In the early days of the division's history, medical and surgical emergencies were separated geographically within the hospital. A receptionist was in charge of separating the cases, sending the "medicals" to one corner of the hospital and the "surgicals" to another. This was not an ideal system, as there were many occasions when surgical residents were called to the medical area and vice versa.

In 1975, emergency services were moved as a combined unit to the hospital's newly constructed Gerrard Wing, and several "supervising paediatricians" were appointed for day-to-day supervision of patient care and teaching. Coverage by these supervisors spanned from 8 a.m. to 2 p.m. until 1989, when round-the-clock coverage was instituted. The Emergency Department is staffed now mainly by PEM board qualified specialists.

The division has an active fellowship program with both a three-year academic fellowship and a one-year clinical fellowship. We continue to train fellows from outside Canada who have gone on to develop PEM in their home countries. A large number of non-paediatric post-graduate trainees and undergraduate medical students continue to receive their primary paediatric training within the division.

The division's research interests have always been wide-ranging. Topics of recently published studies include cardiac and respiratory arrest in children, outcomes of intensive treatment for children with asthma, outpatient therapy for croup, orthopaedic assessment, investigation and treatment of ankle injuries, investigations for suspected intussusception and treatment of constipation with fleet enemas. The results of these clinical research endeavours will affect ultimately a large number of children both locally and internationally.

In the face of increasing financial constraints and restructuring of health care systems, the division has been working closely with other divisions and departments in the hospital, and with other institutions in the community, to develop protocols to expedite patient care. In many cases, emergency paediatricians have assumed responsibility for evaluating patients who were previously seen by other specialists. We have worked with Emergency Departments in the Toronto area to help them develop paediatric-friendly and competent areas within their adult Emergency Departments. The goal is for primary care paediatric patients to be seen in these Emergency Departments in their own communities instead of making the trip to SickKids.