The problem of informed consent in emergency medicine research

The CRASH Trial (Corticosteroid Randomisation After Significant Head injury ), which started in April 1999 hopes to answer the question of whether or n ot there is any benefit to giving high dose corticosteroids after significa nt head injuries. To do this patients are randomised to receive either the standard care for head injuries, as defined by the receiving hospital, or s tandard care plus a 48 hour infusion of corticosteroids. This is to be star ted within eight hours of injury, preferably as soon as possible. As all el igible patients will have a reduced level of consciousness informed consent has been deemed unnecessary. In this review the issue of consent in human experimentation is presented with a special emphasis on the problems faced in emergency medicine research, and the way these have been tackled.