Staffing of Emergency Departments

To the Editor.—  "The skills and teamwork employed in this complex task are improved by practice and repetition, which comes only with a large volume of injured patients" (240:1723, 1978). Thirty years of contact with and teaching in various trauma programs have convinced me that the crux of this matter lies in that sentence. Yet, the persons who attempt to operate these services, usually as a peripheral segment of a busy inpatient service, persistently ignore the necessity of such personnel in favor of the more traditional and economically more palatable alternative of rotating groups of basically unsupervised residents.Surely the provision of expert personnel that is available 24 hours a day in the emergency department represents the appropriate staffing of a category 1 emergency department. These people must have at least two years of full-time experience in the triage, resuscitation intubation, and initial evaluation of emergency patients. They must be