The degree to which specialists are needed in treating emergently ill unstable patients is relative, though their contribution to definitive care is indisputable. It is my personal opinion that no services should be withheld if they benefit the immediate situation; that is as long as the doctor in attending has the competence to deliver.
After morning duties, I took the early part of the afternoon and visited the 'receiving' department of another local hospital. Their claim to fame is the triage of greater than 300 patients per day through this department. After going through the typical bounce through different offices, the 'communication director' personally escorted me to meet the Chair of the department. The department was relatively well lit and clean; it was a long hallway with individual rooms holding patients on single cots--most rooms without any other equipment in the room. There was a crowd of people around a room; most staring quietly; a few screaming, crying. The Chair walked out and greeted us, follow by a tray carrying all the requisite materials for intubation, and a few (reusable) needles. They had been waiting for anesthesia to intubate, but they never showed up. I didn't ask any further questions, but it was obvious an important step in this patient's management wasn't completed.