Casualty, accident and emergency, or emergency medicine, the evolution.

Hospitals have always had to make arrangements for those who arrive at their doors seeking help. Over the years the numbers and complexity of problems presenting in this way have increased at an exponential rate. This increase in demand has been managed in different ways in different countries but in North America, Australia, some parts of Europe and the United Kingdom a new medical specialty has evolved, that of accident and emergency (A&E) medicine (UK) or emergency medicine. This article will examine the evolution of the specialty in the United Kingdom and also look at the possible future changes in the scope of the specialty. The A&E department is the “shop window” of acute hospitals. It is the part of the hospital most closely in contact with the public as it offers the most informal access.1 It plays the most important part in caring for the acutely ill and injured patients. Also it is surrounded by so much drama, tragedy, and media interest. The department and specialty are a rich subject for programmes, debates and criticism; if Shakespeare had been a doctor he would surely have worked in the A&E department.2 What are the origins of our specialty, what has made it successful and what lessons of the past should we not forget when planning our future? The original term (casualty) meant a seriously injured patient. It was predominantly a military word, a general term for the accidents of service: after a battle the dead, the wounded, and the sick lumped together as “casualties”. The term “casual” has its origin from the workhouse “casual” who was not one of the unemployable permanents, but the irregular and unexpected caller who needed temporary help.3 The casualty ward also occurred in Shakespeare, and Dickens writing in 1837 to describe the …