tions, 1 had five consultations and 1 had seven consultations. The 6month recidivism rate for transactions was (176 + 60 + 20 + 5 + 7)/917, or 29%, but the recidivism rate for the patients was (88 + 20 + 5 + 1 + 1)/764, or 15%, or about half of the rate for transactions. In other words, only about 15% of the patients had more than one visit in a 6-month period, but 29% of the consultations were with someone who had already had a consultation during the same period. We are currently engaged in further study of the latter group of patients, who place excessive demands not only on psychiatric services but also frequently on emergency rooms, the police and a variety of social agencies. The emergency psychiatric service is part of a coordinated network of clinical services provided by the department of psychiatry of McMaster University, which participates actively in the planning and coordination of these services. We also collaborate with a number of community agencies, including the Police Department and the Office of the Justice of the Peace, to plan for and coordinate emergency psychiatric consultations. Data from the emergency psychiatric service has, as Eastwood and colleagues have suggested, indeed been useful in the coordination and planning of clinical services at McMaster University.

Hospital. The McMaster service sounds fine, but it would be invidious to compare it with the service at the Clarke Institute of Psychiatry. In reply to Dr. Finlayson's caveat, we planned a study along the lines of the title and are satisfied that we met our mandate. Prior to the inception of a crisis intervention unit the population to be serviced needed to be described according to the recommendation of the Taylor report to the Ontario government (Medical Post, Jan. 31, 1978, page 1). When they attended we learned what the patients suffered from and whether they had used other services previously. Consequently, staffing arrangements were revised to meet the patients' needs. We were then left with the vexed issue of the definition of an emergency. In the light of our findings, we considered that this depended upon the nature and urgency of the case rather than on whether the patient suffered from emotional or social difficulties. Treatment of a mobile population in a downtown area is not an easy matter, but we are better equipped to do this having surveyed before we planned. M.R. EASTWOOD, MD, FRCP[C], FRC PSYCH S. STIASNY, B SC, MBA F. CASHMAN, MD, FRCP[C] S.K. LITTMANN, BA, MB, CH B, FRCP[C] G. VOINESKOS, MD, FRCP[C], MRC PSYCH Clarke Institute of Psychiatry Toronto, Ont.

A.J.R. FINLAYSON, MD, FRcP[c] Director Emergency psychiatric service St. Joseph's Hospital

Skateboard injuries To the editor: I was interested by the article entitled "Skateboard inLecturer juries" written by Dr. Robert G. of psychiatry

Department McMaster University school of medicine Hamilton, Oat.

Smith (Can Med Assoc J 121: 510,

References

The following resolution was passed at the annual business meeting of the Canadian Paediatric Society, June 25, 1979:

I. WATTERS WW, GOODMAN JT, Moi-

NAR JG: Organization of a psychiatric ambulatory care service in a general hospital. Can Psychiair Assoc J 17: 409, 1972 2. BARTOLUCCI

G,

GOODMAN

JT,

STREINER DL: Emergency psychiatric admission to the general hospital: a formulation of the process. Can Psy-

chiatr Assoc J 20: 567, 1975

To the editor: Dr. Finlayson considers that the text of our article did not live up to the title and he goes on to outline a psychiatric emergency service at St. Joseph's

1979).

A recent study in Canada showed a significant number of severe injuries

associated with skateboarding. These ranged from abrasions to sprains and strains of joints, dislocation of joints,

fractures of small and large bones and head injuries. Skateboarding has become a widespread sport, but there

has not been enough emphasis placed on the dangers associated with it. The Sport and Recreation Committee and

the Accident Prevention Committee of the Canadian Paediatric Society

1570 CMA JOURNAL/DECEMBER 22, 1979/VOL. 121

RECOMMEND THAT: 1) THE SKATEBOARD SHOULD BE PROPERLY CONSTRUCTED, PREFERABLY OF REINFORCED PLASTIC, AND SHOULD BE THE PROPER SIZE FOR THE CAPABILITIES OF THE PERSON USING IT. ALUMINUM BOARDS ARE RECOMMENDED NOT AS THEIR EDGES CAN WEAR TO RAZOR-LIKE SHARPNESS. THE WHEELS AND THE MECHANISM WHICH ATTACHES THEM TO THE DECK SHOULD BE APPROPRIATE FOR THE WEIGHT OF THE RIDER. 2) BASIC SAFETY EQUIPMENT MUST BE WORN BY SKATEBOARDERS AND THIS WOULD INCLUDE A HELMET, SUCH AS A HOCKEY HELMET, PADS FOR KNEES, ELBOWS AND HIPS, GLOVES, LONG SLEEVED SHIRT AND LONG PANTS. 3) COMMON SENSE WOULD DICTATE THAT SKATEBOARDING SHOULD BE CONDUCTED IN QUIET AREAS WITHOUT TRAFFIC, OR IN SKATEBOARD PARKS.

I think the concerted efforts of all in the medical profession are required to reduce the number of injuries sustained in this popular sport. VICTOR MARCHESSAULT, MD

Executive vice-president Canadian Paediatric Society Sherbrooke, PQ

Nephrolithiasis in rural practice To the editor: I read with great interest the editorial by Dr. William A. Falk (Can Med Assoc 1 120: 1198, 1979) and the review article by Dr. Gordon J. Johnson (120: 1245, 1979) regarding research in general practice. Since commencing work at Harbour Breton, on the south coast of Newfoundland, I have been impressed with the apparently high prevalence of renal disease, particularly nephrolithiasis, in the local population. In an attempt to confirm this impression I consulted the case records of 50 male and 50 female patients over the age of 15 years consecutively in the local clinic. Seven of the men (aged 27 to 78 years) had had at least one episode of proven renal colic, with passage of a calculus. Of another three men one had had a bacteriologically proven urinary tract infection, one had had renal tuberculosis and one had had undiagnosed hematuria. Of