Does your emergency department (ED) feel like a constant battle? Has the function of your ED been destroyed by external forces? It might strike the reader as extreme to use words related to battle regarding current working conditions in EDs but for most of us this is probably not far from the truth. When you think about battles, you think about frontline casualties (an irony given the origins of emergency medicine (EM)) and how there must be sacrifice for the majority to succeed. Is EM the sacrifice for your hospital to succeed?

EM is still a relatively new specialty with significant advancements in the last 50 years. We have broadened into providing a high level of specialist care and moved away from the ‘Emergency medicine is not a specialty; it is a location’ argument.1 However, none of the current issues including crowding, trolleys and a lack of beds are particularly new. Indeed as far back as 1998 in this journal, Binchy expressed a personal view on the issues facing EM and what they might look like in 25 years. …