Hypoglycaemia in infancy and childhood.

levels in accident and emergency departments. In our own group-though at present the junior medical staffing is relatively satisfactory for the two major departments which provide a continuous casualty service-there have been occasions over the past nine months when the service has been maintained only by the employment of locum tenens, clinical assistants, or by the payment of extra duty allowances to junior medical staff. Work in emergency medical departments requires a high degree of competence and is not appropriate for the inexperienced junior doctor without continuous support of senior medical staff. Casualty duties have been regarded traditionally as a disagreeable chore to be performed or avoided as expeditiously as possible in the hope of escaping the lurking litigation that preys on inexperience. Such duties, therefore, are only acceptable when the junior doctor knows that senior opinion is available in support until a higher level of competence is reached through a defined system of promotion. Winter is again approaching, and with the complex of motorway intersections in this area, we are seriously concerned at the prospect of coping with multiple road accidents, etc., with a medical staff which relies initially on a medical assistant who is the only member of the medical team in the accident and emergency department providing any continuity , plus (if we have been fortunate in recruitment) a senior house officer. Our committee feels that staff of at least medical assistant seniority should be available 24 hours a day. The recent M6 disaster occurred at approximately 7.00 a.m. Had a similar accident taken place in the Salford area, in which is situated the Worsley braided interchange, Britain's most sophisticated motorway multilevel interchange, known locally as "Spaghetti Junction," senior medical staff would not have been available on duty at either of the two major accident centres in this group, which provide a 24-hour casualty service. This implies no criticism of assistance which is readily available at all times in cases of emergency; it is rather that so important a unit as an accident and emergency department should not have to be dependent on assistance from other departments. There are always "back up" services within the hospital; it is the initial facilities in the way of medical staff which are inadequate. Undoubtedly, it may be necessary to rationalize the number of accident and emergency departments which are available, but a prerequisite of this rationalization must be adequate accommodation …