Book Review

Cambridge Textbook of Accident and Emergency Medicine

N Engl J Med 1998; 339:414-415August 6, 1998

Article

Cambridge Textbook of Accident and Emergency Medicine
Edited by David Skinner, Andrew Swain, Rodney Peyton, and Colin Robertson, with Fiona Whimster. 1271 pp., illustrated. New York, Cambridge University Press, 1997. $225. ISBN: 0-521-43379-7

In the United States, the recognition of emergency medicine as a distinct specialty has been a long process, requiring at least 10 years and many separate steps. The evolution of emergency medicine has included the development of independent training programs, the identification of focused areas of research, career development, academic recognition, and the publication of an independent and directed body of literature, including textbooks. The last element is important because the literature of a specialty provides tangible evidence that it is practiced under unique conditions and within specific limits, according to algorithms and treatment plans that usually cannot be extended smoothly to another specialty.

The maturation of the clinical and academic aspects of emergency medicine during the past decade has been paralleled by changes in the lists of contributors to emergency-medicine textbooks. In the specialty's formative years, textbooks were compiled by a single physician or by a group of physicians from a variety of specialties, each writing from a necessarily different perspective. As the specialty became more clearly defined, practitioners of emergency medicine realized that this eclectic approach to publication was becoming obsolete. The emergency department is a fast-paced, demanding cosmos that must be described by clinicians who know it firsthand. Today, the authoritative texts on emergency medicine are edited by practicing emergency physicians who assemble a corps of authors with expertise in specific emergency situations, patient presentations, and diagnostic processes.

A similar evolution appears to be under way in the United Kingdom. The publication of the Cambridge Textbook of Accident and Emergency Medicine represents a milestone in the recognition of the need for emergency-medicine specialists. The pioneering efforts of the editors are to be commended: To varying degrees, all of the major aspects of emergency care are addressed in this book. As a physician practicing emergency medicine in the United States, I was particularly interested in the discussion in chapter 14 of the differences in resources for prehospital care between the United States and European countries. Features of the different systems are detailed in tables, making comparisons easy. As the authors point out, there is no perfect system: each has its own merits and problems.

My accolades for the editors notwithstanding, I do have several criticisms of this book. The foremost is that too many topics were attempted for such a short book, and therefore the amount of detail that can be presented is limited. The Cambridge Textbook is less than half the length of Rosen and Barkin's Emergency Medicine (St. Louis: Mosby, 1998), the foremost U.S. textbook of emergency medicine. The coverage of clinical issues is further compromised in this brief textbook by the inclusion of chapters on ancillary topics such as emergency department staffing and administration. These are certainly important issues, but they cannot be discussed adequately in a book of this size. As a result, for example, only one chapter is devoted to toxicology, curtailing detailed discussion of the pathophysiology, complications, and treatment of many common and not-so-common toxicologic problems.

As was true of the first emergency-medicine textbooks published in the United States, most (75 percent) of the contributors to the Cambridge Textbook are practitioners of specialties other than emergency medicine. This imbalance is disturbing, considering the availability of experienced authors who are emergency physicians. The result is a skewed perspective that may not be directly applicable to an emergency department practice. I anticipate that the percentage of emergency-medicine physicians in the list of contributors will increase in subsequent editions.

In the foreword to the Cambridge Textbook, David J. Williams states that “Accident and Emergency Medicine is not an independent specialty but a specialty which is inter-dependent with all other major clinical disciplines.” This perception of accident and emergency medicine will thwart its development as a specialty. Emergency medicine is practiced in a unique setting under unique circumstances and demands sophisticated skills and decision-making processes. True, we as emergency physicians interact with specialists from all other disciplines. But we are not subsumed by them and we are not their surrogates. We embody a medical specialty now recognized in the United States and beginning to emerge in the United Kingdom.

All told, I find it difficult to recommend the Cambridge Textbook for clinical use over other emergency-medicine publications. However, it is a valuable resource for comparing prehospital and emergency care systems in the United States and the United Kingdom. From that perspective, this book would be a welcome addition to any emergency physician's personal library.

Wade R. Gaasch, M.D.
University of Maryland School of Medicine, Baltimore, MD 21201