Cork University Hospital is set to become one of the country’s two major trauma centres in a comprehensive overhaul of trauma services — but it will require significant investment, writes Catherine Shanahan.
Although the hospital has long described itself as the country’s only level 1 trauma centre, it “currently does not meet the requirements for this designation”, according to Dr Conor Deasy, HSE clinical lead of major trauma audit at the National Office of Clinical Audit (NOCA) and consultant in emergency medicine at CUH.
To meet the requirements, it would need, inter alia, a helipad, a CT scanner in the emergency department and additional bed capacity in the intensive care unit.
Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability.
A Dublin hospital, likely to be either the Mater or Beaumont, will become the second major centre — hospital groups in the Dublin region have been asked to submit proposals nominating their preferred site. Two other Dublin hospitals will have trauma units to deal with lower level traumas.
Outside of Cork and Dublin, the report recommends that Galway have a trauma unit with specialised services, while eight hospitals have been earmarked as potential trauma unit sites: Galway, Letterkenny, Sligo, Mayo, Tullamore, Drogheda, Limerick, Kerry and Waterford.
The plan to reform our major trauma system, outlined in the independent review A Trauma System for Ireland published yesterday, is expected to cost €30m to implement over seven years, according to Health Minister Simon Harris.
It acknowledges the need for enhanced pre-hospital care and improved rehabilitation services.
Dr Deasy said he believed there was “an overwhelming desire to make this [reorganisation] happen”. He said the UK reorganised trauma services in 2012 — with major trauma centres at the hub of a trauma network —and had seen a 30% improvement in survival odds.
He said none of the 26 trauma receiving hospitals in Ireland met international criteria for designation as a major trauma centre and that “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”.
“At the moment, because major trauma patients are dispersed across 26 hospitals, specialist expertise in major trauma care across doctors, nurses, and allied health professionals is challenging to attain and maintain” he said.
He said the “key point” is that 1,600 patients suffer a severe major trauma each year out of the 1.3m patients who attend EDs and injury units, so the majority of trauma patients will continue to be treated outside the major centres.
Last week, a report published by NOCA found 28% of patients had to be transferred to another hospital for ongoing care.
Dr Deasy said the report highlighted the need for a “cohesive trauma system”.
Colm Whooley, former CEO of Spinal Injuries Ireland, who contributed to the trauma system review, said he was “sceptical” initially, but was now convinced it was “the way to go”.
Wicklow-based Mr Whooley, wheelchair-bound since a motorcycle accident 37 years ago, said he was concerned people would oppose the reorganisation plan.
“They will look at it and they will see the spread, but talking as someone who has experienced major trauma, it is critical that people get the right treatment at the right time”.
“I’d rather travel an hour and know I was going to get the right care,” he said.