Future strategy for United Kingdom research in accident and emergency medicine.

The article "Research in accident and emergency medicine" was offered up for debate.' It asks important questions and raises some important issues. We would like to contribute some views on these and other issues, based on our experience in full time research. A historical perspective: lessons from around the world When searching for direction in an attempt to develop a strategy for research in United Kingdom accident and emergency (A&E) medicine, it makes good sense to look backwards and around the world. The list of countries where A&E medicine is organised in a similar way to the United Kingdom and where some academic development has occurred is rather short, but includes the USA, Canada, Aus-tralia, and New Zealand. Academic emergency medicine in both Australia and New Zealand is still very much at an embryonic stage.2' It is only in North America (and most particularly the USA) where academic emergency medicine is established as a subspecialty. During its evolution over the past 10 years American would-be academic emergency physicians faced many similar problems to those facing us today. Academic emergency medicine in the USA did not develop overnight. Instead it developed slowly from the efforts of a small number of individuals concentrated in a few centres in the midwest. These individuals initially struggled to become involved in large research projects and win prestigious grants. Collaboration with local specialists in larger specialties was used to gain expertise and involvement in large research projects.4 Now academic emergency physicians are winning grants totalling millions of dollars from the National Institute of Health (Weber J, personal communication, 1997). Collaboration Hardern et al suggest that collaboration between United Kingdom A&E researchers would be needed to produce meaningful results.' Such an idea is excellent in principle. In practice it may pose several problems: such collaboration may be logistically difficult to organise; and may suffer from varying degrees of enthusiasm of those involved. The "knock on" effect of the latter may be to adversely affect the quality of the data collected and make the conclusions less reliable. We entirely agree with their other point that collaboration with other specialties will be crucial. In the early stages of the academic development of our specialty, collaboration will help to build a sound scientific base. In the longer term a multidisciplinary approach will, as American emergency physicians have already discovered, provide additional skills and offer a different perspective to the problems …