Good morning and welcome to you all – students, nurses and doctors.
Many of you have travelled a long way to be here, particularly the Australian visitors and the two guest speakers, Dr Ian Stiell from Canada and Dr Mike Clancy from the United Kingdom. I hope you all enjoy your stay in New Zealand, and in my home city of Wellington.
As you will be aware, New Zealand is in the closing stages of an election campaign, but I am not electioneering when I say you are visiting the best city in the country. It is a special place to live in and work in, and I hope you have the opportunity to see as much of the city as possible while you are here.
You have made a good start by holding the symposium in Te Papa, and I hope some of you have tickets for tomorrow night to the magnificent Stadium to watch the All Blacks play the Springboks in the Tri-Nations. I am sure the Australians among you will not need reminding of the result of the first match in the series last weekend.
This conference is an excellent opportunity to share information and knowledge and to network, and I know you will all take advantage of this. Emergency medicine has made great strides in recent times and we can all be grateful for the continuing development of your discipline.
It was only in 1967 that the first full-time Director of a 'Casualty Department' was appointed in Australia, and since then there have been a number of achievements in emergency medicine in Australasia.
Your college has been established, a curriculum has been developed, emergency medicine has become recognised as a medical specialty, and now academic emergency medicine is developing.
The large number of you here demonstrates the value of the work that has been done in the past, and I am sure those students new to the field will appreciate what your predecessors have done and be proud to be a part of a strong tradition.
Almost all New Zealanders and Australians will have either had to go to a hospital emergency department themselves, or will have accompanied a friend or relative at some stage.
It is reassuring to see ongoing development of the specialist skills needed to diagnose, treat and refer the undifferentiated mix of patients in the high-pressure and time-critical environment of such departments.
Emergency care is often associated with trauma, but it actually involves dealing with a whole range of medical, behavioural, psychological and social problems at the front line, often in difficult conditions.
The diversity and intensity of this role is demanding physically, emotionally and intellectually. We value the work done by all of you here, and your patience and skill in helping the people who often come through your doors in very stressful circumstances.
Emergency department practitioners are crucial in ensuring patients get the 'right care at the right time in the right place from the right person'.
The departments are the first port of call for many entering hospitals, so accurate and appropriate diagnosis, management and treatment in emergency departments clearly have a positive influence on the patient’s remaining experience in hospital and their clinical outcomes.
Previous inconsistent standards in New Zealand hospital emergency departments were highlighted in the recent past in a number of incidents reported by the Health and Disability Commissioner.
Last year the Ministry of Health conducted a clinical audit of a range of emergency departments. I was pleased to note that the outcomes included dissemination of 'best practice' material, particularly with respect to triaging patients.
The Ministry has also set up an Emergency Department Clinical Advisory Group, which includes several Australasian College of Emergency Medicine members, to advise on a national framework for emergency departments.
I understand the Clinical Advisory Group is looking into issues around staffing, skill mix, and quality assurance, and is about to circulate some recommendations for discussion in the sector.
I look forward to learning about the feedback received on the recommendations and further work to develop a national quality framework for emergency departments.
In the meantime, I am pleased to note the specialist skills of emergency medicine are already becoming increasingly available in hospitals around New Zealand.
The Clinical Training Agency has made a commitment to funding the training of registrars in emergency medicine, quadrupling funding between 1996-2002.
Emergency medicine specialists are now employed in 14 New Zealand hospitals, from Invercargill to Whangarei, and we now have the capacity to train the full complement of registrars in emergency medicine.
While this is extremely encouraging, it remains to be seen whether the increasing numbers of emergency medicine specialists will continue to result in more specialists working in the smaller and provincial hospitals.
We also need to consider how to support emergency care in rural areas that are less able to attract or support specialists, and I encourage the College to take up this challenge in their approach to training and clinical networking.
You will all know that demand management in emergency departments is also an important issue to be considered. We need to ensure that people who attend emergency departments receive appropriate care in a timely fashion.
Clearly, the nature of accident and emergency means patient demand is variable and staffing decisions need to take this into account. Emergency departments can be faced with difficult-to-manage ‘peaks’ at any time.

The difficulty arises when emergency departments are faced with prolonged periods of high demand resulting in overcrowding or inappropriately long waiting times

This is an international issue, and there are no easy answers. Nor is it an issue that emergency medicine can address alone. One key action to help manage demand is ensuring access to care for people who can be appropriately treated in the community. The Primary Health Care Strategy in New Zealand is an important step toward this.
As the Strategy is implemented, and the additional funds moved into primary care are utilised, a better range of primary care services will be available to a greater number of people.

Improving access to appropriate care within the community should allow emergency departments to focus on their key role of the initial diagnosis, management and treatment of ill or injured people who need hospital care.

Managing acute demand also needs to involve collaboration between emergency departments and inpatient units to coordinate the flow of patients through the hospital. I am aware of a number of collaborative initiatives that have been undertaken or suggested, and I look forward to being informed of further work to address this issue.
I am aware that one topic at this conference will be the use of computer simulation for teaching and training. The rapid advancement of technology is giving us exciting options in health care, and I hope your discussions on this topic over the next few days will be encouraging.
I wish you all the best for the conference and if you see nothing else of Wellington, make sure at least that you explore Te Papa thoroughly. I can assure you that you won’t be disappointed. Thank you all once again for the invitation to speak to you.