgh before he emigrated to Perth. He went to Sir Charles Gairdner Hospital, and took the post of Director of the Emergency Department.

There was some discussion of the proposed College name. The American College of Emergency Physicians had already taken the initials ACEP which made it difficult for us to use the same letters. So we adopted the name “Australasian College for Emergency Medicine”. I insisted that it should be “for” and not “of”, so that we could be seen to be standing FOR a new discipline, and not just be a collection of individual experts.

All the medically qualified people working full time in the field were accepted as “Grandfathers” - Foundation Fellows, and they were not required to sit the new examination.  

It was agreed that the qualifying examination should be in two parts, following the surgical lead. There would be a Primary Examination, and this would be in four parts - Anatomy, Physiology, Pharmacology and Pathology. This was more extensive than the Surgeons examination which did not include Pharmacology, or the Anaesthetists which did not include Pathology or Anatomy. 

A more difficult examination was not seen as creating too great a hurdle, and did the image of the College no harm.

 

Timeline

  • 1973 - David Race, Hospital & Charities Commission suggested organisation
  • 1974 - Association of Casualty Supervisors of Victorian Hospitals
  • 1979 - Australian Casualty Association
  • 1980 - Casualty Services Consultative Council
  • 1980 - Australian Society for Emergency Medicine
  • 1983 - Australasian College for Emergency Medicine
  • 1993 - Specialist status granted to Fellows of ACEM

 

Nomenclature

Originally the “Casualty Department” where patients attended ‘casually’ - i.e. with no appointment, as distinct from the Out-Patients Department, where an appointment (and probably a referral by a doctor) was necessary.

Then, after the Platt Report in the UK, they became “Accident & Emergency Departments”. This was a tautology, but is still heard occasionally. Platt recommended that the Departments should be placed under the control of Orthopaedic Surgeons, as so much of their work was fractures, especially in winter time when the elderly slipped, fell over, and broke their wrists!

In the USA, they were Emergency Departments, but sometimes Emergency Rooms. This description was so obviously descriptive of their real role that it was adopted and is now almost universal.

Dr Edward Brentnall

 

This song's for you Dr Brentnall - thanks for all you have done for Emergency Medicine here in Australasia.

Neil Young Old Man (Live at Massey Hall) Live At Massey Hall 1971