Whither theacutemedical patient

The continual changeinNHS structure demandsreappraisal ofboththeservices provided andtheallocation ofresources to ensure appropriate standardsof care. Unfortunately thisequation never seems tobalance. Although theoverall goalisto havean excellent standardofcare, the necessary resources nearlyalwaysare lacking. Asa consequence "we"often have to critically analyse andchangeclinical practice toachieve thisgoal. Nowherein medicine isthispoint more pertinent than in themanagement of acute medical emergencies. Thisarticle examinesnot onlyhow thechanging faceofmedicine influences thissituation butalsopossible solutions tothequestionwhowill manage thesepatients inthefuture. (7Accid EmergMed1997;14:167-169)