Many of the world leaders in emergency medicine and in disaster medicine systems have made advances in these fields, and I compliment them on the accomplishments that I have seen over the years. Dr. Safar charged me to look ahead, if that is possible, and offer some perspective—obviously my own—on the next five to ten years. Hopefully, our future can be controlled in certain limits. Toynbee philosophized that when new and unanticipated challenges are presented, they represent great opportunity for response. If we fail to respond or if we respond in an inappropriate way, we may become a fossil in history—in this case, in the history of medicine. I have attempted to look at important challenges that I see in emergency medicine, and to predict from these a course that I think represents a proper response.

The first challenge, one that you have heard of before, clearly is the most important one. It is the challenge of limited or relative resources. The term “relative” means that fraction of a country's or region's output or wherewithall that is available in a logical or rational way for emergency medicine.