New system of injury care urged

DEATHS caused by trauma could be cut by a third through proper care in the immediate aftermath of serious injury, according to the Royal College of Surgeons in Ireland (RCSI).

New guidelines published by the college say improved staff training, particularly of those involved in pre-hospital care, and improved transport to specialist care centres could prevent one in three trauma deaths.

Eight minutes is the maximum recommended time between an emergency call and the arrival of aid before lives are endangered, according to a separate report on ambulance services.

The study by the Health Boards Executive showed that in some areas emergency staff had still not reached patients after 20 minutes. This is often the critical time when initial management of patient care can determine the outcome.

The guidelines, Initial Management of the Severely Injured Patient, draw attention to weaknesses in the Irish healthcare structure including:

a dependence on nursing and junior medical staff to provide emergency services;

problems accessing services such as radiology and pathology;

difficulties accessing inpatient beds.

Professor Niall O’Higgins, chairman of the clinical guidelines committee, said excessive waiting times and overcrowding in A&E departments also created difficulties, as did inappropriate reassessment of admissions by inexperienced doctors.

He said the guidelines were unique as they pinpointed gaps in emergency care and identified what needed to be done.

“They not only identify the optimum treatments for severely injured patients, but they also identify specific inadequacies within the current healthcare system and highlight the structures needed to provide optimum emergency medical care in Ireland.”

The guidelines suggest a number of ways in which optimum management of severely injured patients might be achieved. These include:

regional emergency departments located in major hospitals with a catchment population of 250,000 providing resuscitation, stabilisation and initial treatment for all emergencies and acting as a referral source and retrieval service for other centres;

hospital emergency departments with access to some on-site surgical and medical specialities that are linked to the regional emergency departments for subspecialty services;

hospital emergency departments with access to off-site specialist services that act as centres for minor injury care and resuscitation and limited stabilisation before referral.

Designed for use within a clinical environment, the guidelines detail best practice in relation to the main areas which arise in injury and trauma cases. These include immediate assessment, airway and ventilatory management, shock, abdominal trauma, head trauma, spine and spinal cord trauma, injuries due to burns or due to extreme cold, paediatric trauma and trauma in pregnant women.

Injury or trauma is one of the leading causes of death and disability in Ireland. They include those caused by road traffic collisions; accidental injury and death associated with the construction and marine industries; an increase in gun-related and other gangland violence; the high levels of personal assaults in Ireland and the high risk of young male suicide.

The guidelines were first reported in the Irish Medical Times.