Portlaoise hospital likely to have a third tier status in new major trauma plan

Conor Ganly

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Conor Ganly

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Portlaoise hospital is not a designated centre treatment of victims of car crashes, falls and others who have suffered serious injury, according to a new plan for the care of major Trauma in Ireland.

Instead, the Midlands Regional Hospital, Portlaoise looks likely to be in the third tier of hospitals that will be part of new Trauma Networks set out in A Trauma System - Report of the Trauma Steering Group Report for Ireland.

The key finding in the plan is that there will be two Major Trauma Centres one each in Cork University Hospital and a yet to be decided Dublin hospital. A third Trauma Unit in Galway will have specialist centres.

It says the Major Trauma Centre will be supported by a network of Trauma Units that deliver trauma care for less complex cases.

Central Trauma Network will serve a population of approximately 3.1 million. This will be served by a Major Unit in Dublin and a number of other Trauma Units. The only midlands trauma unit would be based at the Midlands Regional Hospital, Tullmore.

According the plan the heart of the Trauma Network will be the Major Trauma Centre, which will be tasked with the management of patients that have suffered major trauma.

So-called Local Emergency Hospitals, such as Portlaoise, will provide Emergency Department services but will not manage major trauma cases. It says Local Emergency Hospitals will continue to provide Emergency Department services to patients with illnesses requiring urgent treatment and injuries of a lesser severity but will not manage major trauma cases.

Injury Units will continue to provide treatment for broken bones, dislocations, sprains, strains, wounds, scalds and minor burns that are unlikely to need admission to hospital.

It remains to be seen what impact this will have on Portlaoise or what status the hospital will have in any reconfiguration. The HSE has a plan to downgrade the A&E and remove paediatrics, maternity, ICU and most surgery.

The plan says a pre-hospital emergency care service will be a critical part of the network, playing a key role in the assessment and transportation of patients to the right location - either directly to a Major Trauma Centre or to a Trauma Unit as appropriate.

It says trauma bypass protocols, based on best international practice, will be put in place to ensure that injured patients are not inappropriately brought to Local Emergency Hospitals by ambulance.

It recommends that Local Emergency Hospitals will also put processes in place to ensure that if a trauma patient self presents with treatment needs beyond the capability of the ED, they will be stabilised and transferred to a Trauma Unit or Major
Trauma Centre as appropriate.

The plan says that it should be noted that major trauma accounts for a very low volume of total Emergency Department activity and, therefore, trauma bypass should not impact on Emergency Department activity overall in Local Emergency Hospitals. The Royal College of Surgeons in England has reported that major trauma represents less than 1 in every 1,000 Emergency Department admissions.

The report says change is needed because the current system of trauma service provision by multiple hospitals is considered inadequate by international standards.

It says trauma patients requiring orthopaedic treatment are being routinely brought from the scene of the accident to one of nine acute hospitals that do not have trauma and orthopaedic surgery on-site.

It adds that patients are often transferred to a second hospital – for example, for specialised diagnostics and/ or interventions, such as neurosurgery, cardiothoracic or trauma orthopaedic treatment - causing potential delays in patients receiving appropriate definitive treatment and care.

The plan refers to an analysis was conducted of the catchment areas and travel times to each of the 16 identified hospitals
in Ireland that currently have 24/7 Emergency Department with Trauma & Orthopaedic Surgery and General Surgery available on-call, i.e. all potential Trauma Units.

Travel times to potential Trauma Units were categorised as less than 30 minutes, between 30 and 45 minutes, between 45 and 60 minutes and greater than 60 minutes by road ambulance from the nearest potential Trauma Unit.

The plan says this analysis demonstrated that 96% of the population is located within a 60 minute road travel time from a potential Trauma Unit.

The needs of those outside of 60 minutes road travel time from a Trauma Unit (white areas on Figure 4 below, 4% of the population) must be considered and addressed. This will require the targeted provision of additional pre-hospital care resources for these areas.

Dr Conor Deasy, National Clinical Lead noted that 28% of patients needed to be transferred to another hospital as the treatment they needed could not be provided in the first hospital. 

“An Inclusive Trauma System in Ireland should ensure that the Major Trauma Centre (MTC) at the hub of the trauma network shares responsibility and provides support to the Trauma Units, Injury Units and Local Emergency Hospitals for the patient so that transfer to the MTC occurs seamlessly when required.

"Key investigations and management are currently being delayed, with only one-third of patients with head injuries requiring a CT scan receiving one within one-hour, in line with international best practice standards. Major Trauma Audit by NOCA will measure the effects of the changes in trauma care delivery on processes of care (for example seniority of doctors involved in trauma care, time to CT, theatre or an intensive care bed, access to rehabilitation etc) and outcomes (for example survival and quality of life of survivors).

 “The recommendations arising from the Trauma Steering Group need to be implemented to ensure that there is a cohesive trauma system in place in Ireland. Currently, none of the 26 trauma receiving hospitals in Ireland meet international criteria to be designated as a major trauma centre. Critically, none receive the threshold volume of severely injured patients to maintain clinician's skills in the delivery of care to this complex group of patients. Internationally, where trauma networks have been introduced, in excess of a 30% increase in the odds of survival has been observed,” he said.