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This paper reviews the current evidence available on the practice of spinal immobilisation in the prehospital environment. Following this, initial conclusions from a consensus meeting held by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in March 2012 are presented.

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The Gnosall Primary Care Memory Clinic has been operating since 2006 and adds the skills of a specialist old age psychiatrist to the extensive skills and knowledge available in primary care. Key to the organisation and function of the clinic is the eldercare facilitator, a new role situated in primary care and linking with the specialist and a wide range of other agencies and people. In order to facilitate replication of the model elsewhere, the function, role and competencies of existing and previous eldercare facilitators in the clinic have been reviewed, clarified and related to a competency framework and to similar initiatives in the literature. The selection and training of people with the attributes and skills required to become an eldercare facilitator will determine whether extension of the model is successful elsewhere.

Objectives-To examine the profile of regular attenders to an accident and emergency (A&E) department, and to estimate the percentage of the overall departmental workload attributed to this group of patients, together with the resultant cost to the department of these attendances. The aim of this study was to profile our "regular attenders" to identify how many actually fit the category of "regular attenders" and estimate the percentage of the overall workload of the department attributed to this group of patients. In addition, we also aimed to examine the number of alcohol related attendances and the proportion of patients classified as having no fixed abode. The range of presenting complaints, investigations performed and the cost of these together with the disposal of these patients were also analysed. MethodsThere seems to be no standardised definition of a regular attender. Several definitions have been proposed, all of which have been arbitrarily chosen, ranging from two or more visits per year 6 to more than 10. 7 We defined a regular attender as anyone attending the department on average at least once per month over the study period. Therefore, anyone with at least six attendances over the six month period was included for analysis.A retrospective observational study was performed over the period 1 January 1998 to 30 June 1998 to identify all patients with at least six attendances to the accident and emergency (A&E) department at Hull Royal Infirmary.These patients were identified by means of a thorough search of the departmental computer database together with an examination of the "regulars folders" kept in the department. Patients were allocated "regulars folders" based on the number of previous attendances. Finally, all A&E cards were examined to avoid missing any eligible patients.Data collected included age, sex, marital status, accommodation, number and variety of presentations, history of concurrent alcohol or drug use, investigations performed and disposal from A&E.The cost of the investigations undertaken was calculated on the basis of these being carried out both in hours and out of hours, as it was not always possible to accurately establish when these had been performed. Each department responsible for performing these investigations was contacted to establish their cost. The cost of admission was based on an average cost for an inpatient episode of £200 per night. The inpatient case notes were retrieved to identify the duration of inhospital stay. ResultsA total of 191 "regular attenders" folders are kept in our A&E department, however of these only 40 (20.9%) met the criteria of at least one presentation each month for six months. Eighty one patients (42.4%) attended less than six times while 70 (36.6%) did not present at

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